加味补阳还五汤联合532nm激光对气阴两虚夹瘀型消渴目病患者血清VEGF、PEDF表达影响的研究

发布时间：2018-03-25 08:00

  本文选题：加味补阳还五汤　切入点：532nm激光　出处：《福建中医药大学》2016年硕士论文

【摘要】：背景：消渴目病相当于现代医学的糖尿病视网膜病变(diabetic retinopathy, DR),随着现代医疗水平及细胞生物学发展,血管内皮生长因子(vascular endothelial growth factor, VEGF)和色素上皮衍生因子(pigment epithelium derived factor, PEDF)与糖尿病视网膜病变的关系越来越受到重视。研究表明VEGF是导致视网膜新生血管形成的主要原因之一,VEGF也与糖尿病性黄斑水肿关系密切,PEDF则是对新生血管生长有抑制作用的主要因子。目的：研究正常体检者(以下统称正常对照组)、糖尿病无消渴目病患者(以下统称DM组)和气阴两虚夹瘀型消渴目病患者(以下统称DR组)血清VEGF、PEDF含量的变化；观察加味补阳还五汤联合532nm激光对气阴两虚夹瘀型消渴目病患者治疗前后最佳矫正视力、眼底荧光血管造影(fluorescein fundus angiography,FFA)、光学相干断层扫描(optical coherence tomography, OCT)等指标的变化及血清VEGF、PEDF含量变化,进一步认识消渴目病发病及联合治疗的机理,从而提高本病治疗效果,降低致盲率,丰富临床治疗方法。方法：(1)在福建中医药大学附属人民医院体检中心收集30例正常体检者,内分泌科收集30例糖尿病无消渴目病患者,眼科门诊及住院部收集30例气阴两虚夹瘀型消渴目病患者。采用酶联免疫吸附测定法(enzyme linked immunosorbent assay, ELISA)检测正常对照组、DM组和DR组血清VEGF、PEDF含量。(2)通过观察加昧补阳还五汤联合532m=n激光对DR组患者治疗前及治疗1个月后患者最佳矫正视力、FFA、OCT等指标的变化,评估联合治疗的疗效。(3)采用ELISA法检测加味补阳还五汤联合532nm激光治疗的DR组患者治疗前及治疗1个月后血清VEGF、PEDF含量。结果：(1)正常对照组、DM组和DR组血清VEGF含量逐渐上升,三组间比较,差异有统计学意义(Z=35.84,P0.01);正常对照组、DM组和DR组血清PEDF含量逐渐下降,三组间比较,差异有统计学意义(Z=16.29,P0.01)。(2)加味补阳还五汤联合532nm激光治疗DR组患者有显著疗效,其中Ⅲ期有效率可达100%,Ⅳ期有效率可达85.71%,V期有效率为33.33%,总有效率可达89.66%。(3)加味补阳还五汤联合532nm激光治疗1个月后DR组患者血清VEGF含量较治疗前下降,治疗前后比较,差异有统计学意义(T=2.613,P=0.0140.05)；加味补阳还五汤联合532nm激光治疗1个月后DR组患者血清PEDF含量较治疗前上升,治疗前后比较,差异有统计学意义(Z=3.363,P=-0.010.05)。结论：(1)血清VEGF、PEDF含量与消渴目病的发生、发展有一定关系,血清VEGF含量随着消渴目病病程逐渐上升,血清PEDF含量随着消渴目病病程逐渐下降,二者可作为消渴目病发生、发展评估的指标。(2)加味补阳还五汤联合532nm激光对气阴两虚夹瘀型消渴目病治疗有显著的疗效。(3)加味补阳还五汤联合532nm激光对气阴两虚夹瘀型消渴目病治疗的机理可能是通过上调患者血清VEGF水平及下调血清PEDF水平来实现。
[Abstract]:Background: diabetes retinopathy (DRN) is equivalent to diabetic retinopathy (DRN) in modern medicine, with the development of modern medical treatment and cell biology. The relationship between vascular endothelial growth factor (VEGF) and pigment epithelium-derived factor pigment epithelium derived factor (PEDFs) and diabetic retinopathy has been paid more and more attention. Studies have shown that VEGF is the main cause of retinal neovascularization. VEGF is also closely related to diabetic macular edema. PEDF is the main factor that inhibits the growth of neovascularization. Objective: to study the effect of PEDF on the growth of neovascularization. The changes of PEDF in serum of patients with diabetes mellitus (DM group) and patients with deficiency of Qi and yin (Dr group) and those with deficiency of Qi and Yin (Dr group); To observe the effects of modified Buyang Huanwu decoction and 532nm laser on the best corrected visual acuity, fluorescein fundus angiography-FFAA, optical coherence tomography (Oct) and the content of VEGF PEDF in serum of patients with Qi-Yin deficiency and stagnation syndrome before and after treatment. In order to improve the therapeutic effect, reduce the rate of blindness and enrich the clinical treatment methods, 30 normal people were collected from the people's Hospital of Fujian University of traditional Chinese Medicine. The Endocrinology Department collected 30 patients with diabetes mellitus without diabetes. Thirty patients with dyspepsia with deficiency of qi and yin and blood stasis were collected from ophthalmological outpatient department and inpatient department. Enzyme linked immunosorbent assay (Elisa) was used to detect the content of VEGF immunosorbent PEDF in DM group and Dr group of normal control group. Changes of best corrected visual acuity (BCVA) and FFA-Oct in Dr group before treatment and one month after treatment with decoction and 532m=n laser. To evaluate the curative effect of combined therapy, ELISA method was used to detect the level of serum VEGF VEGF in Dr group before treatment and 1 month after 532nm laser treatment. Results the serum VEGF levels in DM group and Dr group of normal control group increased gradually. The difference among the three groups was statistically significant (P 0.01), the serum PEDF content of DM group and Dr group in the normal control group decreased gradually, and the difference was statistically significant among the three groups (P 0.01, P 0. 01, P 0. 01, P 0. 01, P 0. 01, P 0. 01, P 0. 01, P 0. 01, P 0. 01, P 0. 01, P 0. 01, P 0. 01, P 0. 01, P 0. 01, P 0. 01, P 0. 02). The effective rate of stage 鈪，

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