参苓白术散加减联合激光治疗DR的临床疗效观察及血清IL-6表达的研究

参苓白术散加减联合激光治疗DR的临床疗效观察及血清IL-6表达的研究参苓白术散加减联合激光治疗DR的临床疗效观察及血清IL-6表达的研究

摘要：

目的：探讨参苓白术散加减联合激光治疗糖尿病视网膜病变（DR）的临床疗效及其对血清IL-6表达的影响。

方法：选取78例DR患者随机分为观察组和对照组各39例，对照组采用传统西药治疗，观察组在对照组基础上加用参苓白术散，同时应用激光治疗。观察并比较两组治疗前后的视力、视野、眼底病变指数（DI）、FPG、HbA1c及血清IL-6表达水平。

结果：经过12周治疗，观察组总有效率达到97.4%，显著高于对照组的58.9%（P<0.05）。观察组治疗后视力、视野、DI均明显改善，而对照组改善不明显。观察组FPG、HbA1c及血清IL-6表达水平均较对照组有所下降（P<0.05）。

结论：参苓白术散加减联合激光治疗DR具有一定的临床疗效，可有效改善患者的视力、视野和眼底病变指数，同时可降低血糖及血清IL-6表达水平。

关键词：参苓白术散、DR、激光治疗、血清IL-6、临床疗效

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