| Part one:Study of GLP-1 analogues in the treatment of early diabetic retinopathyObjective:To study the clinical efficacy of glucagon-like peptide-1 analogue liraglutide in the treatment of mild to moderate non-proliferative diabetic retinopathy.Methods:Sixty patients with type 2 diabetes mellitus complicated with mild to moderate non-proliferative diabetic retinopathy were enrolled in our hospital.They were randomly divided into the experimental group and the control group.Under the guidance of the endocrinologist,the patients in the experimental group were treated with metformin+insulin combined with liraglutide to control blood glucose,and the control group was treated with metformin+insulin.The amplitudes of the a-wave b-wave and the total amplitude of the oscillating potential of the light and dark adaptation 3.0 of the glycosylated hemoglobin value,diabetic retinopathy staging,macular retinal thickness,and full-field flash electroretinogram were compared between the two groups before and after treatment.The amplitude and the P100 latency of the visual evoked potential and the amplitude of the P100 wave.Results:There was no significant difference in glycosylated hemoglobin between the two groups after treatment(P=0.505).There was no significant difference in the clinical stage of DR between the two groups after treatment(P=0.665).The macular retina before and after treatment in the experimental group.The thicknesses were(284.35±29.89)um,(278.37±28.46)um,the difference was statistically significant(P<0.01).The retinal thickness of the macular area before and after treatment was(283.69±29.13)um,(284.40±30.52)um,the difference was not statistically significant(P=0.438).There was no significant difference in the retinal thickness between the two groups after treatment(P=0.332).The amplitude of the total wave amplitude of the two groups was higher than that before treatment.The differences were statistically significant(both P<0.01),The total amplitude of Ops in the experimental group was higher than that in the control group after treatment(P=0.049).The b-wave amplitudes of Ming adaptation 3.0 and dark adaptation 3.0 after treatment in the experimental group were higher than those in the control group,and the difference was statistically significant(P=0.001,0.014);however,the two groups of patients before and after treatment were significantly adapted to 3.0 and There was no significant difference in a-wave amplitude values of dark-adapted 3.0(both P>0.05).After treatment,the b-wave amplitude of the experimental group and the dark-adapted 3.0 increased compared with the pre-treatment group,and the difference was statistically significant(P<0.01,P=0.019).There was no significant difference in b-wave amplitude changes between the control group and the dark-adapted 3.0(P=0.148,0.205).Although the P100 amplitude of the experimental group increased compared with that before treatment,the difference was statistically significant(P=0.023).However,there was no significant difference in P100 amplitude between the two groups before and after treatment(P=0.949,0.207).There was no significant difference in P100 latency between the experimental group and the control group before and after treatment(P=0.693,0.058).Conclusion:GLP-1 analogue can improve the retinal microcirculation and nerve cell function in patients with mild to moderate NPDR to a certain extent,and has a positive effect on the prognosis of DR.Part two:Clinical application of GLP-1 analogues in the treatment of PDR combined with CSMEObjective:To investigate the efficacy of GLP-1 analogue liraglutide in the treatment of PDR with clinically significant macular edema(CSME).Methods:Thirty patients(34 eyes)with PDR and CSME treated in our department from 2017-6 to 2018-9 were enrolled.They were randomly divided into the experimental group(14patients、15eyes)and the control group(16 patients、19 eyes).The patients in the experimental group were treated with metformin,insulin and liraglutide to lower blood glucose,and the control group was treated with metformin and insulin.After enrollment,the patients in both groups were treated with intravitreal injection of Compaqip and panretina photocoagulation(PRP).The changes of BCVA and central macular thickness(CMT)before treatment and 1、3months after PRP treatment were compared between the two groups.Results:There were no significant differences in BCVA between the two groups at each time point before and after treatment(P=0.604,0.668,0.663).The BCVA was significantly improved in both groups after 1 month and 3 months after PRP(P<0.01).The BCVA of the experimental group decreased from March to January after PRP,but the difference was not statistically significant(P=0.653).The BCVA of the control group decreased significantly from March after PRP,and the difference was statistically significant(P=0.002).There was no significant difference in CMT between the two groups at each time point before and after treatment(P=0.591,0.533,0.623).CMT was significantly improved in both groups after 1 month and 3 months after PRP(P<0.01).CMT decreased in the test group at 3 months after 1 month,but the difference was not statistically significant(P=0.286).The CMT increased at 3 months after PRP in the control group compared with 1 month(P=0.034).Conclusion:GLP-1 analogues can improve retinal function and reduce retinal edema in patients with PDR and CSME within 3 months,and can delay the progression of the disease based on anti-VEGF combined with PRP. |
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