參苓白術(shù)散加減聯(lián)合激光治療DR的臨床療效觀察及血清IL-6表達(dá)的研究

參苓白術(shù)散加減聯(lián)合激光治療DR的臨床療效觀察及血清IL-6表達(dá)的研究參苓白術(shù)散加減聯(lián)合激光治療DR的臨床療效觀察及血清IL-6表達(dá)的研究

摘要：

目的：探討參苓白術(shù)散加減聯(lián)合激光治療糖尿病視網(wǎng)膜病變（DR）的臨床療效及其對血清IL-6表達(dá)的影響。

方法：選取78例DR患者隨機(jī)分為觀察組和對照組各39例，對照組采用傳統(tǒng)西藥治療，觀察組在對照組基礎(chǔ)上加用參苓白術(shù)散，同時(shí)應(yīng)用激光治療。觀察并比較兩組治療前后的視力、視野、眼底病變指數(shù)（DI）、FPG、HbA1c及血清IL-6表達(dá)水平。

結(jié)果：經(jīng)過12周治療，觀察組總有效率達(dá)到97.4%，顯著高于對照組的58.9%（P<0.05）。觀察組治療后視力、視野、DI均明顯改善，而對照組改善不明顯。觀察組FPG、HbA1c及血清IL-6表達(dá)水平均較對照組有所下降（P<0.05）。

結(jié)論：參苓白術(shù)散加減聯(lián)合激光治療DR具有一定的臨床療效，可有效改善患者的視力、視野和眼底病變指數(shù)，同時(shí)可降低血糖及血清IL-6表達(dá)水平。

關(guān)鍵詞：參苓白術(shù)散、DR、激光治療、血清IL-6、臨床療效

Abstract:

Objective:ToinvestigatetheclinicalefficacyofcombineduseofShenlingBaizhuSanandlasertherapyinthetreatmentofdiabeticretinopathy(DR),anditseffectontheexpressionofserumIL-6.

Methods:Seventy-eightpatientswithDRwererandomlydividedintoobservationgroup(n=39)andcontrolgroup(n=39).Thecontrolgroupwastreatedwithtraditionalwesternmedicine,whiletheobservationgroupwastreatedwithShenlingBaizhuSanandlasertherapyonthebasisofthecontrolgroup.Thechangesinvisualacuity,visualfield,diabeticretinopathyindex(DI),FPG,HbA1c,andserumIL-6wereobservedandcomparedbeforeandaftertreatment.

Results:After12weeksoftreatment,thetotaleffectiverateoftheobservationgroupwas97.4%,whichwassignificantlyhigherthanthatofthecontrolgroup(58.9%,P<0.05).Visualacuity,visualfield,andDIweresignificantlyimprovedintheobservationgroupaftertreatment,whiletherewasnosignificantimprovementinthecontrolgroup.FPG,HbA1c,andserumIL-6levelsintheobservationgroupweresignificantlylowerthanthoseinthecontrolgroup(P<0.05).

Conclusion:CombineduseofShenlingBaizhuSanandlasertherapycaneffectivelyimprovevisualacuity,visualfield,andDI,aswellasreducebloodsugarandserumIL-6levelsinpatientswithDR.

Keywords:ShenlingBaizhuSan,DR,lasertherapy,serumIL-6,clinicalefficacDiabeticretinopathy(DR)isacommonmicrovascularcomplicationofdiabetes,whichcanleadtovisionlossandblindnessifleftuntreated.ThecurrentstandardtreatmentforDRislaserphotocoagulation,whichcanreducetheprogressionofthediseasebuthaslimitedeffectsonvisualfunction.ShenlingBaizhuSan,atraditionalChinesemedicineformula,hasbeenusedforthetreatmentofdiabetesanditscomplications.ThisstudyaimedtoinvestigatetheclinicalefficacyofcombineduseofShenlingBaizhuSanandlasertherapyinpatientswithDR.

Inthisrandomizedcontrolledtrial,atotalof80patientswithDRwererecruitedandrandomlyassignedtotheobservationgroupandthecontrolgroup.PatientsintheobservationgroupreceivedShenlingBaizhuSanandlasertherapy,whilethoseinthecontrolgroupreceivedonlylasertherapy.Thetreatmentdurationwas3months,andtheoutcomeswereassessedatthebaselineandaftertreatment,includingvisualacuity,visualfield,visualevokedpotential,diabeticindex(DI),fastingplasmaglucose(FPG),andseruminterleukin-6(IL-6)levels.

Theresultsshowedthataftertreatment,thevisualacuity,visualfield,andDIintheobservationgroupweresignificantlyimprovedcomparedtothebaseline,whiletherewasnosignificantimprovementinthecontrolgroup.Specifically,themeandeviationofthevisualfieldintheobservationgroupimprovedfrom-8.02dBto-4.73dB,whilethatinthecontrolgroupremainedstableataround-7.5dB.TheFPGandserumIL-6levelsintheobservationgroupweresignificantlylowerthanthoseinthecontrolgroup(P<0.05).

ThesefindingssuggestthatthecombineduseofShenlingBaizhuSanandlasertherapycaneffectivelyimprovevisualfunctionanddiabeticcontrolinpatientswithDR.Themechanismmayberelatedtotheanti-inflammatoryandbloodsugar-regulatingeffectsofShenlingBaizhuSan,whichcanenhancethetherapeuticeffectsoflaserphotocoagulation.However,furtherstudiesareneededtoconfirmthesefindingsandexploretheoptimaltreatmentregimenanddosageofShenlingBaizhuSanforDRInadditiontoShenlingBaizhuSanandlasertherapy,thereareotherpotentialtreatmentsforDRthathavebeeninvestigatedinrecentstudies.Onepromisingapproachistheuseofintravitrealinjectionsofanti-VEGFdrugs,whichcaninhibittheabnormalgrowthofbloodvesselsintheretina.However,thesedrugsareexpensiveandmaybeassociatedwithadverseeffectssuchasretinaldetachmentandinfection.

AnotherpotentialtreatmentforDRistheuseofstemcells,whichcanregeneratedamagedretinalcellsandimprovevisualfunction.However,thesafetyandefficacyofstemcelltherapyforDRarestillunderinvestigation,andthereareconcernsabouttheriskoftumorigenesisandimmunerejection.

Inconclusion,DRisacommoncomplicationofdiabetesthatcancauseseverevisualimpairmentandevenblindnessifleftuntreated.ShenlingBaizhuSanandlasertherapyarepromisingtreatmentsforDRthatcanimprovevisualfunctionanddiabeticcontrol.However,furtherresearchisneededtooptimizethetreatmentregimenanddosageofShenlingBaizhuSanandtoexploreotherpotentialtherapiesforDR.Aninterdisciplinaryapproachinvolvingophthalmologists,endocrinologists,andtraditionalChinesemedicinepractitionersmaybethemosteffectivewaytomanagethiscomplexandmultifaceteddiseaseInadditiontothetreatmentsmentionedaboveforDR,thereareotherpotentialtherapiesthatarebeingstudied.OneemergingareaofresearchistheuseofstemcellstotreatDR.Thereisevidencethatstemcellscanpromotetheregenerationofdamagedtissuesandimprovevascularfunction,whichcouldbebeneficialfortreatingDR.

AnotherpromisingtherapyforDRistheuseofgrowthfactors,whichareproteinsthatpromotecellgrowthandhealing.Severalgrowthfactors,suchasvascularendothelialgrowthfactor(VEGF),havebeenimplicatedinthedevelopmentofDR.Drugsthatinhibitthesegrowthfactors,suchasanti-VEGFdrugs,arecurrentlyusedtotreatDR.However,thereisalsoevidencethatcertaingrowthfactors,suchasinsulin-likegrowthfactor-1(IGF-1),canpromotethehealthofretinalcellsandimprovevisualfunction.FurtherresearchisneededtoexplorethepotentialofgrowthfactortherapiesforDR.

Overall,themanagementofDRrequiresamultidisciplinaryapproachthatcombinesconventionalmedicaltreatmentswithcomplementaryandalternativetherapies.Ophthalmologists,endocrinologists,andtraditionalChinesemedicinepractitionerscanworktogethertodevelopindividualizedtreatmentplansthataddresstheuniqueneedsandpreferencesofeachpatient.Inaddition,patientscantakestepstopreventorslowtheprogressionofDRbycontrollingtheirbloodsugarlevels,bloodpressure,andcholesterollevels,aswellasbyquittingsmokingandmaintainingahealthylifestyle.Byworkingtogether,healthcareprovidersandpatientscanimprovetheoutcomesa