眼底激光联合曲安奈德治疗糖尿病性视网膜病变的疗效
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摘要
目的:观察眼底激光联合曲安奈德(triamcinolone acetonide,TA)治疗糖尿病性视网膜病变(diabetic retinopathy,DR)的疗效。方法:对2016-09/2017-09我院94例112眼DR患者临床资料进行回顾性分析,根据其治疗方案分为眼底激光+TA组(研究组, 54例64眼)和眼底激光组(对照组, 40例48眼)。于治疗前(T1)及治疗7d和1、3、6mo(T2、T3、T4、T5)时监测治疗情况,包括最佳矫正视力(best corrected visual acuity,BCVA)、黄斑区视网膜厚度; T5时评估疗效,记录临床表现(眼底出血、渗出、视网膜水肿)改善时间;于T1、T5时检测患者血清学相关指标,包括细胞间黏附分子(intercellular adhesion moleclar-1, ICAM-1)、血管内皮生长因子(vascular endothelial growth factor,VEGF)水平。结果:T1～T5时,两组患者BCVA、黄斑区视网膜厚度组间效应、时间点效应及组间与时间点交互效应差异均有统计学意义(P<0. 05); T2～T5时,两组患者BCVA和黄斑区视网膜厚度随时间推移而减小,差异均有统计学意义(P<0. 05)。研究组疗效优于对照组,眼底出血、渗出、视网膜水肿改善时间小于对照组,差异均有统计学意义(P <0. 05)。T5时,两组患者血清ICAM-1、VEGF水平均较T1时降低,且研究组低于对照组,差异均有统计学意义(P<0. 05)。结论:眼底激光联合TA可有效改善DR患者视力和视网膜水肿,疗效显著,并对促进临床症状恢复、减轻血管内皮损伤、抑制新生血管形成有一定帮助。
AIM: To observe the efficacy of fundus photocoagulation combined with triamcinolone acetonide( TA) in the treatment of diabetic retinopathy( DR).METHODS: The clinical data of 94 patients( 112 eyes) in our hospital from September 2016 to September 2017 were analyzed retrospectively. According to the treatment regimen, the patients were divided into fundus photocoagulation with TA group( study group,54 cases64 eyes) and fundus photocoagulation group( control group,40 cases 48 eyes). The treatment conditions [best corrected visual acuity( BCVA), macular retinal thickness] were monitored before treatment( T1) and after 7 d,1,3 and 6 mo of treatment( T2,T3,T4,T5),and the efficacy was assessed at T5,and the improvement times of clinical manifestations( fundus hemorrhage,exudation, retinal edema) were recorded, and the serological markers [intercellular adhesion molecule( ICAM-1) and vascular endothelial growth factor( VEGF) ]were measured at T1 and T5. RESULTS: At T1 to T5, there were statistically significant differences in the between-group effects,time-point effects and interaction effects of between-group and time-point of BCVA and macular retinal thickness( P<0. 05). At T2 to T5,the BCVA was improved in the two groups with time while the macular retinal thickness was decreased with time( P<0. 05). The efficacy in study group was better than that in control group,and the improvement times of fundus hemorrhage,exudation and retinal edema were less than those in control group( P<0. 05). At T5,the serum levels of ICAM-1 and VEGF in the two groups were lower than those at T1,and the levels were lower in study group than those in control group( P<0. 05). CONCLUSION: Fundus photocoagulation combined with TA can effectively improve the visual acuity and retinal edema in patients with DR,and it has significant efficacy,and it can help promote the recovery of clinical symptoms,reduce the vascular endothelial injury,and inhibit the neovascularization.
AIM: To observe the efficacy of fundus photocoagulation combined with triamcinolone acetonide( TA) in the treatment of diabetic retinopathy( DR).METHODS: The clinical data of 94 patients( 112 eyes) in our hospital from September 2016 to September 2017 were analyzed retrospectively. According to the treatment regimen, the patients were divided into fundus photocoagulation with TA group( study group,54 cases64 eyes) and fundus photocoagulation group( control group,40 cases 48 eyes). The treatment conditions [best corrected visual acuity( BCVA), macular retinal thickness] were monitored before treatment( T1) and after 7 d,1,3 and 6 mo of treatment( T2,T3,T4,T5),and the efficacy was assessed at T5,and the improvement times of clinical manifestations( fundus hemorrhage,exudation, retinal edema) were recorded, and the serological markers [intercellular adhesion molecule( ICAM-1) and vascular endothelial growth factor( VEGF) ]were measured at T1 and T5. RESULTS: At T1 to T5, there were statistically significant differences in the between-group effects,time-point effects and interaction effects of between-group and time-point of BCVA and macular retinal thickness( P<0. 05). At T2 to T5,the BCVA was improved in the two groups with time while the macular retinal thickness was decreased with time( P<0. 05). The efficacy in study group was better than that in control group,and the improvement times of fundus hemorrhage,exudation and retinal edema were less than those in control group( P<0. 05). At T5,the serum levels of ICAM-1 and VEGF in the two groups were lower than those at T1,and the levels were lower in study group than those in control group( P<0. 05). CONCLUSION: Fundus photocoagulation combined with TA can effectively improve the visual acuity and retinal edema in patients with DR,and it has significant efficacy,and it can help promote the recovery of clinical symptoms,reduce the vascular endothelial injury,and inhibit the neovascularization.
引文
1李东洁,吴迪,张旭乡.糖尿病视网膜神经节细胞损伤的研究进展.国际眼科杂志2016; 16(4):670-672
2 陈淑惠,孟倩丽,张敏,等. 2型糖尿病视网膜病变与糖尿病其他并发症的相关性.国际眼科杂志2016; 16(2):309-312
3 吴万民,张文芳,杨义,等.促血管生成素/酪氨酸激酶受体、血管内皮生长因子及其受体信号通路在糖尿病性视网膜病变中的研究进展.中国糖尿病杂志2017; 9(4):258-261
4 Luo DW,Zheng Z,Wang H, et al. UPP mediated Diabetic Retinopathy via ROS/PARP and NF-κB inflammatory factor pathways. Curr Mol Med 2015; 15(8):790-799
5 中华医学会眼科学会眼底病学组.我国糖尿病视网膜病变临床诊疗指南(2014年).中华眼科杂志2014; 50(11):851-865
6 张书林,尧雪洲.眼底激光联合雷珠单抗治疗糖尿病性视网膜病变的临床研究.中国医学装备2015; 22(5):78-81
7 张凤俊,易敬林,李晶明,等.糖尿病视网膜病变发病机制研究进展.眼科新进展2016; 36(6):584-587
8 周爱意,陈凌,周陈静,等.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.眼科新进展2016; 36(4):352-355
9 张茉莉,田蓓,魏文斌. 577、532nm激光全视网膜激光光凝治疗非增生型糖尿病视网膜病变疗效比较.中华眼底病杂志2016; 32(2):135-139
10 韩林峰,柯根杰,王林,等.全视网膜激光光凝对增生型糖尿病视网膜病变视网膜前膜中环氧化酶-2、血管内皮生长因子表达的影响.中华眼底病杂志2016; 32(2):140-143
11江新利,苗慧鹏,周忠友,等.玻璃体内注射色素上皮源性因子对大鼠早期糖尿病视网膜病变的保护作用.眼科新进展2016; 36(3):210-215
12 于宏飞,董志军,张铁民,等.丝胶对糖尿病大鼠视网膜微血管的保护作用及其作用机制.中华实验眼科杂志2017; 35(1):32-37
13 莫香红,黄敏丽.糖尿病黄斑水肿的激光治疗进展.眼科新进展2017; 37(7):688-691
14 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
15 刘宁姝,李世迎,孙成,等.巩膜后注射曲安奈德治疗糖尿病性黄斑水肿的疗效和安全性.中华实验眼科杂志2017; 35(7):622-627
16 Tripathy K,Sharma YR,Singh HI, et al. Scleral abscess following posterior subtenon triamcinolone acetonide injection for diabetic macular edema. Saudi J Ophthalmol 2016; 30(2):130-132
2 陈淑惠,孟倩丽,张敏,等. 2型糖尿病视网膜病变与糖尿病其他并发症的相关性.国际眼科杂志2016; 16(2):309-312
3 吴万民,张文芳,杨义,等.促血管生成素/酪氨酸激酶受体、血管内皮生长因子及其受体信号通路在糖尿病性视网膜病变中的研究进展.中国糖尿病杂志2017; 9(4):258-261
4 Luo DW,Zheng Z,Wang H, et al. UPP mediated Diabetic Retinopathy via ROS/PARP and NF-κB inflammatory factor pathways. Curr Mol Med 2015; 15(8):790-799
5 中华医学会眼科学会眼底病学组.我国糖尿病视网膜病变临床诊疗指南(2014年).中华眼科杂志2014; 50(11):851-865
6 张书林,尧雪洲.眼底激光联合雷珠单抗治疗糖尿病性视网膜病变的临床研究.中国医学装备2015; 22(5):78-81
7 张凤俊,易敬林,李晶明,等.糖尿病视网膜病变发病机制研究进展.眼科新进展2016; 36(6):584-587
8 周爱意,陈凌,周陈静,等.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.眼科新进展2016; 36(4):352-355
9 张茉莉,田蓓,魏文斌. 577、532nm激光全视网膜激光光凝治疗非增生型糖尿病视网膜病变疗效比较.中华眼底病杂志2016; 32(2):135-139
10 韩林峰,柯根杰,王林,等.全视网膜激光光凝对增生型糖尿病视网膜病变视网膜前膜中环氧化酶-2、血管内皮生长因子表达的影响.中华眼底病杂志2016; 32(2):140-143
11江新利,苗慧鹏,周忠友,等.玻璃体内注射色素上皮源性因子对大鼠早期糖尿病视网膜病变的保护作用.眼科新进展2016; 36(3):210-215
12 于宏飞,董志军,张铁民,等.丝胶对糖尿病大鼠视网膜微血管的保护作用及其作用机制.中华实验眼科杂志2017; 35(1):32-37
13 莫香红,黄敏丽.糖尿病黄斑水肿的激光治疗进展.眼科新进展2017; 37(7):688-691
14 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
15 刘宁姝,李世迎,孙成,等.巩膜后注射曲安奈德治疗糖尿病性黄斑水肿的疗效和安全性.中华实验眼科杂志2017; 35(7):622-627
16 Tripathy K,Sharma YR,Singh HI, et al. Scleral abscess following posterior subtenon triamcinolone acetonide injection for diabetic macular edema. Saudi J Ophthalmol 2016; 30(2):130-132