雷珠单抗联合玻璃体切割对增生性糖尿病视网膜病变玻璃体中VEGF、TF表达的影响

徐晨; 纪丽君; 苗林

doi:10.12025/j.issn.1008-6358.2021.20210280

雷珠单抗联合玻璃体切割对增生性糖尿病视网膜病变玻璃体中VEGF、TF表达的影响

Effect of ranibizumab and vitrectomy on VEGF and TF expression in vitreous body of proliferative diabetic retinopathy

摘要

摘要:
目的探讨雷珠单抗联合玻璃体切割治疗增生性糖尿病视网膜病变（proliferative diabetic retinopathy，PDR）的临床疗效及对血管内皮长因子（vascular endothelial growth factor，VEGF）、组织因子（tissue factor，TF）表达的影响。
方法选择2017年6月至2020年6月上海市普陀区人民医院眼科收治入院的PDR患者53例（56眼），单纯行玻璃体切割术者为对照组（n=26），玻璃体切割术前行玻璃体内注射雷珠单抗者为观察组（n=30）。随访3个月，比较2组的最佳矫正视力（best corrected visual acuity，BCVA），平均黄斑中心凹厚度（central macular thickness，CMT），玻璃体VEGF、TF含量，手术时间和并发症。
结果 2组治疗前BCVA均值差异无统计学意义。对照组治疗后3 d、1个月、3个月BCVA均值较治疗前提高，组内差异均有统计学意义（F=18.356，P < 0.05），观察组治疗后3 d、1个月、3个月BCVA均值较治疗前提高，组内差异均有统计学意义（F=20.174，P < 0.05）。治疗后观察组3 d、1个月、3个月BCVA均值优于对照组，组间差异均有统计学意义（t=3.644、3.525、4.447，P < 0.05）。对照组治疗后1个月、3个月CMT均值较治疗后3 d降低，组内差异均有统计学意义（F=26.847，P < 0.05），观察组治疗后1个月、3个月CMT均值较治疗后3 d降低，组内差异均有统计学意义（F=23.643，P < 0.05）。治疗后观察组3 d、1个月、3个月CMT均值优于对照组，组间差异均有统计学意义（t=4.947、3.592、14.770，P < 0.05）。观察组玻璃体内注射雷珠单抗后玻璃体VEGF含量均值（130.68±30.39）pg/mL与TF含量均值（153.88±32.13）pg/mL，低于对照组玻璃体VEGF含量均值（315.65±43.41）pg/mL与TF含量均值（281.00±57.34）pg/mL，差异均有统计学意义（t=25.426、15.843，P < 0.05）。观察组手术时间短于对照组（t=10.547，P < 0.05），医源性裂孔、电凝止血、术后出血发生率低于对照组，差异均有统计学意义（χ²=4.634、5.127、4.625，P < 0.05）。
结论雷珠单抗联合玻璃体切割治疗能减轻视网膜黄斑水肿提高视力，抑制VEGF和TF的表达，成为PDR的综合治疗模式。

Abstract:
Objective To explore the clinical efficacy of ranibizumab combined with vitrectomy in the treatment of proliferative diabetic retinopathy (PDR) and the expression of vascular endothelial growth factor (VEGF) and tissue factor (TF).
Methods Retrospective longitudinal study of 53 patients (56 eyes) with PDR treated from June 2017 to June 2020. The vitrectomy group was the control group(n=26), intravitreal injection of ranibizumab combined with vitrectomy was the observation group (n=30), vitreous incision was performed before vitrectomy. The follow-up time was 3 months. The optimal corrective vision (best corrected visual acuity, BCVA), macular center thickness (CMT), VEGF, TF content, surgical time, and complications were compared between the two groups.
Results The mean BCVA in the two groups was similar and the difference was not statistically significant before treatment. The mean BCVA of the control group at 3 days, 1 and 3 months after treatment was significantly higher than that before treatment (F=18.356, P < 0.05). The BCVA mean value of the observation group at 3 days, 1 and 3months after treatment was higher than that before treatment, and the intragroup differences were statistically significant (F=20.174, P < 0.05). After treatment, the BCVA of the observation group at 3 days, 1 and 3 months was better than that of the control group, the difference was statistically significant (t=3.644, 3.525, 4.447, P < 0.05). After treatment, the mean CMT of the observation group at 3 days, 1and 3 months was better than that of the control group (t=4.947, 3.592, 14.770, P < 0.05). In the observation group after intravitreal injection of ranibizumab, the mean vitreous VEGF content was (130.68±30.39) pg/mL and the mean TF content was (153.88±32.13) pg/mL, which was lower than the control group's mean vitreous VEGF content of (315.65±43.41) pg/mL and the mean TF content was (281.00±57.34) pg/mL, the difference was statistically significant (t=25.426, 15.843, P < 0.05). The operation time of the observation group was shorter than that of the control group (t=10.547, P < 0.05), and the incidence of iatrogenic hiatus, electrocoagulation hemostasis, and postoperative bleeding in the observation group were lower than those in the control group (χ²=4.634, 5.127, 4.625, P < 0.05).
Conclusions Intravitreal injection of ranibizumab combined with vitrectomy can reduce retinal macular edema and improve visual acuity and inhibit the expression of VEGF and TF. Intravitreal injection of ranibizumab combined with vitrectomy is becoming a comprehensive treatment model for proliferative diabetic retinopathy.

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