宋焰 陈向东 李怡琛 聂辅娇 王萱 蒲玟伶 胡卓瑜 刘志敏 欧阳红波

〔摘要〕 目的 观察丹黄明目汤联合激光光凝术治疗糖尿病视网膜病变的临床疗效。方法 将诊断为阴虚内热，脉络瘀阻证的糖尿病视网膜病变患者43例（80只眼）随机分为对照组22例（40只眼）与观察组21例（40只眼）。对照组予以单纯激光光凝术治疗，观察组在对照组的基础上口服丹黄明目汤。治疗3个月后，观察两组患者治疗前后在最佳矫正视力（BCVA）、黄斑中心凹厚度（CMT）、中医临床症状评分以及疗效上的差异。结果 治疗后两组患者在BCVA、CMT上均有改善，且观察组改善程度优于对照组（P<0.05）;与治疗前相比，对照组在中医临床症状评分上的差异无统计学意义（P>0.05），而观察组在中医临床症状评分上的差异具有统计学意义（P<0.05）。观察组的有效率为95%，高于对照组的80%（P<0.05）。结论 丹黄明目汤联合激光光凝术能够显著改善糖尿病视网膜病变患者的视力、CMT，缓解临床症状，其疗效优于单纯激光光凝术治疗。

〔关键词〕 糖尿病视网膜病变;丹黄明目汤;视网膜激光光凝术;临床观察

〔中图分类号〕R276.7;R587.1       〔文献标志码〕B       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.07.023

〔Abstract〕 Objective To observe the clinical effect of Danhuang Mingmu Decoction combined with laser photocoagulation treatment on diabetic retinopathy. Methods 43 patients （80 eyes） with diabetic retinopathy diagnosed as Yin deficiency and internal heat， and blood stasis type were randomly divided into control group 22 cases （40 eyes） and observation group 21 cases （40 eyes）. The control group was only treated with laser photocoagulation， and the observation group was treated with Danhuang Mingmu Decoction on the basis of the control group. The difference between the two groups before and after treatment in best corrected visual acuity （BCVA）， central macular thickness （CMT）， traditonal Chinese medicine （TCM） clinical symptom score and curative effect were observed. Results After treatment， both groups of patients improved on BCVA and CMT， and the improvement of the observation group was better than that of the control group （P<0.05）; compared with before treatment， there was no statistically significant difference in the TCM clinical symptom score in the control group （P>0.05）， but the difference in the TCM clinical symptom score of the observation group was statistically significant （P<0.05）. The effective rate in the observation group was 95%， significantly higher than 80% in the control group （P<0.05）. Conclusion Danhuang Mingmu Decoction combined with laser photocoagulation can significantly improve the visual acuity， CMT， relieve clinical symptoms in patients with diabetic retinopathy， and its efficacy is better than laser photocoagulation treatment.

〔Keywords〕 diabetic retinopathy; Danhuang Mingmu Decoction; retinal laser photocoagulation; central macular thickness; Shengdihuang （Rehmanniae Radix）; Maidong （Ophiopogonis Radix）; Danshen （Salviae Miltiorrhizae Radix Et Rhizoma）; clinical observation

糖尿病視网膜病变（diabetic retinopathy， DR）是糖尿病微血管损伤的眼部表现，是糖尿病并发症中最常见且危害严重的致盲性眼病。目前视网膜激光光凝术是全世界范围内认可的治疗DR的有效方法[1]。激光光凝术使用得当可及时延缓DR病情进展，降低失明率。但激光光凝术作为一种破坏性的治疗手段，会直接损伤视网膜，破坏血-视网膜屏障，导致光凝区域视网膜组织水肿脱离，并促进炎性细胞因子释放，引起炎症刺激等[2]。近年来，国内多项研究表明中医药联合激光光凝术治疗DR，在提高患者视力、减少视网膜渗出、改善患者全身症状等方面具有独特优势[3-4]。本研究采用自拟丹黄明目汤联合激光光凝术治疗糖尿病视网膜病变，观察其临床疗效并探讨其中医作用机制，以期为临床中医治疗DR提供新的思路和方法。……