目的 探讨复方丹参滴丸联合硫辛酸治疗糖尿病视网膜病变的临床疗效。方法 选取2021年11月—2022年7月苏州科技城医院门诊收治的116例糖尿病视网膜病变患者，按随机数字表法将所有患者分为对照组和治疗组，每组各58例。对照组口服硫辛酸胶囊，0.2 g/次，3次/d。治疗组在对照组基础上口服复方丹参滴丸，20丸/次，3次/d。两组疗程均为3个月。观察两组的临床疗效，比较两组面色晦暗、视物昏花的消失率。比较治疗前后两组最小分辨角对数（logMAR）、眼底改变指标（微血管瘤和出血灶数）、眼底荧光血管造影检查相关指标[臂-视网膜循环时间（A-Rct）和视网膜毛细血管无灌注区（NPA）面积、血管渗漏（VL）面积]及黄斑水肿相关指标[黄斑中心凹厚度（CMT）、视网膜体积（TMV）]。结果 治疗后，治疗组总有效率是91.38%，显著高于对照组的77.59%（P＜0.05）。治疗后，治疗组面色晦暗消失率62.07%和视物昏花消失率50.00%均显著高于对照组的43.10%、31.03%（P＜0.05）。治疗后，两组患者logMAR、微血管瘤数和出血灶数均显著减少（P＜0.05）；且治疗后治疗组logMAR、微血管瘤数和出血灶数低于对照组（P＜0.05）。治疗后，两组A-Rct均显著缩短，视网膜毛细血管NPA面积和VL面积均显著缩小（P＜0.05）；治疗后，治疗组A-Rct、视网膜毛细血管NPA面积和VL面积均小于对照组（P＜0.05）。治疗后，两组CMT、TMV均较治疗前显著减小（P＜0.05），均以治疗组降低更显著（P＜0.05）。结论 复方丹参滴丸联合硫辛酸治疗糖尿病视网膜病变具有确切疗效，能安全有效地减轻患者视力损伤，缓解临床症状，改善眼底病理改变及视网膜血流状况。

Objective To investigate the clinical efficacy of Compound Danshen Dropping Pills combined with thioctic acid in treatment of diabetic retinopathy. Methods A total of 116 patients with diabetic retinopathy admitted to the outpatient department of Suzhou Science and Technology City Hospital from November 2021 to July 2022 were selected and divided into control group and treatment group according to random number table method, with 58 patients in each group. Patients in the control group were po administered with Thioctic Acid Capsules, 0.2 g/time, three times daily. Patients in the treatment group were po administered with Compound Danshen Dripping Pills on the basis of the control group, 20 pills/time, three times daily. The treatment course of both groups was 3 months. The clinical efficacy of the two groups was observed, and the disappearance rate of dull complexion and dim vision was compared. The logarithm of minimum resolution Angle (logMAR), fundus change index (number of microhemangioma and bleeding foci), fundus fluorescence angiography related index [arm-retinal circulation time (A-Rct), retinal capillary non-perfusion area (NPA), vascular leakage (VL) area] and macular edema related index [Macular fovea thickness (CMT) and retinal volume (TMV)] were compared between the two groups before and after treatment. Results After treatment, the total effective rate of the treatment group was 91.38%, significantly higher than that of the control group (77.59%) (P < 0.05). After treatment, the disappearance rate of complexion dull 62.07% and visual faintness 50.00% in the treatment group were significantly higher than those in the control group (43.10% and 31.03%, P < 0.05). After treatment, logMAR, the number of microhemangioma and the number of bleeding foci were significantly decreased in 2 groups (P < 0.05). The number of logMAR, microhemangioma and bleeding focus in the treatment group were lower than those in the control group after treatment (P < 0.05). After treatment, A-Rct was significantly shortened, and retinal capillary NPA area and VL area were significantly reduced in both groups (P < 0.05). After treatment, A-Rct, retinal capillary NPA area and VL area in the treatment group were smaller than those in the control group (P < 0.05). After treatment, CMT and TMV in 2 groups were significantly decreased compared with before treatment (P < 0.05), and the decrease was more significant in the treatment group (P < 0.05). Conclusion Compound Danshen Dropping Pills combined with thioctic acid has definite curative effect in treatment of diabetic retinopathy, and can safely and effectively reduce visual impairment of patients, relieve clinical symptoms, which can improve fundus pathological changes and retinal blood flow.

R977;R988.1

吴阶平医学基金会临床科研专项资助基金（320.6750.18528）