【作者】 陈新；

【导师】 段俊国；

【作者基本信息】 成都中医药大学 ， 中西医结合临床， 2013， 硕士

【摘要】 目的：研究探讨芪明颗粒对糖尿病视网膜病变患者尿白蛋白排泄率的影响及与眼底病变的关系。方法：采用随机、多中心、平行、阳性药导升明对照,分析符合纳入标准的糖尿病视网膜病变病例94例,试验组给予芪明颗粒对照组给予导升明药物,12周为1个疗程,共观察2个疗程。观察视力、眼底(眼底镜、彩色眼底照相、荧光血管造影检查)、尿白蛋白排泄率、糖化血红蛋白等指标。结果：1.芪明颗粒治疗12周、24周后视力均较治疗前明显改善,P<0.05,差异有统计学意义。芪明颗粒治疗24周后眼底微血管瘤较治疗前明显改善,P<0.05,差异有统计学意义。芪明颗粒治疗24周后眼底硬性渗出较前明显改善P<0.05芪明颗粒治疗12周、24周后眼底出血均较治疗前明显改善,P<0.05。2.芪明颗粒治疗12周后尿白蛋白排泄率较前降低,P<0.05,差异有统计学意义。治疗24周后与疗前比较P<0.01有统计学意义,差异显著。导升明治疗12周、24周尿白蛋白排泄率有升高,P>0.05,无统计学意义。芪明颗粒与导升明治疗24周后分别与治疗前进行差值比较,P<0.05,差异有统计学意义。将两组尿白蛋白排泄率的疗效进行比较,结果芪明颗粒组显效5(8.19%)例,有效50(81.9%)例,无效6(9.8%)例,导升明组显效3(9.09%)例,有效10(30.3%)例,无效20(60.6%)例,两组尿白蛋白排泄率疗效比较,P=0.00,疗效显著。3.芪明颗粒治疗12周、24周糖化血红蛋白较前明显降低,P<0.05,治疗前后差异有统计学意义。导升明治疗12周,糖化血红蛋白与治疗前比较无统计学意义P>0.05,治疗24周后与治疗前比较差异有统计学意义P<0.05。4.芪明颗粒治疗24周后甘油三酯较治疗前明显改善,P<0.05,治疗前后差异有统计学意义。导升明治疗12周、24周后甘油三酯增加,且差异无统计学意义。两组间比较P>0.05,差异无统计学意义。芪明颗粒组与导升明组两组治疗12周24周后胆固醇较治疗前相当,治疗前后差异无统计学意义；两组间比较疗效相当,差异无统计学意义。5.芪明颗粒组61例患者治疗后中医症候疗效情况：显效7例,有效32例,无效22例,导升明组33例治疗后中医症候疗效：显效0例,有效15例,无效18例,两组间比较P<0.05,差异具有统计学的意义。6.尿白蛋白排泄率与DM病程呈正相关(P<0.05)；而与DR病程、视力无明显相关性(P>0.05)；与眼底硬性渗出呈显著正相关(P<0.01)；与眼底出血呈正相关(P<0.05);与糖化血红蛋白呈显著正相关(P<0.01),而与胆固醇、甘油三酯则无明显相关性(P>0.05)。结论：1.芪明颗粒治疗糖尿病视网膜病变疗效确切。2.芪明颗粒降低患者的尿白蛋白排泄率,随疗程延长疗效有增加趋势,且疗效优于导升明。3.芪明颗粒可以改善糖尿病视网膜病变的中医症候,疗效优于导升明。4.尿白蛋白排泄率与患者的DM病程、眼底硬性渗出、眼底出血,糖化血红蛋白呈正相关(P<0.05),与视力、DR病程、眼底微血管瘤不具相关性。更多还原

【Abstract】 Objective:The therapeutic effect of diabetic retinopathy treated by QiMing granule is exact, due to diabetic retinopathy and diabetic nephropathy with diabetic microangiopathy,This experiment further studies the effect of QiMing granule on urine albumin excretion rate, discuss the affect of QiMing granule on diabetic microangiopathy.Methods:According to the method of randomized, multi-center, parallel, positive medicine Doxium contrast, analysis included in the standard of94cases of diabetic retinopathy,experimental group given QiMing granule and control group given Doxium,12weeks for a period of treatment,observation2period. visual acuity, fundus (ophthalmoscope, fundus photography, fluorescent angiography), glycosylated hemoglobin, urine albumin excretion rate, etc would be observed.Result:1. The visual acuity improved significantly after12and24weeks’treatment using Qi Ming granule compared with that before treating,(P<0.05). The retinal microaneurysms and hard exudates decreased significantly after24weeks’treatment using Qi Ming granule compared with that before treating (P<0.05). The retinal hemmorage reduced significantly after12and24weeks’treatment using Qi Ming granule compared with that before treating,(P<0.05).2. The urinary albumin excretion rate reduced significantly after12and24weeks’ treatment using Qi Ming granule compared with that before treating,(P<0.05and P<0.01,respectively). There were no significant difference in urinary albumin excretion rate after12and24weeks’treatment using Doxium,(P>0.05). Comparing the results of24weeks’ treatment using Qi Ming granule and Doxium with that before treating respectively, it had significant difference. Comparing the urinary albumin excretion rate in two treatment groups, Qi Ming granule group had5excellent cases (8.19%),50effective cases (81.9%),6invalid cases (9.8%), and Doxium had3excellent cases (9.09%),10effective cases (30.3%),20invalid cases (60.6%), it has significant curative effect (P=0.00)3. The glycosylated hemoglobin decreased significantly after12and24weeks’ treatment using Qi Ming granule compared with that before treating. Compared with that before treating, the glycosylated hemoglobin had no significant difference after12weeks’treatment using Doxium and was significantly different after24weeks’ treatment using Doxium.4. Treated by Qi Ming Granules with24weeks, the triglycerides were significantly improved before the treatment, P<0.05, with statistical significancebefore and after treatment。The triglycerides were improved after being treated with Doxium after12weeks and24weeks, and there was no statistical significance between the differences. Compared the two groups, there was no statistical significance.5. The efficacy of TCMsymptoms and signsof61patients in the Qi Ming Granules group:obvious effects occurred7patients,32patients were effective,22patients were ineffective. theefficacy of TCMsymptoms and signsof33patients in the Doxium group:obvious effects occurred0patients,15patients were effective,18patients were ineffective, between two groups P>0.05,and there was significant difference.6. Urine albumin excretion rate (UAER) and course of DM were positively correlated (P<0.05); and it was not obviously correlated with course of DR and visual sight (P>0.05).it was significantly and positively correlated with fundus hard exudates (P<0.01); and it was obviously correlated with fundus hemorrhages (P<0.05).it was significantly and positively correlated with glycosylated hemoglobin (P<0.01); and it was not obviously correlated with cholesterol and triglycerides (P>0.05)Conclusion: 1. The therapeutic effect of diabetic retinopathy treated by QiMing granule is exact.2. The QiMing granule will lower patients’urinary albumin excretion rate, with the extension of treatment, the efficacy will increase, and the effects is better than the Doxium.3. The QiMing granule willimprove micro vascular complications of diabetes symptoms in TCM, and the effect is better than the Doxium.4. Urinary albumin excretion rate is positively correlated with DM duration, hard exudates, retinal hemorrhage, glycosylated hemoglobin (P<0.05), unrelated tovisual activity, DR duration, microaneurysm.更多还原