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目的观察芪明颗粒辅助雷珠单抗治疗糖尿病性黄斑水肿(DME)的临床疗效。方法选取2014年10月至2015年10月我科收治的103例DME患者(131眼)为研究对象,按照随机数字表分为观察组(n=51,64眼)和对照组(n=52,67眼),对照组给予玻璃体腔内注射雷珠单抗注射液治疗,一月1次,连续治疗3次;观察组在对照组治疗基础上给予芪明颗粒口服辅助治疗,一日3次,疗程为3个月。观察两组治疗前后的血液流变学及血流动力学的变化情况;并记录治疗前后的黄斑中心凹视网膜厚度(CMT)、黄斑总体积(TMV)、视力表Log MAR得分及荧光素眼底血管造影(FFA)的变化情况,记录两组治疗前后视力的恢复情况。结果两组患者治疗后全血黏度(高切、低切)、血浆黏度、红细胞聚集指数和纤维蛋白原水平均显著降低(P<0.05),且治疗后观察组各项指标均低于对照组(P<0.05);两组患者治疗后眼动脉、视网膜中央动脉的收缩期流速峰值(VS)、舒张末期流速(VD)及血管搏动指数(PI)较治疗前明显改善(P<0.05),且治疗后观察组各项指标均优于对照组(P<0.05)。两组患者治疗后CMT、TMV和视力表Log MAR得分均显著下降,且治疗后观察组CMT、TMV和视力表Log MAR得分均低于对照组(P<0.05);两组患者治疗后患者黄斑区荧光渗漏情况均有改善,FFA结果提示观察组减轻眼数为56眼(87.5%)显著高于对照组的47眼(70.1%,P<0.05);治疗后,观察组患者视力提高率为71.9%显著高于对照组52.2%(P<0.05)。结论芪明颗粒辅助玻璃体腔内注射雷珠单抗注射液治疗能够显著降低DME患者的血液黏度,改善血流动力学,减轻患者视网膜渗漏及黄斑水肿,提高视力。
Objective To observe the clinical efficacy of stilberamide-assisted ranibizumab in the treatment of diabetic macular edema (DME). Methods A total of 103 DME patients (131 eyes) were enrolled in our department from October 2014 to October 2015. The patients were divided into observation group (n = 51,64 eyes) and control group (n = 52) according to random number table , 67 eyes). The control group was treated with intravitreal injection of ranibizumab injection once a month for 3 times. The observation group was given oral adjuvant treatment with Qiming granule on the basis of the control group, three times a day , Treatment for 3 months. The changes of hemorheology and hemodynamics before and after treatment were observed. The foveal thickness (CMT), total macular volume (TMV), Log MAR score and fluorescein fundus fundus before and after treatment were recorded Imaging (FFA) changes, record the recovery of visual acuity before and after treatment in both groups. Results After treatment, the whole blood viscosity (high-cut, low-cut), plasma viscosity, erythrocyte aggregation index and fibrinogen level were significantly decreased in both groups (P <0.05). After treatment, the indexes in the observation group were lower than those in the control group P <0.05). The peak systolic velocity (VS), end-diastolic velocity (VD) and vascularity index (PI) of the two groups were significantly improved after treatment (P <0.05) After treatment, the indicators in the observation group were better than those in the control group (P <0.05). After treatment, CMT, TMV and Log-Log score of visual acuity decreased significantly in both groups, and CMT, TMV and Log MAR in visual acuity group were lower than those in control group after treatment (P <0.05); after treatment, macular The results of FFA showed that the number of eyes in the observation group was 56 eyes (87.5%) significantly lower than 47 eyes in the control group (70.1%, P <0.05). After treatment, the visual acuity improvement rate 71.9% was significantly higher than the control group 52.2% (P <0.05). CONCLUSION: Qiming granule-assisted intravitreal injection of ranibizumab can significantly reduce the blood viscosity, improve hemodynamics, reduce retinal leakage and macular edema, and improve visual acuity in DME patients.