目的：观察补阳还五汤加减辅助治疗气阴两虚兼血瘀型非增殖期糖尿病视网膜病变疗效及对患者中医证候和视功能水平的影响。

方法：选取2017-01/2019-12期间我院气阴两虚兼血瘀型非增殖期糖尿病视网膜病变患者110例，进行回顾性分析，根据治疗方式分为观察组55例110眼、对照组55例110眼，对照组参考相关指南根据患者病情程度予以常规治疗，观察组患者在此基础上联合补阳还五汤加减辅助治疗。比较两组患者治疗3mo临床疗效，治疗前、治疗3mo中医证候积分，临床指标(黄斑水肿情况评分、黄斑视网膜体积、黄斑中心凹视网膜厚度)，视功能(最佳矫正视力、视野平均敏感度)，以及血清生化指标\〖血管内皮生长因子(VEGF)、低氧诱导因子-1(HIF-1)\〗。

结果：治疗3mo后，观察组治疗总有效率显著高于对照组(P<0.05)； 治疗3mo后，两组患者中医证候积分均较治疗前降低，且观察组低于对照组(P<0.05)； 治疗3mo后，两组患者黄斑水肿情况评分、黄斑视网膜体积、黄斑中心凹视网膜厚度均较治疗前减小，且观察组小于对照组(P<0.05)； 治疗3mo后，两组患者最佳矫正视力、视野平均敏感度均较治疗前改善，且观察组优于对照组(P<0.05)； 治疗3mo后，两组患者血清VEGF、HIF-1水平均较治疗前降低，且观察组低于对照组(P<0.05)。

结论：补阳还五汤加减辅助治疗气阴两虚兼血瘀型非增殖期糖尿病视网膜病变疗效确切，可能通过降低VEGF、HIF-1表达改善症状，促进视功能恢复。

AIM: To observe the efficacy of addition and subtraction of Buyang Huanwu decoction in the adjuvant treatment of non-proliferative diabetic retinopathy of Qi-Yin deficiency and blood stasis and its effects on traditional Chinese medicine(TCM)syndromes and visual function level.

METHODS: A total of 110 patients with non-proliferative diabetic retinopathy of Qi-Yin deficiency and blood stasis in our hospital between January 2017 and December 2019 were selected and divided into observation group(55 cases, 110 eyes)and control group(55 cases, 110 eyes). Patients in control group received conventional treatment according to the condition of patients with reference to relevant guidelines, and patients in observation group were combined with addition and subtraction of Buyang Huanwu decoction adjuvant therapy on this basis. The clinical efficacy after 3mo of treatment, and TCM syndromes scores, clinical indicators(macular edema score, macular retinal volume, macular foveal retinal thickness), visual function(best corrected visual acuity, average visual field sensitivity)and serum biochemical indicators \〖vascular endothelial growth factor(VEGF), hypoxia-inducible factor-1(HIF-1)\〗 before treatment and 3mo after treatment were compared between the two groups.

RESULTS: After 3mo of treatment, the total effective rate of treatment in observation group was significantly higher than that in control group(P<0.05). After 3mo of treatment, the TCM syndromes scores in the two groups were decreased compared with those before treatment, and the scores in observation group were lower than those in control group(P<0.05). After 3mo of treatment, the macular edema score, macular retinal volume and macular foveal retinal thickness in the two groups were reduced compared with those before treatment, and the indexes in observation group were smaller than those in control group(P<0.05). After 3mo of treatment, the best corrected visual acuity and average visual field sensitivity in the two groups were improved compared with those before treatment, and the indexes in observation group were higher than those in control group(P<0.05). After 3mo of treatment, the levels of serum VEGF and HIF-1 in the two groups were decreased compared with those before treatment, and the levels in observation group were lower than those in control group(P<0.05).

CONCLUSION: Addition and subtraction of Buyang Huanwu decoction has an exact efficacy in the adjuvant treatment of non-proliferative diabetic retinopathy of Qi-Yin deficiency and blood stasis, and it can improve symptoms and promote visual function recovery by reducing the expressions of VEGF and HIF-1.

四川省卫生和计划生育委员会科研课题(No.17PJ534)