雷珠单抗联合玻璃体切割术对PDR患者视网膜新血管形成的影响
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摘要
目的探讨雷珠单抗联合玻璃体切割术对增殖型糖尿病性视网膜病变(PDR)患者视网膜新血管形成的影响。方法将90例PDR患者分为两组,每组45例。对照组采用玻璃体切割术治疗,研究组在玻璃体切割术前给予玻璃体注射雷珠单抗;对比两组手术基本情况及术后2个月恢复情况。结果研究组手术时间、电凝止血次数、医源性裂孔个数、术中出血发生率均显著低于对照组,差异有统计学意义(t=4.467,χ~2=5.404、6.672、6.273,P<0.05);两组治疗后最佳纠正视力(BCVA)、黄斑中心视网膜厚度(CMT)显著降低(P<0.05);研究组治疗后BCVA、CMT显著低于对照组,差异有统计学意义(t=6.566、3.027,P<0.05);两组治疗后血管内皮生长因子(VEGF)、人基质细胞衍生因子1(SDF-1)、细胞间黏附因子1(ICAM-1)水平显著降低(P<0.05);研究组治疗后VEGF、SDF-1、ICAM-1水平显著低于对照组,差异有统计学意义(t=7.506、10.035、7.340,P<0.05)。结论术前注射雷珠单抗能有效抑制PDR患者视网膜新血管生成,有助于提高玻璃体切割术的治疗效果。
Objective To investigate the effect of the combination of the monoclonal antibody and vitrectomy on the formation of new retinal blood vessels in patients with proliferative diabetic retinopathy(PDR).Methods A total of 90 cases of PDR were divided into two groups,45 cases in each group.The control group was treated with vitrectomy.The study group was given the vitreous injection of monoclonal antibody before vitrectomy.The basic situation of the two groups was compared two months after the operation.Results In the study group,the operation time,the frequency of coagulation and hemostasis,iatrogenic fracture and bleeding were significantly lower than those in the control group(t=4.467,χ~2=5.404,6.672,6.273,P<0.05).Best cowelated visual acuity(BCVA)and central macular retinal thickness(CMT)were significantly decreased after treatment in two groups(P<0.05).After treatment,best corrected visual acuity(BCVA)and CMT in the study group were significantly lower than those in the control group after treatment(t=6.566,3.027,P<0.05).After treatment,the levels of vascular endothelial growth factor(VEGF),human stromal cell derived factor 1(SDF-1)and intercellular adhesion molecule 1(ICAM-1)were significantly lower in the two groups(P<0.05).After treatment,the levels of VEGF,SDF-1and ICAM-1in the study group were significantly lower than those in the control group after treatment(t=7.506,10.035,7.340,P<0.05).Conclusion Preoperative injection of monoclonal antibodies can effectively inhibit the formation of new retinal blood vessels in patients with PDR,and it is helpful to improve the therapeutic effect of vitrectomy.
Objective To investigate the effect of the combination of the monoclonal antibody and vitrectomy on the formation of new retinal blood vessels in patients with proliferative diabetic retinopathy(PDR).Methods A total of 90 cases of PDR were divided into two groups,45 cases in each group.The control group was treated with vitrectomy.The study group was given the vitreous injection of monoclonal antibody before vitrectomy.The basic situation of the two groups was compared two months after the operation.Results In the study group,the operation time,the frequency of coagulation and hemostasis,iatrogenic fracture and bleeding were significantly lower than those in the control group(t=4.467,χ~2=5.404,6.672,6.273,P<0.05).Best cowelated visual acuity(BCVA)and central macular retinal thickness(CMT)were significantly decreased after treatment in two groups(P<0.05).After treatment,best corrected visual acuity(BCVA)and CMT in the study group were significantly lower than those in the control group after treatment(t=6.566,3.027,P<0.05).After treatment,the levels of vascular endothelial growth factor(VEGF),human stromal cell derived factor 1(SDF-1)and intercellular adhesion molecule 1(ICAM-1)were significantly lower in the two groups(P<0.05).After treatment,the levels of VEGF,SDF-1and ICAM-1in the study group were significantly lower than those in the control group after treatment(t=7.506,10.035,7.340,P<0.05).Conclusion Preoperative injection of monoclonal antibodies can effectively inhibit the formation of new retinal blood vessels in patients with PDR,and it is helpful to improve the therapeutic effect of vitrectomy.
引文
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[7]冯萧萧,肖丽波,胡竹林,等.单纯23G玻璃体切割手术与玻璃体腔注射抗血管内皮生长因子单克隆抗体ranibizumab联合23G玻璃体切割手术治疗增生型糖尿病视网膜病变对比观察[J].中华眼底病杂志,2014,30(2):193-194.
[8]贾洪强,刘敏,刘玉军,等.全视网膜光凝术对糖尿病视网膜病变视网膜神经纤维层厚度的影响[J].中国实用眼科杂志,2014,32(2):175-178.
[9]宋莉,沙翔垠,杨瑞明,等.雷珠单抗辅助玻璃体切割术治疗增生性糖尿病视网膜病变[J].中国实用眼科杂志,2015,33(11):1275-1277.
[10]王德功,陈松,王昀,等.玻璃体腔注射抗血管内皮生长因子单克隆抗体ranibizumab辅助微创玻璃体视网膜手术治疗严重增生型糖尿病视网膜病变的临床观察[J].中华眼底病杂志,2014,30(2):136-140.
[11]谢安明,王雅君,崔丽珺,等.血管内皮祖细胞与VEGF对增生性糖尿病视网膜病变新生血管形成的影响[J].西安交通大学学报(医学版),2013,34(2):233-236.
[12]李昕,郑曰忠.糖尿病视网膜病变患者血清肿瘤坏死因子-α白细胞介素-2和细胞间粘附分子-1水平检测意义[J].中国实用眼科杂志,2013,31(2):111-114.
[2]傅维娜,陈梅珠,王云鹏,等.手术前玻璃体腔注射雷珠单抗对增生型糖尿病视网膜病变患眼玻璃体切割手术操作时间及手术后视力的影响[J].中华眼底病杂志,2016,32(1):26-30.
[3]胡安娣娜,李涛,罗燕,等.增殖性糖尿病视网膜病变的危险因素分析[J].中国实用眼科杂志,2011,29(9):925-928.
[4]朱丽,陈晓,宋艳萍,等.玻璃体腔注射雷珠单抗联合25G玻璃体视网膜手术治疗增生型糖尿病视网膜病变的临床观察[J].中华眼底病杂志,2016,32(1):22-25.
[5]陈美兰,蔡季平.糖尿病视网膜病变发病机制[J].中国实用眼科杂志,2011,29(6):521-524.
[6]魏雁涛,蒋欣桐,张钊填,等.玻璃体腔注射雷珠单抗对增生型糖尿病视网膜病变患眼微创玻璃体切割手术及手术后视力的影响[J].中华眼底病杂志,2015,31(4):337-340.
[7]冯萧萧,肖丽波,胡竹林,等.单纯23G玻璃体切割手术与玻璃体腔注射抗血管内皮生长因子单克隆抗体ranibizumab联合23G玻璃体切割手术治疗增生型糖尿病视网膜病变对比观察[J].中华眼底病杂志,2014,30(2):193-194.
[8]贾洪强,刘敏,刘玉军,等.全视网膜光凝术对糖尿病视网膜病变视网膜神经纤维层厚度的影响[J].中国实用眼科杂志,2014,32(2):175-178.
[9]宋莉,沙翔垠,杨瑞明,等.雷珠单抗辅助玻璃体切割术治疗增生性糖尿病视网膜病变[J].中国实用眼科杂志,2015,33(11):1275-1277.
[10]王德功,陈松,王昀,等.玻璃体腔注射抗血管内皮生长因子单克隆抗体ranibizumab辅助微创玻璃体视网膜手术治疗严重增生型糖尿病视网膜病变的临床观察[J].中华眼底病杂志,2014,30(2):136-140.
[11]谢安明,王雅君,崔丽珺,等.血管内皮祖细胞与VEGF对增生性糖尿病视网膜病变新生血管形成的影响[J].西安交通大学学报(医学版),2013,34(2):233-236.
[12]李昕,郑曰忠.糖尿病视网膜病变患者血清肿瘤坏死因子-α白细胞介素-2和细胞间粘附分子-1水平检测意义[J].中国实用眼科杂志,2013,31(2):111-114.