普罗布考辅助治疗高血脂糖尿病黄斑水肿的临床观察  

Clinical study of probucol in the treatment of hyperlipidemia diabetic maeular edema

作　　者：陈忠平[1] 唐仕波[1] 王启常[1] 陈娟[1] 周增超[1] 段毅琴[1] 

机构地区：[1]长沙爱尔眼科医院眼底病科,410015

出　　处：《中华眼底病杂志》2013年第5期490-494,共5页Chinese Journal of Ocular Fundus Diseases

基　　金：长沙市科技计划项目（K1203037-3I）;湖南省科技计划项目（2009FJ3033）;湖南省卫生厅课题（c2008-011）

摘　　要：目的观察普罗布考应用于经局限性或格栅样激光光凝治疗后的高血脂糖尿病黄斑水肿（DME）的治疗效果。方法前瞻性随机对照研究。纳入48例患有2型糖尿病且伴DME及高血脂患者，随机分为A、B、C3组。双眼发病患者仅纳入较差眼进行研究。入选者均严格控制血糖、血压在正常范围。所有患者接受黄斑区激光光凝治疗。其中，A组16例患者应用普罗布考治疗，B组16例患者接受阿托伐他汀治疗，c组16例患者在观察的3个月内未用降血脂药。观察这3个月期间患者黄斑区水肿及硬性渗出、视力、黄斑中心区视网膜厚度（CMT）、血脂及尿8-羟基脱氧鸟苷（8-OHdG）的变化情况。结果A、B、C组各有13、12、5例患者硬性渗出减少，硬性渗出减少发生率分别为81．25％、75．00％、31．25％；A、B组与C组硬性渗出减少发生率比较，差异有统计学意义（Z=-3．282、-2．957，P〈0．05）。A、B、C组各有12、11、8例患者黄斑水肿消退，黄斑水肿消退发生率分别为75．00％、68．75％、50．00%；3组间黄斑水肿消退发生率比较，差异无统计学意义（X2=2．368，P〉0．05）。A、B组与C组CMT比较，差异有统计学意义（t=4．929、4．669，P=0．000）。A、B、C组各有9、8、6例患者视力上升，视力评价总有效率分别为56．25％、50．00％、37．50％；3组间视力评价总有效率比较，差异无统计学意义（X2=1．169，P〉0．05）。A、B组甘油三酯（TG）（t=7．954、6．832）、总胆固醇（TC）（t=6．643、5．368）、低密度脂蛋白胆固醇（LDLC）（t=3．279、3．835）降低（P〈0．05），C组未见降低；3组高密度脂蛋白胆固醇较治疗前无明显变化。A、B2组8-OHdG含量逐渐降低，C组无降低。其中，治疗后1个月，A、B2组间8-OHdG比较，差异无统计学意义；治疗后3个月，A组患者8—0HdG较B组患者低，差异有统计学意义（t=2．947，P�Objective To determine the clinical efficacy of probueol in patients with diabetic macular edema （DME） and elevated serum lipids after focal/grid laser photocoagulation. Methods A prospective randomized controlled study included 48 type 2 diabetic patients with DME and dyslipidemia which were randomly divided into three groups. For patients with bilateral disease only the more severe eye was included. All patients were subjected to strict metabolic and blood pressure control during enrollment. All cases received maeular laser photoeoagulation. Besides, sixteen patients in group A were treated with probueol, 16 members in group t3 with atorvastatin and 16 members in group C were not treated with any lipid-lowering therapy for about three months. The outcome measurements were status of macular edema and hard exudates, visual acuity, foveal thickness, serum lipids and urine 8-hydroxy-deoxyguanosine （8-OHdG） during the three months. Results The study included 20 men and 28 women with non-insulin dependent diabetes mellitus who could achieve good metabolic and blood pressure control within three months of inclusion in the study. Thirteen of 16 patients in group A, twelve of 16 patients in group B and five of 16 patients in group C showed reduction in hard exudates. Regression of macular edema was seen in twelve patients in group A, 11 in group B and eight in group C （X2 =2. 368, P^0.05）. The difference of foveal thickness in group A, B and C was statistically significant （t= 4. 929, 4. 669; P=0. 000）. Nine patients in group A, eight in group B and six in group C showed improving of visual acuity （X2 =1. 169, P= 0.05）. Three months after treatment, triglycerides （TG） （t=7. 954, 6. 8323 P〈0.05）, total cholesterol （TC） （t= 6. 643, 5. 368; P=0.05） and low-density lipoprotein cholesterol （LDLC） （t= 3. 279, 3. 835; P〈0.05） decreased in group A and group B but not in group C, and high-density lipoprotein cholesterol showed no significant difference in the three groups. 80HdG de

关 键 词：黄斑水肿 药物疗法 高脂血症 药物疗法 普罗布考 治疗应用 糖尿病 2型 并发症 

分 类 号：R774.5[医药卫生—眼科]