[1]张鹏飞,张杰,高荣玉,等.玻璃体内注射血管内皮生长因子（VEGF）抑制剂治疗糖尿病视网膜病变患者的疗效[J].眼科新进展,2018,38(10):977-981.[doi:10.13389/j.cnki.rao.2018.0231]
　ZHANG Peng-Fei,ZHANG Jie,GAO Rong-Yu,et al.The efficacy of intravitreal injection of vascular endothelial growth factor （VEGF） inhibitors in patients with diabetic retinopathy[J].Recent Advances in Ophthalmology,2018,38(10):977-981.[doi:10.13389/j.cnki.rao.2018.0231]
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玻璃体内注射血管内皮生长因子（VEGF）抑制剂治疗糖尿病视网膜病变患者的疗效/HTML
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《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
38卷
期数:
2018年10期
页码:
977-981
栏目:
应用研究
出版日期:
2018-10-05

文章信息/Info

Title:
The efficacy of intravitreal injection of vascular endothelial growth factor （VEGF） inhibitors in patients with diabetic retinopathy
作者:
张鹏飞; 张杰; 高荣玉; 孙先勇; 徐鑫彦
264000　山东省烟台市，滨州医学院（张鹏飞）；261000　山东省潍坊市，潍坊眼科医院（张杰，高荣玉，孙先勇，徐鑫彦）
Author(s):
ZHANG Peng-Fei; ZHANG Jie; GAO Rong-Yu; SUN Xian-Yong; XU Xin-Yan
Binzhou Medical University （ZHANG Peng-Fei），Yantai 264000，Shandong Province，China；Weifang Eye Hospital （ZHANG Jie，GAO Rong-Yu，SUN Xian-Yong，XU Xin-Yan），Weifang 261000，Shandong Province，China
关键词:
糖尿病性视网膜病变; 视网膜激光光凝; 无灌注区; 血管内皮生长因子; 康柏西普; 再灌注
Keywords:
diabetic retinopathy; laser therapy; non-perfusion area; vascular endothelial growth factor; conbercept; reperfusion
分类号:
R774
DOI:
10.13389/j.cnki.rao.2018.0231
文献标志码:
A
摘要:
目的　探讨玻璃体内注射血管内皮生长因子抑制剂康柏西普在糖尿病性视网膜病变（diabetic retinopathy，DR）患者中的疗效。方法　选取2016年7月至2017年7月在我院经眼底检查、荧光素眼底血管造影及光学相干断层扫描检查确诊的Ⅳ期DR患者30例34眼，按所采用治疗方法不同分为注药组和激光组，注药组16例18眼给予玻璃体内注射康柏西普（0.05 mL/0.5 mg）治疗，激光组14例16眼给予全视网膜激光光凝术治疗，对比分析两组治疗前及治疗后1个月、2个月、3个月、6个月最佳矫正视力（best corrected visual acuity，BVCA）、黄斑中心凹视网膜厚度（central macular retinal thickness，CMT）的变化及治疗后6个月两组有效率、再灌注率，并分析再灌注的可能影响因素。结果　注药组治疗后不同时间点BCVA较治疗前均有不同程度提高，激光组除治疗后1个月外，其他各时间点BCVA也均较治疗前提高，差异均有统计学意义（均为P＜0.05）；注药组治疗后各时间点的BCVA均优于激光组，差异均有统计学意义（均为P＜0.05）。两组治疗后不同时间点CMT较治疗前均有不同程度降低，差异均有统计学意义（均为P＜0.05）；注药组治疗后各时间点CMT均低于激光组，差异均有统计学意义（均为P＜0.05）。注药组和激光组治疗后6个月有效率分别为72.2%（13眼）、75.0%（12眼），差异无统计学意义（P=0.855）。注药组中10眼视网膜无灌注区恢复部分再灌注，再灌注率为55.6%，激光组视网膜无灌注区均未见再灌注。Logistic回归分析显示，尚不能认为年龄、糖尿病史、治疗前BCVA、治疗前CMT、注药次数与再灌注间存在联系。结论　玻璃体内注射康柏西普治疗Ⅳ期DR在减轻黄斑水肿、提高患者视力方面优于单纯激光光凝术；视网膜无灌注区恢复再灌注可能与玻璃体内注射VEGF抑制剂有关。
Abstract:
Objective　To evaluate the clinical efficacy of multiple intravitreal injections of conbercept and laser photocoagulation for the treatment of stage IV diabetic retinopathy.Methods　Thirty patients （34 eyes） with stage IV diabetic retinopathy （DR） diagnosed by fundus examination，fundus fluorescein angiography and optical coherence tomography in our hospital from July 2016 to July 2017 were selected and divided into injection group and laser group according to different treatment methods.Injection group had 16 patients of 18 eyes，and laser group had 14 patients of 16 eyes.Injection group was given intravitreal injection of conbercept （0.05ml/0.5mg）；laser group was given panretinal photocoagulation.The changes in the best corrected visual acuity （BVCA） and central macular retinal thickness （CMT） before and 1 month，2 months，3 months，and 6 months after treatment in the two groups，as well as postoperative six-month effective rate and reperfusion rate were analyzed comparatively，and finally reperfusion factors were analyzed.Results　As for the injection group，the BCVA at different time points after treatment increased to a different extent compared with before treatment；in the laser group，the BCVA was lower 1 month after treatment than that before treatment，but the BCVA at other time points were higher than those before surgery，and the differences were statistically significant （all P<0.05）.The BCVA of the injection group was higher than that of the laser group at each time after treatment，and the difference was statistically significant （all P<0.05）.The CMT values of the both groups at different time points after treatment decreased to a different extent，and the difference was statistically significant （all P<0.05）.The effective rates at 6 months after injection in the injection group and the laser group were 72.2%（13 eyes） and 75.0%（12 eyes），respectively，with no significant difference （P=0.855）.In the injection group，retinal reperfusion was restored in 10 eyes’ non-perfusion area，and the rate of reperfusion was 55%.Reperfusion was not found in the retinal non-perfusion area in the laser group.Logistic regression analysis showed that there was no relationship among age of sample，diabetic retinopathy （DM） history，BCVA of pretreatment，CMT of pretreatment，number of injections and reperfusion.Conclusion　The effect of intravitreal injection of conbercept for stage IV DR is superior to laser photocoagulation in reducing macular edema and improving the visual acuity of the patient.Retinal reperfusion in diabetic retinopathy may be related to the intravitreal injection of VEGF inhibitors.

参考文献/References:

［1］　HAO F Q.The effect of intravitreal Lucentis combined with vitrectomy for diabetic ratinopathy［J］Chin J Pract Ophthalmol，2015，33（1）：30-33.
郝风芹.Lucentis在玻璃体术中治疗增殖性糖尿病性视网膜病变影响研究［J］.中国实用眼科杂志，2015，33（1）：30-33.
［2］　LI Y R.Curative effect of small doses of triamcinolone acetonide in vitreous body cavity injection treatment on retinal vein occlusion macular edema［J］.J Xinxiang Med Univ，2016，33（8）：695-697.
李玉茹.小剂量曲安奈德玻璃体内注射治疗静脉阻塞黄斑水肿疗效观察［J］.新乡医学院学报，2016，33（8）：695-697.
［3］　MORADIAN S，AHMADIEH H，MALIHI M，SOHEILIAN M，DEHGHAN M H，AZARMINA M.Intravitreal bevacizumab in active progressive proliferative diabetic retinopathy［J］.Arch Clin Exp Ophthalmol，2008，246（12）：1699-1705.
［4］　MOHAN N，MONICKARAJ F，BALASUBRAMANYAM M，REMA M，MOHAN V.Imbalanced levels of angiogenic and angiostatic factors in vitreous，plasma and postmortem retinal tissue of patients with proliferative diabetic retinopathy［J］.J Diabetes Complicat，2012，26（5）：435-441.
［5］　CHEN X H，WANG Y P，CHEN M Z.Role of VEGF in pathogenesis of diabetic retinopathy and anti-VEGF therapy［J］.Rec Adv Ophthalmol，2015，35（7）：692-696.
陈小红，王云鹏，陈梅珠.VEGF在糖尿病性视网膜病变发病机制中的作用及抗VEGF治疗新进展［J］.眼科新进展，2015，35（7）：692-696.
［6］　LEVIN A M，RUSU I，ORLIN A，GUPTA M P，COOMBS P，D’AMICO D J，et al.Retinal reperfusion in diabetic retinopathy following treatment with anti-VEGF intravitreal injections［J］.Clin Ophthalmol，2017，11：193-200.
［7］　LI H，CAO H，WANG Y S.Recent advances on laser treatment in diabetic retinopathy［J］.Rec Adv Ophthalmol，2010，30（5）：489-492.
李红，曹虹，王雨生.激光治疗糖尿病视网膜病变的研究进展［J］.眼科新进展，2010，30（5）：489-492.
［8］　DONG M，CHEN S.Progress in the treatment of diabetic macular edema with ranibizumab［J］.Chin J Pract Ophthalmol，2014，32（6）：686-689.
董蒙，陈松.雷珠单抗治疗糖尿病黄斑水肿研究进展［J］.中国实用眼科杂志，2014，32（6）：686-689.
［9］　LI X，XU G，WANG Y，XU X，LIU X，TANG S.Safety and efficacy of conbercept in neovascular age-related macular degeneration：results from a 12-month randomized phase 2 study：AURORA study［J］.Ophthalmology，2014，121（9）：1740-1747.
［10］　LIU B，YANG Y X，LIU X，LI W L，MO Z Z.Intravitreal injection of Lucentis for diabetic macular edema［J］.Rec Adv Ophthalmol，2015，35（1）：45-47.
刘斌，杨玉霞，刘杏，李伟力，莫正政.玻璃体内注射Lucentis治疗糖尿病黄斑水肿［J］.眼科新进展，2015，35（1）：45-47.
［11］　ZHOU A Y，CHEN L，ZHOU C J，QUAN Y L.Panretinal photocoagulation for high-risk proliferative diabetic retinopathy［J］.Rec Adv Ophthalmol，2016，36（4）：352-355.
周爱意，陈凌，周陈静，权彦龙.全视网膜激光光凝治疗高危增生型糖尿病视网膜病变的效果分析［J］.眼科新进展，2016，36（4）：352-355.
［12］　LI F Q，LI Q M，XIE C H.Clinical study of laser photocoagulafion for the treatment of diabetic retinopathy［J］.Chin J Ocular Traum Eye Dis，2016，38（6）：440-443.
李福琴，李秋明，谢春红.糖尿病视网膜病变激光光凝术的临床研究［J］.中华眼外伤职业眼病杂志，2016，38（6）：440-443.
［13］　CAMPOCHIARO P A，BHISITKUL R B，SHAPIRO H，RUBIO R G.Vascular endothelial growth factor promotes progressive retinal nonperfusion in patients with retinal vein occlusion［J］.Ophthalmology，2013，120（4）：795-802.
［14］　CAMPOCHIARO P A，WYKOFF C C，SHAPIRO H，RUBIO R G，EHRLICH J S.Neutralization of vascular endothelial growth factor slows progression of retinal nonperfusion in patients with diabetic macular edema［J］.Ophthalmology，2014，121（9）：1783-1789.
［15］　GIANTONIO B J，CATALANO P J，MEROPOL N J，O’DWYER P J，MITCHELL E P，ALBERTS S R.et al.Bevacizumab in combination with oxaliplatin，fluorouracil，and leucovorin （FOLFOX4） for previously treated metastatic colorectal cancer：results from the Eastern Cooperative Oncology Group Study E3200［J］.J Clin Oncol，2007，25（12）：1539-1544.

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备注/Memo

备注/Memo:
山东省潍坊市科技局基金资助（编号：2016YX026）
更新日期/Last Update: 2018-09-28