【作者】 孙雅彬；

【导师】 宋鄂；

【作者基本信息】 吉林大学 ， 眼科学， 2004， 硕士

【摘要】 糖尿病是临床上常见的代谢性疾病，长期的代谢异常会导致血管并发症，糖尿病性视网膜病变（diabetic retinopathy,DR）是糖尿病严重的微血管并发症之一。DR已成为成人致盲的重要原因。DR的发病是一个复杂的、与多因素相关的病理过程，DR的基本病理改变包括:①周细胞选择性的丢失; ②基底膜增厚;③微血管瘤的形成;④内皮细胞增生;⑤新生血管形成。其中周细胞选择性的丢失是最早的病理改变，继而微血管瘤形成、毛细血管基底膜增厚,进一步产生血-视网膜屏障破坏、毛细血管闭塞、动静脉改变,乃至新生血管形成及纤维增厚,最终导致视力障碍甚至失明。其确切发病机制尚未完全阐明，国内外大量研究证实与多元醇-肌醇代谢异常、蛋白质非酶糖基化终末产物的生成和堆积、自由基的作用、细胞因子的作用等诸多因素有关。而目前中医界认为DR是由于糖尿病发病日久，阴虚津亏、目窍失养所致。阴虚燥热，久则耗气伤阴，气阴两虚，阴阳失调，气血不和，导致久病难愈。故认为糖尿病为“本”，DR为“标”。肝肾亏虚，血淤痰结为“常”；肝肾亏虚日久，病变由阴及气、阴损及阳，可出现气阴两虚，或阴阳两虚，为“变”。病证随着由阴虚→气阴两虚→阴阳两虚的演变，不仅DR发生的可能性逐渐增高，而且DR由单纯型向增殖型发展，并且肾虚贯穿糖尿病和DR的始终。因“肝肾同源”，故其认为肝肾虚损、阴损及阳、目窍失养是导致<WP=57>DR发生发展的基本病机。目前对于DR的治疗方法主要有：1.药物治疗：（1）西药主要是针对上述机理，应用醛糖还原酶抑制剂(ARI)、蛋白质非酶糖基化抑制剂、自由基清除剂、DG-PKC系统抑制剂等药物治疗，纠正DR患者体内代谢紊乱，改善眼底局部微循环。（2）中药针对糖尿病气虚血瘀、阴虚血滞的病机，采用活血化瘀的药物，祛瘀通络，以达到治疗目的。2.视网膜激光光凝术：主要用于治疗经荧光眼底造影检查确诊为PDR的患者，做全视网膜激光光凝术，以防止新生血管的形成，并使已形成的新生血管退变，阻止病变继续恶化。4.玻璃体切割手术：对于DR患者玻璃体积血长时间不吸收、牵拉视网膜脱离，特别是新发生的黄斑部脱离，应行玻璃体切割手术。目前由于视网膜激光光凝术及玻璃体切割等手术方法的改进使DR致盲的危险性明显下降，但这些治疗方法可使视网膜受到严重损害或带来其他方面的危险。DR西医发病机理虽未完全阐明，但现有的学说已基本得到学术界的公认，针对这些机理而随之研制开发出的各种西药相继问世，然而药物疗效却未达到预期的效果，除少数改善微循环药物外，其余药物均未广泛应用于临床。故随着对其中医病机探讨的不断深入，中医药治疗DR将有着广阔的开发前景及深远的治疗意义。本研究选取确诊为DR的患者30例，60眼，在注射胰岛素或口服降糖药物控制血糖的前提下，给与中药糖网I号口服治疗，对上述患者用药前后血清AGEs、血脂、血液流变学各项指标进<WP=58>行检测分析，结果显示：（1）中药治疗后，患者眼部情况PDR组有效率为77.08%,NPDR组为91.67%，总有效率达80.00%，PDR组与NPDR组间总有效率无显著性差异（P>0.05）。（2）服用中药后，血清AGEs水平较用药前显著下降（P<0.0005）。PDR组与NPDR组间用药前后血清AGEs水平无显著性差异（P>.05）。（3）用药后血清CHOL水平较服药前显著下降（P<0.01），TG、LDL-C、HDL-C、ApoA1、ApoB水平较用药前无显著性变化（P>0.05）。PDR组与NPDR组间用药前后血脂各项指标无显著性差异（P>0.05）。（4）用药后全血粘度高切、血沉、全血还原粘度高切较用药前显著下降（P<0.05）,红细胞变形指数较用药前显著升高（P<0.05）。PDR组与NPDR组间用药前后血流变学各项指标无显著性差异（P>.05）。通过本文研究表明，糖网I号可以有效地降低DR患者血清AGEs水平，能够减轻AGEs所导致的一系列病理变化，降低血脂，改善血液流变学异常，从而达到治疗DR病情、延缓DR发展进程的作用，但对于PDR组和NPDR组在治疗效果上无显著性差异。虽然糖网I号治疗DR的具体机理尚有待进一步研究阐明，但本文及大量文献报道证实了，中药在控制DR病情、延缓DR病程中发挥着极其重要的作用。故随着祖国医学对于DR病机研究、探讨的不断深入，中医药的开发研制对于DR的治疗有着极其深远的意义。更多还原

【Abstract】 Diabetes is a kind of common clinical metabolism disease. A long period of metabolism abnormality will cause capillaries complications. diabetic retinopathy( DR) is one of the serious capillaries in diabetes complicationses,and it has become an important reason acquirred blindness.The outbreak of DR is a complicated pathologic process related with many factors.The basic pathologic changes in DR include：①the choice lost of round cells;②the increasing thick of base membrance; ③the formation of the micro-capillaries lump; ④the proliferation of endothelium; ⑤the formation of new-born blood vessel. In these changes,the choice lost of round cells is the earlist.The following is micro-capillaries lump formation ,the base membrance of capillaries turnig thick. Feathermoer, the blood-retinol barriar is broken down, and capillaris is broken down,new-born blood vessel is formating.The end leading to visal loss ,even blind. The accurate mechanism of DR has not been clarified completely yet.A large quantity of reseach prooved that the outbreak of DR is related to many factors ,including the formation and accumulation of Advanced glycation end products（AGEs），the metablisom abnormality of polyalchol-myoalchol,the effection of free radical,the effection of cytokine et al.While,Chinese traditional medicine consider that with the occurences and <WP=60>develepments of the pathalogical changes in retina and the representations of whole body’s symptom and blood stasis(血瘀)，the evolution of the disease is as following:from deficiency of ying(阴虚)to deficiency of both qi and ying(气阴两虚)，then to deficiency of both ying and yang (阴阳两虚).It is indicated that the basic factors leading to the occurences of diabetic funfus are deficiency of liver-ying and kidney-ying (肝肾亏损)，deficiency of ying affecting yang（阴损及阳）and denutrition of qiao of eyes（目窍失养）;the important factors for the development of the disease deficiency of heart and spleen(心脾亏虚)，stasis resulting from the deficiency(因虚致瘀)and sluggishiness in mu luo（目络阻滞），deficiency in origin and excess in superficislity(本虚标实)，mixture of deficiency and excess（虚实夹杂）are the charecter of the syptom complex of the disease.Currently,the treatment to DR is mainly including:1.Drugs treatment:Westen medicine treats DR acording to its mechannism.Chinese traditional medicine cures DR by making blood flowing and dissolving the stasis(活血化淤).In another way,we can using retinol photocoagulation to cure the edema ,leaking and new-born blood vessel,and when such affairs as vitreous hemorrhage ,detachment of retina occure ,we can do the surgical operation of vitreous body incising.With the development of DR mechanism reseschs,much westen <WP=61>was reseached and manufactured,while the curritive effection of the medicine is not satifactive.So the Chinese traditional medicine has very vast foreground.An analysis on syptoms of 30 patients with DR treated with the Tangwang I showed that Tangwang I can reduce the level of AGEs in blood ,lower the blood-fat and reduce the blood viscosity and erythrocyte sedimentation rate(ESR).So we can make the conclusion that Tangwang I can control the condition ,defer the evolution of DR.From this reseach ,we can see Chinese traditional medicine will play an very important role in the treatment of DR.In our research, We chose 30 paitients(60 eyes) who indured with DR,and gave them Tangwang I ,1/2fu,oral taking twice a day.After one month’s taking,we made analysis in the quantity of advanced glycation end products (AGEs) ,the index signs of blood-fat and hemorheology,sight and the changes of retina.Results:(1) The quantity of AGEs in blood is reduced after using Tangwang I.(P<0.05) (2) The quantity of cholesterol (CHOL) in blood is decreased.(P<0.05) (3) The whole blood viscosity (WBV) and erythrocyte sedimentation rate(ESR) is decreased.(P<0.05) (4) In part of the patients ,the sight is increased and the hemorrhage,exudate and edema in retina is alleviated obviously.The total effeciency is 80.00%. By th更多还原