Background: To explore the effect of calcium dobesilate combined with hypoglycemic drugs in the treatment of cataract complicated with non-proliferative diabetic retinopathy (NPDR) and its effects on fundus microcirculation, intercellular adhesion molecule 1 (ICAM-1), mono - cyte chemoattractant protein 1 (MCP-1), and macrophage migration inhibitory factor (MIF).
Methods: From March 2019 to January 2021, a total of 114 patients with cataract and NPDR were included, and the patients were assigned into the control and the observation groups by random number table method, with 57 cases/group. The control was given hypoglycemic drugs, and the observation was given calcium dobesilate combined therapy. The therapeutic efficacy, blood glucose and blood lipid levels, fluorescein fundus angiography results, fundus microcirculation indexes, retinal neovascularizationrelated factors, and ICAM-1, MCP-1, and MIF levels before and after treatment were compared between the two groups.
Results: The total effective rate of treatment in the observation was higher vs. the control (P < 0.05); Fasting blood glucose (FBG), 2 h postprandial blood glucose (2hPG), glycosylated hemoglobin (HbA1c), triglyceride (TG), total cholesterol (TC) and low density lipoprotein (LDL) in the observation after treatment were reduced vs. the control (P < 0.05); The number of micro-hemangiomas in the observation after treatment was less vs. the control, and the area of hemorrhage, the area of exudation and the thickness of the yellow plate were smaller vs. the control (P < 0.05); The resistance index (RI) value of the observation after treatment was lower than the control, and the end-diastolic blood flow velocity (EDV) and the peak systolic blood flow velocity (PSV) of the observation were higher vs. the control (P < 0.05). ICAM-1, MCP-1, MIF, vascular endothelial growth factor (VEGF) and insulin-like growth factor-1 (IGF1) in the observation after treatment were reduced vs. the control, but pigment epithelium-derived factor (PEDF) were higher vs. the control (P < 0.05); one case of gastrointestinal reaction took place in the observation, but no adverse reaction occurred in the control, and no clear difference exhibited in the incidence of adverse reactions between the two groups (P > 0.05).
Conclusions: Calcium dobesilate combined with hypoglycemic drugs has good clinical efficacy in the treatment of cataract complicated with NPDR, which can effectively reduce the level of blood glucose and blood lipids, reduce inflammation, and mitigate the microcirculation of branch retinal vein occlusion lesions.
Uvod: Cilj je bio da se istraži efekat kalcijum dobesilata u kombinaciji sa hipoglikemijskim lekovima u lečenju katarakte komplikovane neproliferativnom dijabetičkom retinopatijom (NPDR) i njenih efekata na mikrocirkulaciju fundusa, molekula intercelularne adhezije 1 (ICAM-1), monocitnog hemoatraktantnog proteina 1 (MCP-1) i faktor inhibitora migracije makrofaga (MIF).
Metode: Od marta 2019. do januara 2021. godine uključeno je ukupno 114 pacijenata sa kataraktom i NPDR, a pacijenti su raspoređeni u kontrolnu i opservacionu grupu metodom tabele slučajnih brojeva, sa 57 slučajeva/grupi. Kontroli su davani hipoglikemijski lekovi, a posmatranoj kom binovana terapija kalcijum dobezilatom. Terapijska efikasnost, nivo glukoze u krvi i lipida u krvi, rezultati fluoresceinske angiografije fundusa, indeksi mikrocirkulacije fundusa, faktori povezani sa neovaskularizacijom retine i nivoi ICAM-1, MCP-1 i MIF pre i posle tretmana su upoređeni između dve grupe.
Rezultati: Ukupna efektivna stopa tretmana u posmatranju bila je viša u odnosu na kontrolu (P < 0,05); Glukoza u krvi natašte (FBG), 2 h postprandijalne glukoze u krvi (2hPG), glikozilovani hemoglobin (HbA1c), trigliceridi (TG), ukupni holesterol (TC) i lipoprotein niske gustine (LDL) u opservaciji nakon tretmana bili su smanjeni u odnosu na kontrolu (P < 0,05); Broj mikrohemangioma u opservaciji nakon tretmana bio je manji u odnosu na kontrolu, a površina hemoragije, površina eksudacije i debljina žute ploče bili su manji u odnosu na kontrolu (P < 0,05); Vrednost indeksa rezistencije (RI) opservacije nakon tretmana bila je niža od kontrolne, a krajnja dijastolna brzina protoka krvi (EDV) i vršna brzina sistolnog krvotoka (PSV) posmatranja su bila veća u odnosu na kontrolnu (P < 0,05). ICAM-1, MCP-1, MIF, faktor rasta vaskularnog endotela (VEGF) i faktor rasta sličan insulinu-1 (IGF-1) u opservaciji nakon tretmana bili su smanjeni u odnosu na kontrolni, ali faktor koji potiče od pigmentnog epitela (PEDF ) bio je veći u odnosu na kontrolu (P < 0,05); jedan slučaj gastrointestinalne reakcije se desio u posmatranju, ali nijedna neželjena reakcija se nije javila u kontroli, i nije bilo jasne razlike u incidenci neželjenih reakcija između dve grupe (P > 0,05).
Zaključak: Kalcijum dobesilat u kombinaciji sa hipoglikemijskim lekovima ima dobru kliničku efikasnost u lečenju katarakte komplikovane NPDR, što može efikasno da smanji nivo glukoze u krvi i lipida u krvi, smanji zapaljenje i ublaži mikrocirkulaciju okluzivnih lezija vena retine.
Keywords: calcium dobesilate; cataract with nonproliferative diabetic retinopathy; combination therapy; fundus microcirculation; intercellular adhesion molecule 1; macrophage migration inhibitory factor; monocyte chemotactic protein 1.
2023 XiaoMan Wang, Zhao Zhang, Yi Qing Ge, Xia Wu, Yin Chao Ma, published by CEON/CEES.