Diabetic Retinopathy, Micro-dialectical Basic Research

Diabetic retinopathy (DR) named eye disease of consumption in Chinese medicine. It is an intraocular disease caused by consumptive disease. It is characterized clinically by hemorrhages, microaneurysms(MA), cotton-wool spots, hard exudates, macular edema, capillary- occlusion, and ultimately, neovascularization. It is the most important reason that leads to blindness in old people. So looking for prevention and treating methods have become the big challenge in conquering DR.Recent years, a lot of experts concluded the theory of Chinese medicine clinical manifestation about DR. Syndrome differentiation of preclinical phase is yin deficiency and dryness-heat. Syndrome differentiation of nonproliferative phase is deficiency of both qi and yin. Syndrome differentiation of proliferative phase is deficiency of both yin and yang. This three patterns is a linear developing progress. Based on this theory, we review the relationship between syndrome patterns and the pathological changes of fundus, syndrome patterns and the general examinations. The conclusion may be helpful of guiding the clinical treatment and prevention of the disease.This thesis includes two parts, which are review and clinical study of DR. The review includes two parts.One is The Study of the pathogenesis Development of DR.The other is The Overview of The Study of DR in Chinese medicine .In the first part,the pathogenesis concerned with cell, molecule, gene are interpreted. In the second part, the pathogenesis, therapeutics, relationship between syndrome patterns and objective index are remarked.Abstract of the clinical study part: Purpose: learn the characters of the symptoms in TCM, contact DR's syndrome patterns in TCM and objective marker to analyse the internal relatio- n between them; Make the syndrome differentiation normal and the syndrome patterns objec- tive. Methods: 100 cases are registered according to observations table of DR about the TCM symptoms and signs and divided into there groups on the basis of the syndrome differentiate- on: Syndrome of yin deficiency and dryness-heat; Syndrome of deficiency of both qi and yin; and Syndrome of deficiency of both yin and yang. Moreover we connect the patients' examin ation of Fudus Flourescein Angiography(FFA) and general examination with the syndrome patterns and have a clinical investigation.Result: 1. In this study, there are 85 percent patients aged from 50 to 80 years old; The average age in syndrome of yin deficiency and dryness-heat is 54.12y and it is the yo- ungest in the three groups. The oldest group is syndrome of deficiency of both yin and yang ,the average age is 63.58y. There is no significant difference among the groups in diabetes duration. The average duration is 9.78y; 2. After statistics, correlation coefficient of syndrome patterns in TCM and the DR by western medicine stage is 0.42. There is significant linear correlation relationship between syndrome and DR stages.The positive relationship between syndrome patterns and FFA: MA(P<0.05)non- perfusion area(P<0.05),IRMA(P<0.01), neovascularization(P<0.01),macular edema(P<0.01).Hemorrhage has no relation with syndrome .3.Smoking is relative with syndrome patterns(P<0.05), there is no relationship between syndrome patterns and drinking, so is family history. No relationship between hypertension and syndrome patterns.4.Blood-fasting sugar among the groups showed no significantly difference. Blood glucose after meal (P<0.05)and HbAlc(P<0.05) showed significantly difference. Urine protein and Cr increased significantly from yin deficiency and dryness-heat to deficiency of both yin and yang(P<0.05). Triglyceride in syndrome of deficiency of both qi and yin showed significantly higher level than yin deficiency and dryness-heat(P<0.05). 5. Hemoglobin in the group with MA showed significantly lower than the group without MA(P<0.05).Urine albumin and urea nitrogen showed significantly higher than the group without MA(P<0.05) .There is no significantly difference when grouped according to the hemorrhages, hard exudates, cotton- wool spots and IRMA.Conclusion: 1. There is significant linear correlation relationship between syndrome and DR stages.2. The significant positive linear relationship between syndrome patterns and MA,non- perfusion area, IRMA, neovascularization, macular edema.3. smoking is relative with syndrome patterns.4. blood glucose after meal and HbAlc showed significantly difference. Urine protein and Cr increased significantly from yin deficiency and dryness-heat to deficiency of both yin and yang(P<0.05).Triglyceride in syndrome of deficiency of both qi and yin showed significantly higher level than yin deficiency and dryness-heat. 5. Hemoglobin in the group with MA showed significantly lower than the group without MA. Urine albumin and urea nitrogen showed significantly higher than the group without MA.