桂枝茯苓丸治疗糖尿病白内障术后黄斑水肿的临床效果及部分机制探析(1)
摘要 目的：观察桂枝茯苓丸对糖尿病白内障术后黄斑水肿的临床疗效，并评价其对干扰素诱导蛋白-10(IP-10)、巨噬细胞趋化蛋白-1(MCP-1)及血管内皮生长因子(VEGF)的影响。方法：选取2016年1月至2017年1月成都市第一人民医院收治的糖尿病白内障术后黄斑水肿的患者60例，按照随机数字表法随机分为对照组和观察组，每组30例。对照组使用普拉洛芬眼液、妥布霉素地塞米松眼液治疗，观察组在对照组治疗方案基础上加用桂枝茯苓丸口服，2组患者均接受为期4周的治疗，疗程结束后比较2组患者临床疗效、中医证候积分、黄斑中心凹视网膜厚度、IP-10、MCP-1及VEGF浓度变化，同时将黄斑中心凹视网膜厚度与IP-10、MCP-1及VEGF浓度相关性进行分析。结果：1)治疗后观察组临床总有效率89%，与对照组68%比较，差异有统计学意义(P<0.05)；2)治疗后2组患者中医证候积分均有所下降，观察组优于对照组，差异有统计学意义(P<0.05)；3)治疗后2组患者黄斑中心凹视网膜厚度均有明显下降，与治疗前比较差异有统计学意义(P<0.05)，治疗后观察组黄斑中心凹视网膜厚度较对照组下降明显，差异有统计学意义(P<0.05)；4)疗程结束后观察组眼底情况改善较对照组明显，差异有统计学意义(P<0.05)；5)2组患者治疗后IP-10、MCP-1及VEGF浓度均有不同程度下调，其中观察组改善的趋势更明显，差异有统计学意义(P<0.05)；6)黄斑中心凹视网膜厚度与IP-10、MCP-1及VEGF浓度具有正相关性，差异有统计学意义(P<0.05)。结论：桂枝茯苓丸可明显改善糖尿病白内障术后黄斑水肿的病情，其作用机制可能与抑制新生血管以及改善脉络膜循环有关。
关键词 糖尿病；白内障术后；黄斑水肿；桂枝茯苓丸；VEGI；VEGF；血管新生；脉络膜循环
Abstract Objective：To observe the clinical effect of Guizhi Fuling Pill on macular edema after diabetic cataract surgery，and to evaluate its effect on interferon IP-10 (Inducible protein-10)，MCP-1 (macrophage chemoattractant protein-1) and VEGF (vascular endothelial growth factor).Methods：A total of 60 patients with macular edema after diabetic cataract surgery treated in Chengdu First People′s Hospital from January 2016 to January 2017 were selected and randomly divided into the control group and the observation group with 30 cases in each group.The control group using the Pla Lo Finn eye drops，tobramycin and dexamethasone eye drops treatment，and the observation group added the use of Guizhi Fuling Pill based on the treatment of the control group.Both groups received treatment for 4 weeks.After treatment，clinical curative effect，TCM Syndrome integral，retinal thickness of macular fovea，IP-10，MCP-1 and VEGF concentration of the patients in the two groups were compared，while the retinal thickness of macular fovea and IP-10，MCP-1 and VEGF concentration correlation were analyzed.Results：1) After treatment，the total efficiency of the observation group 89%，and the difference was statistically significant compared with 68% in the control group (P Key Words Diabetic； Post cataract surgery； Macular edema； Guizhi Fuling Pill； VEGI； VEGF； Angiogenesis； Choroidal circulation
中圖分类号：R587.1；R285.6 文献标识码：A doi：10.3969/j.issn.1673-7202.2018.12.029
白内障是2型糖尿病常见的并发症之一，人工晶体摘除术是治疗该病的主要临床措施，但有数据显示与单纯白内障比较，2型糖尿病合并白内障患者术后炎性反应更为明显，极易发生黄斑水肿，导致病情的进一步恶化[1-2]。糖尿病白内障者术后黄斑水肿属于中医学“视瞻昏缈”等范畴，《素问》一书中曾描述：“中央色黄，入通于脾”，认为黄斑病变与脾脏关系密切，脾失健运、水湿内聚成瘀，上犯于黄斑是该病的主要病机，故健脾利水、活血化瘀是主要治则[3-4]。桂枝茯苓丸是首载于《金匮要略》，有活血化瘀利水之功，是治疗妇科疾病的经典名方，《血证论》一书中提出“血水同治”理论，随着中医药逐渐发展，血与水的辨证论治理论逐渐运用于各类疾病的治疗，有临床人员利用桂枝茯苓丸治疗白内障术后黄斑水肿，获得理想疗效，但其作用机制尚不明确，基于此我们亦用桂枝茯苓丸对60例糖尿病白内障术后黄斑水肿患者，并对其作用机制进行进一步研究，报道如下。, http://www.100md.com(陈鸣 张鸿 曾流芝)
关键词 糖尿病；白内障术后；黄斑水肿；桂枝茯苓丸；VEGI；VEGF；血管新生；脉络膜循环
Abstract Objective：To observe the clinical effect of Guizhi Fuling Pill on macular edema after diabetic cataract surgery，and to evaluate its effect on interferon IP-10 (Inducible protein-10)，MCP-1 (macrophage chemoattractant protein-1) and VEGF (vascular endothelial growth factor).Methods：A total of 60 patients with macular edema after diabetic cataract surgery treated in Chengdu First People′s Hospital from January 2016 to January 2017 were selected and randomly divided into the control group and the observation group with 30 cases in each group.The control group using the Pla Lo Finn eye drops，tobramycin and dexamethasone eye drops treatment，and the observation group added the use of Guizhi Fuling Pill based on the treatment of the control group.Both groups received treatment for 4 weeks.After treatment，clinical curative effect，TCM Syndrome integral，retinal thickness of macular fovea，IP-10，MCP-1 and VEGF concentration of the patients in the two groups were compared，while the retinal thickness of macular fovea and IP-10，MCP-1 and VEGF concentration correlation were analyzed.Results：1) After treatment，the total efficiency of the observation group 89%，and the difference was statistically significant compared with 68% in the control group (P Key Words Diabetic； Post cataract surgery； Macular edema； Guizhi Fuling Pill； VEGI； VEGF； Angiogenesis； Choroidal circulation
中圖分类号：R587.1；R285.6 文献标识码：A doi：10.3969/j.issn.1673-7202.2018.12.029
白内障是2型糖尿病常见的并发症之一，人工晶体摘除术是治疗该病的主要临床措施，但有数据显示与单纯白内障比较，2型糖尿病合并白内障患者术后炎性反应更为明显，极易发生黄斑水肿，导致病情的进一步恶化[1-2]。糖尿病白内障者术后黄斑水肿属于中医学“视瞻昏缈”等范畴，《素问》一书中曾描述：“中央色黄，入通于脾”，认为黄斑病变与脾脏关系密切，脾失健运、水湿内聚成瘀，上犯于黄斑是该病的主要病机，故健脾利水、活血化瘀是主要治则[3-4]。桂枝茯苓丸是首载于《金匮要略》，有活血化瘀利水之功，是治疗妇科疾病的经典名方，《血证论》一书中提出“血水同治”理论，随着中医药逐渐发展，血与水的辨证论治理论逐渐运用于各类疾病的治疗，有临床人员利用桂枝茯苓丸治疗白内障术后黄斑水肿，获得理想疗效，但其作用机制尚不明确，基于此我们亦用桂枝茯苓丸对60例糖尿病白内障术后黄斑水肿患者，并对其作用机制进行进一步研究，报道如下。, http://www.100md.com(陈鸣 张鸿 曾流芝)
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