和彩玲 尹虹 张定华

摘要：目的 觀察糖脂平方治疗非增殖期糖尿病视网膜病变（NPDR）的临床疗效及对血清血管内皮细胞生长因子（VEGF）和色素上皮衍生因子（PEDF）的影响。方法 将86例NPDR患者随机分为治疗组和对照组各43例。2组均予降糖、降压、调脂基础治疗。对照组予羟苯磺酸钙胶囊，每次0.5 g，每日3次，口服；治疗组在对照组基础上予糖脂平方，每次1剂，每日2次，口服。均4周为1个疗程，连续治疗3个疗程。评价2组临床疗效及眼底疗效，观察中医症状积分、眼底积分、视力情况，检测空腹血糖（FPG）、餐后2 h血糖（2 h PG）、糖化血红蛋白（HbAlc）、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）及血清VEGF、PEDF含量变化。结果 对照组与治疗组分别脱落2、3例。对照组临床疗效、眼底疗效总有效率分别为65.00%、68.35%，治疗组分别为87.50%、84.62%，2组比较差异有统计学意义（P<0.05）。与本组治疗前比较，2组治疗后中医症状积分、眼底积分明显下降（P<0.01）；2组治疗后比较，治疗组中医症状积分、眼底积分低于对照组（P<0.05，P<0.01）。与本组治疗前比较，2组治疗后视力明显改善（P<0.05，P<0.01）。与本组治疗前比较，2组治疗后FPG、2 h PG、HbAlc及TC、TG、LDL-C水平明显下降（P<0.01）。2组治疗后比较，治疗组2 h PG、HbAlc及TC、TG、LDL-C水平低于对照组（P<0.05，P<0.01）。与本组治疗前比较，2组VEGF水平下降，PEDF水平提高，差异有统计学意义（P<0.01）；2组治疗后比较，治疗组VEGF、PEDF改善优于对照组（P<0.05，P<0.01）；VEGF、PEDF呈负相关（r=-0.320，P<0.01）。结论 糖脂平方可有效改善NPDR患者的临床表现，通过降糖、降脂及调节血清VEGF、PEDF含量以减缓NPDR的病程进展。

关键词：非增殖期糖尿病视网膜病变；气阴两虚兼瘀证；糖脂平方；色素上皮衍生因子；血管内皮细胞生长因子

DOI：10.3969/j.issn.1005-5304.2018.09.005

中图分类号：R259.872 文献标识码：A 文章编号：1005-5304（2018）09-0018-05

Abstract： Objective To observe the clinical efficacy of Tangzhiping Prescription on non-proliferative diabetic retinopathy （NPDR） and the effects on serum vascular epithelial growth factor （VEGF） and pigment epithelium derived factor （PEDF）. Methods Totally 86 NPDR patients were randomly divided into treatment group （43 cases） and control group （43 cases）. Both groups were given hypoglycemic， anti hypertensive and lipid-regulatory basic therapy. The control group was given calcium distillate capsules， 0.5 g per time， 3 times a day， orally； the treatment group was treated with Tangzhiping Prescription based on the control group， 1 dosage per day， twice a day， orally. Four weeks were set as one treatment course. Treatment for both groups lasted for three courses. Clinical efficacy and fundus efficacy of both groups were evaluated. TCM symptom scores， fundus scores， and visual condition were observed； FPG， 2 h PG， HbA1C， TC， TG， HDL-C and LDL-C and changes in the contents of VEGF and PEDF were detected. Results The control group and the treatment group lost 2 and 3 cases respectively. The total effective rate of clinical efficacy and total fundus efficiency of the control group were 65.00% and 68.35%， respectively， and the treatment group were 87.50% and 84.62% respectively， with statistical significance （P<0.05）. Compared with before treatment， TCM symptom scores and fundus scores decreased significantly after treatment in both groups （P<0.01）； After treatment， the TCM symptom scores and fundus scores in the treatment group were lower than those in the control group （P<0.05， P<0.01）. Compared with before treatment， visual acuity improved significantly after treatment in both groups （P<0.05， P<0.01）. Compared with before treatment， levels of FPG， 2 h PG， HbA1c， TC， TG， and LDL-C decreased significantly in both groups after treatment （P<0.01）. After treatment， the levels of 2 h PG， HbA1c， TC， TG， and LDL-C in the treatment group were significantly lower than the control group （P<0.05， P<0.01）. Compared with before treatment， the levels of VEGF decreased and PEDF levels increased in both groups， with statistical significance （P<0.01）. After treatment， the improvement of VEGF and PEDF in the treatment group was better than that in the control group （P<0.05， P<0.01）； negative correlation was found between VEGF and PEDF （r=-0.320， P<0.01）. Conclusion Tangzhiping Prescription can effectively improve the clinical symptoms of patients with NPDR and slow down the progress of NPDR via reducing the blood glucose and blood lipids， and regulating the contents of VEGF and PEDF.

Keywords： non-proliferative diabetic retineopathy； syndrome of of qi-yin deficiency and stasis； Tangzhiping Prescription； pigment epithelium derived factor； vascular epithelial growth factor

糖尿病视网膜病变（diabetic retinopathy，DR）是糖尿病眼部微血管并发症，也是成人致盲的常见疾病之一[1]。研究表明，新生血管参与DR的发生发展，其中血清血管内皮细胞生长因子（VEGF）的异常表达与增殖期糖尿病视网膜病（PDR）关系密切，VEGF刺激血管内皮细胞增殖、增高血管壁通透性，促进PDR的发生[2]。糖脂平方立足于DR气阴两虚、目络瘀阻的病机特点施治，其主要功用是养阴益气、通络明目。本研究观察糖脂平方对早期糖尿病视网膜病的临床疗效，并通过观察患者血清VEGF、色素上皮衍生因子（PEDF）含量变化及二者相关性，从细胞因子层面探寻其可能的作用机制，为临床治疗DR提供依据。……