联合用药对DR患者视网膜血管血氧饱和度和血清Apelin水平的影响
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摘要
目的:探讨复方樟柳碱注射液联合曲安奈德对糖尿病视网膜病变(diabetic retinopathy,DR)患者视网膜血管血氧饱和度和血清Apelin水平的影响。方法:选取2014-06/2016-12我院收治的增殖性DR患者58例60眼为研究对象,根据随机数字表法分为对照组(29例30眼)和观察组(29例30眼)。对照组接受全视网膜激光光凝治疗,观察组在全视网膜激光光凝治疗术前玻璃体腔内注射曲安奈德,术后复方樟柳碱颞侧浅层皮下注射。比较两组患者的视力恢复情况、治疗前后视网膜血管血氧饱和度和血清Apelin水平变化情况、治疗后并发症情况。结果:治疗后1mo,两组患者视力均明显增高,且观察组患者视力提高比例(90%)明显高于对照组(67%),差异有统计学意义(P<0. 05)。治疗后1d,1、2mo不同时间点比较,观察组视野平均阈值敏感度均明显高于对照组,差异有统计学意义(P<0. 05);治疗后1mo两组患者视网膜动脉、静脉血管血氧饱和度均显著降低,差异有统计学意义(P<0. 05),且观察组视网膜血管血氧饱和度均明显优于对照组,差异有统计学意义(P<0. 05);治疗后1mo两组血清Apelin水平显著降低,差异有统计学意义(P<0. 05),且观察组血清Apelin水平水平显著低于对照组,差异有统计学意义(P<0. 05)。观察组并发症发生率为3%,对照组并发症发生率为17%,观察组并发症发生率明显低于对照组,但差异无统计学意义(P=0. 109)。结论:复方樟柳碱注射液联合曲安奈德治疗DR疗效显著,能够有效降低患者视网膜血管血氧饱和度和血清Apelin水平的影响,缓解视网膜缺血缺氧损伤,有利于术后视力恢复,安全性较好。
AIM: To explore the influence of compound anisodine combined with triamcinolone acetonide on the oxygen saturation of retinal vessels and serum Apelin in patients with diabetic retinopathy( DR).METHODS: Totally 58 cases of patients( 60 eyes) with diabetic retinopathy from June 2014 to December 2016 in our hospital were selected as the research object. All of them were randomly divided into control group( 29 cases,30 eyes) and observation group( 29 cases, 30 eyes). The control group received panretinal photocoagulation; the observation group was given intravitreal injection of triamcinolone acetonide before panretinal photocoagulation combined with compound anisodine after panretinal photocoagulation. After treatment, the postoperative visual recovery and the complications were recorded.The oxygen saturation of retinal vessels and the serum levels of Apelin of the two groups were analyzed and compared as well.RESULTS: After the treatment,the visual acuity of the two groups increased significantly, the proportion of vision improvement in the observation group( 90%) was significantly higher than that in the control group( 67%,P< 0.05). The mean sensitivities of visual field in the observation group in 1 d,1 mo and2 mo after photocoagulation were significantly higher than those in the control group( P < 0. 05). Compared with the before treatment,the oxygen saturation of retinal vessels had decreased after treatment in both groups, that in observation group was significantly higher than control group( P< 0.05). Compared with the before treatment, the level of Apelin had decreased after treatment in both groups,the Apelin levels was significantly lower in observation group than control group( P < 0. 05). The complication rate in the observation group was 3% while the complication rate in the control group was 17%,no difference was found on the incidence of complication between the observation group and control group( P = 0. 109).CONCLUSION: The implementation of intravitreal injection of triamcinolone acetonide combined with the injection of compound anisodine via temporal subcutaneous tissue for patients with diabetic retinopathy is significantly effective, it can effectively reduce the level of the Apelin to inhibit the proliferation of retinal vessels,relieve the ischemic and hypoxia injury,which benefits the postoperative vision recovery with high safety.
AIM: To explore the influence of compound anisodine combined with triamcinolone acetonide on the oxygen saturation of retinal vessels and serum Apelin in patients with diabetic retinopathy( DR).METHODS: Totally 58 cases of patients( 60 eyes) with diabetic retinopathy from June 2014 to December 2016 in our hospital were selected as the research object. All of them were randomly divided into control group( 29 cases,30 eyes) and observation group( 29 cases, 30 eyes). The control group received panretinal photocoagulation; the observation group was given intravitreal injection of triamcinolone acetonide before panretinal photocoagulation combined with compound anisodine after panretinal photocoagulation. After treatment, the postoperative visual recovery and the complications were recorded.The oxygen saturation of retinal vessels and the serum levels of Apelin of the two groups were analyzed and compared as well.RESULTS: After the treatment,the visual acuity of the two groups increased significantly, the proportion of vision improvement in the observation group( 90%) was significantly higher than that in the control group( 67%,P< 0.05). The mean sensitivities of visual field in the observation group in 1 d,1 mo and2 mo after photocoagulation were significantly higher than those in the control group( P < 0. 05). Compared with the before treatment,the oxygen saturation of retinal vessels had decreased after treatment in both groups, that in observation group was significantly higher than control group( P< 0.05). Compared with the before treatment, the level of Apelin had decreased after treatment in both groups,the Apelin levels was significantly lower in observation group than control group( P < 0. 05). The complication rate in the observation group was 3% while the complication rate in the control group was 17%,no difference was found on the incidence of complication between the observation group and control group( P = 0. 109).CONCLUSION: The implementation of intravitreal injection of triamcinolone acetonide combined with the injection of compound anisodine via temporal subcutaneous tissue for patients with diabetic retinopathy is significantly effective, it can effectively reduce the level of the Apelin to inhibit the proliferation of retinal vessels,relieve the ischemic and hypoxia injury,which benefits the postoperative vision recovery with high safety.
引文
1 Yamada Y,Suzuma K,Onizuka N,et al.Evaluation of retinal blood flow before and after panretinal photocoagulation using pattern scan laser for diabetic retinopathy.Curr Eye Res 2017;42(12):1707-1712
2 Ishibazawa A,Nagaoka T,Yokota H,et al.Characteristics of retinal neovascularization in proliferative diabetic retinopathy imaged by optical coherence tomography angiography.Invest Ophthalmol Vis Sci 2016;57(14):6247
3 Guduru A,Martz TG,Waters A,et al.Oxygen saturation of retinal vessels in all stages of diabetic retinopathy and correlation to ultra-Wide field fluorescein angiography.Invest Ophthalmol Vis Sci 2016;57(13):5278
4 Soualmia H,Midani F,Hadj-Fradj S,et al.The A445C variant in apelin receptor and diabetic retinopathy in tunisian patients.Clin Lab2017;63(2):379
5 Figueira J,Silva R,Henriques J,et al.Ranibizumab for high-risk proliferative diabetic retinopathy:An Exploratory Randomized Controlled Trial.Ophthalmologica 2016;235(1):34-41
6徐琪,赵秀丽.复方樟柳碱注射液在眼科的临床应用研究进展.中国临床药理学杂志2017;33(9):861-864
7阳桥生.糖尿病性视网膜病变的诊断.医学综述2009;15(3):426-428
8 Subash M,Comyn O,Samy A,et al.The effect of multispot laser panretinal photocoagulation on retinal sensitivity and driving eligibility in patients with diabetic retinopathy.JAMA Ophthalmol 2016;134(6):666-672
9朱文魁.增生型糖尿病性视网膜病变术前玻璃体内注射曲安奈德的价值.眼科新进展2016;36(4):359-361
10吴育芝,黄峰.复方樟柳碱对糖尿病视网膜病变患者视神经与多焦视网膜电图的影响.实用药物与临床2016;19(11):1393-1396
11周琰倢,由彩云,王甜,等.玻璃体切割术治疗增生性糖尿病视网膜病变中应用曲安奈德的止血作用及其机制.中华实验眼科杂志2017;35(5):439-442
12张茉莉,田蓓,魏文斌.复方樟柳碱对糖尿病视网膜病变眼全视网膜光凝后视网膜功能损伤的修复作用.中华实验眼科杂志2015;33(2):155-158
13程金涛,戚金泽,梁佳美,等.糖尿病视网膜病变患者血清apelin与血脂水平观察.中华眼底病杂志2015;31(2):139-142
14张小露.血清Apelin水平监测在糖尿病视网膜病变诊断中的意义.广东医学2016;37(18):2779-2781
15花蒂豪,徐奕爽,邢怡桥.糖尿病视网膜病变患者的病变程度及糖化血红蛋白水平与视网膜血管血氧饱和度相关性研究.中华眼底病杂志2017;33(1):36-39
16程艳,李明新.532nm激光光凝联合复方樟柳碱治疗重度非增生型糖尿病视网膜病变的疗效观察.中华眼底病杂志2017;33(5):532-533
2 Ishibazawa A,Nagaoka T,Yokota H,et al.Characteristics of retinal neovascularization in proliferative diabetic retinopathy imaged by optical coherence tomography angiography.Invest Ophthalmol Vis Sci 2016;57(14):6247
3 Guduru A,Martz TG,Waters A,et al.Oxygen saturation of retinal vessels in all stages of diabetic retinopathy and correlation to ultra-Wide field fluorescein angiography.Invest Ophthalmol Vis Sci 2016;57(13):5278
4 Soualmia H,Midani F,Hadj-Fradj S,et al.The A445C variant in apelin receptor and diabetic retinopathy in tunisian patients.Clin Lab2017;63(2):379
5 Figueira J,Silva R,Henriques J,et al.Ranibizumab for high-risk proliferative diabetic retinopathy:An Exploratory Randomized Controlled Trial.Ophthalmologica 2016;235(1):34-41
6徐琪,赵秀丽.复方樟柳碱注射液在眼科的临床应用研究进展.中国临床药理学杂志2017;33(9):861-864
7阳桥生.糖尿病性视网膜病变的诊断.医学综述2009;15(3):426-428
8 Subash M,Comyn O,Samy A,et al.The effect of multispot laser panretinal photocoagulation on retinal sensitivity and driving eligibility in patients with diabetic retinopathy.JAMA Ophthalmol 2016;134(6):666-672
9朱文魁.增生型糖尿病性视网膜病变术前玻璃体内注射曲安奈德的价值.眼科新进展2016;36(4):359-361
10吴育芝,黄峰.复方樟柳碱对糖尿病视网膜病变患者视神经与多焦视网膜电图的影响.实用药物与临床2016;19(11):1393-1396
11周琰倢,由彩云,王甜,等.玻璃体切割术治疗增生性糖尿病视网膜病变中应用曲安奈德的止血作用及其机制.中华实验眼科杂志2017;35(5):439-442
12张茉莉,田蓓,魏文斌.复方樟柳碱对糖尿病视网膜病变眼全视网膜光凝后视网膜功能损伤的修复作用.中华实验眼科杂志2015;33(2):155-158
13程金涛,戚金泽,梁佳美,等.糖尿病视网膜病变患者血清apelin与血脂水平观察.中华眼底病杂志2015;31(2):139-142
14张小露.血清Apelin水平监测在糖尿病视网膜病变诊断中的意义.广东医学2016;37(18):2779-2781
15花蒂豪,徐奕爽,邢怡桥.糖尿病视网膜病变患者的病变程度及糖化血红蛋白水平与视网膜血管血氧饱和度相关性研究.中华眼底病杂志2017;33(1):36-39
16程艳,李明新.532nm激光光凝联合复方樟柳碱治疗重度非增生型糖尿病视网膜病变的疗效观察.中华眼底病杂志2017;33(5):532-533