探讨止血散瘀明目汤（由黄芪、牡丹皮、山药、知母、黄柏、生地黄等中药组成）联合全视网膜激光光凝（PRP） 对糖尿病视网膜病变（DR）患者视力、黄斑厚度及血清脂联素水平的影响。【方法】 回顾性分析2020年2月至2022年5月收治 的98例气阴两虚、脉络瘀滞型DR患者的临床资料，根据治疗方式的不同分成PRP组48例和联合组50例。PRP组单纯给予 PRP治疗，联合组在PRP治疗基础上联合止血散瘀明目汤治疗，疗程为3个月。观察2组患者治疗前和治疗3个月后中医证 候积分、视力、黄斑厚度、视网膜中央静脉（CRV）血流相关参数[舒张末期血流速度（EDV）、收缩期峰值血流速度（PSV）]、 血脂指标及血清脂联素水平的变化情况。【结果】（1）治疗3个月后，2组患者的中医证候积分、黄斑厚度均较治疗前明显降低 （P＜0.05），视力均较治疗前明显升高（P＜0.05），且联合组治疗后的中医证候积分、黄斑厚度明显低于PRP组，视力明显高 于PRP组，差异均有统计学意义（P＜0.01）。（2）治疗3个月后，2组患者的CRV血流相关参数EDV、PSV均较治疗前明显升高 （P＜0.05），且联合组的EDV、PSV均明显高于PRP组，差异均有统计学意义（P＜0.01）。（3）治疗3个月后，联合组的总胆固 醇（TC）、低密度脂蛋白胆固醇（LDL-C）水平均较治疗前降低（P＜0.05），而 PRP 组的 TC、LDL-C 水平均无显著性改变（P＞ 0.05）；治疗后组间比较，联合组的TC、LDL-C水平均明显低于PRP组，差异均有统计学意义（P＜0.01）。（4）治疗3个月后， 2组患者的血清脂联素水平均较治疗前升高（P＜0.01），且联合组治疗后的血清脂联素水平明显高于 PRP组，差异有统计学 意义（P＜0.01）。【结论】 针对气阴两虚、脉络瘀滞型 DR患者，在 PRP治疗基础上联合止血散瘀明目汤治疗，可有效上调血 清脂联素水平，明显减小黄斑厚度，显著改善血脂指标、CRV血流相关参数及患者视力。

To investigate the effect of Zhixue Sanyu Mingmu Decoction （composed of Astragali Radix， Moutan Cortex， Dioscoreae Rhizoma， Anemarrhenae Rhizoma， Phellodendri Chinensis Cortex， Rehmanniae Radix，etc.） combined with panretinal photocoagulation （PRP） on visual acuity，macular thickness and serum adiponectin level in patients with diabetic retinopathy （DR）. Methods A retrospective analysis was carried out for the clinical data of 98 patients with DR of qi-yin deficiency complicated with blood stasis and qi stagnation in vessels and collaterals type admitted from February 2020 to May 2022. According to the treatment methods，the patients were divided into PRP group （48 cases） and combined group （50 cases）. The PRP group was treated with PRP alone，and the combined group was given Zhixue Sanyu Mingmu Decoction orally together with PRP. The course of treatment for the two groups lasted for 3 months. Before treatment and 3 months after treatment，the two groups were observed in the changes of traditional Chinese medicine （TCM） syndrome scores， visual acuity， macular thickness， blood flow related parameters of central retinal vein （CRV） such as end diastolic velocity （EDV） and peak systolic velocity （PSV），blood lipid indicators and serum adiponectin level. Results （1） After 3 months of treatment，TCM syndrome scores and macular thickness in the two groups were significantly lower than those before treatment （P＜0.05），and the visual acuity was significantly higher than that before treatment （P＜ 0.05）. The TCM syndrome scores and macular thickness in the combined group were significantly lower than those in the PRP group，and the visual acuity was significantly higher than that in the PRP group，the differences being statistically significant （P＜0.01）.（2） After 3 months of treatment， the CRV blood flow related parameters of EDV and PSV in the two groups were significantly increased compared with those before treatment （P＜0.05），and the EDV and PSV in the combined group were significantly higher than those in the PRP group，the differences being statistically significant （P＜0.01）.（3） After 3 months of treatment，the levels of total cholesterol （TC） and low-density lipoprotein cholesterol （LDL-C） in the combined group were decreased compared with those before treatment （P＜0.05），while there were no obvious changes in the levels of TC and LDL-C of the PRP group （P＞ 0.05）. After treatment，the levels of TC and LDL-C in the combined group were significantly lower than those in the PRP group，and the differences were statistically significant（P＜0.01）.（4） After 3 months of treatment，the serum adiponectin level in the two groups was significantly increased compared with that before treatment （P＜ 0.01），and the level in the combined group was significantly higher than that in the PRP group，the difference being statistically significant（P＜0.01）. Conclusion For the treatment of DR patients with qi-yin deficiency complicated with blood stasis and qi stagnation in vessels and collaterals type，the oral administration of Zhixue Sanyu Mingmu Decoction based on PRP can effectively up-regulate serum adiponectin level，significantly reduce the macular thickness，and markedly improve blood lipid indicators，CRV blood flow related parameters and the visual acuity of the patients.

R587.2

国家自然科学基金项目（编号：8207031666）；浙江省医药卫生科技计划项目（编号：2020KY1089）