小梁切除术联合康柏西普或雷珠单抗治疗对NVG患者视力、眼压及血清IP-10、TNF-α、VEGF水平的影响
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摘要
目的观察小梁切除术联合康柏西普或雷珠单抗治疗对新生血管性青光眼(neovascular glaucoma, NVG)患者视力、眼压及血清干扰素诱导蛋白-10(IP-10)、肿瘤坏死因子-α(TNF-α)、血管内皮生长因子(VEGF)水平的影响。方法选取我院2016年1月—2018年1月收治的NVG患者42例(42眼)为研究对象,采用随机数字表法分为A组和B组各21例(21眼),A组给予小梁切除术联合康柏西普玻璃体腔内注射,B组给予小梁切除术联合雷珠单抗玻璃体腔内注射。观察两组新生血管消退情况(消退时间、复发率);比较两组玻璃体腔注药前(T1)、注药后(T2)及小梁切除术后1周(T3)、1个月(T4)、3个月(T5)、6个月(T6)时最佳矫正视力(best-corrected visual acuity, BCVA)、眼压,T1、T4时血清IP-10、TNF-α、VEGF水平;观察两组治疗期间并发症发生情况。结果 A组新生血管消退时间显著短于B组(P<0.01)。两组复发率、术后总并发症发生率比较差异均无统计学意义(P>0.05)。两组T4、T5、T6时BCVA水平较T1时显著升高(P<0.01),T3～T6时眼压较T1时显著降低(P<0.01);两组组间不同时点BCVA、眼压比较差异均无统计学意义(P>0.05)。T4时,两组血清IP-10水平均较T1时升高,血清TNF-α、VEGF水平均较T1时降低,且A组上述指标升高及降低程度均大于B组,差异均有统计学意义(P<0.05或P<0.01)。结论小梁切除术联合康柏西普或雷珠单抗治疗NVG均可使新生血管消退,有效控制眼压、改善视力,但康柏西普在抑制新生血管形成、控制炎性反应方面更具优势。
Objective To observe the effect of trabeculectomy combined with Conbercept or ranibizumab on visual acuity, intraocular pressure and serum levels of interferon-inducible protein-10(IP-10), tumor necrosis factor-α(TNF-α) and vascular endothelial growth factor(VEGF) in patients with neovascular glaucoma(NVG).Methods A total of 42 cases(42 eyes) of NVG patients treated in our hospital from January 2016 to January 2018 were selected for the study ans were divided into group A(n=21, 21 eyes) and group B(n=21, 21 eyes) according to the the random number table method. Group A was given trabeculectomy combined with intravitreal injection of Conbercept, and group B was given trabeculectomy combined with intravitreal injection of ranibizumab. The regression of neovascularization(regression time, recurrence rate) was observed in the two groups, and the best corrected visual acuity(BCVA) and intraocular pressure before intravitreous injection(T1), after injection(T2), and at 1 week(T3), 1 month(T4), 3 months(T5) and 6 months(T6) after trabeculectomy, and the levels of serum IP-10, TNF-α and VEGF at T1 and T4 were compared between the two groups. In addition, the occurrence of complications during treatment was observed in the two groups. Results The regression time of neovascularization in group A was significantly shorter than that in group B(P<0.01). There were no significant differences in the relapse rate and total incidence rate of postoperative complications between the two groups(P>0.05). The BCVA level at T4, T5 and T6 was significantly increased compared with that at T1(P<0.01), and the intraocular pressure at T3-T6 was significantly decreased compared with that at T1(P<0.01). There were no significant differences in the BCVA and intraocular pressure at different time points between the two groups(P>0.05). At T4, the serum IP-10 level in the two groups was increased compared with that at T1 while the serum levels of TNF-α and VEGF were decreased compared with those at T1, and the increases and decreases of above indexes in group A were greater than those in group B(P<0.05 or P<0.01). Conclusion Trabeculectomy combined with Conbercept or ranibizumab can regress neovascularization, effectively control intraocular pressure and improve visual acuity. Conbercept has advantages in inhibiting neovascularization and controlling inflammatory response.
Objective To observe the effect of trabeculectomy combined with Conbercept or ranibizumab on visual acuity, intraocular pressure and serum levels of interferon-inducible protein-10(IP-10), tumor necrosis factor-α(TNF-α) and vascular endothelial growth factor(VEGF) in patients with neovascular glaucoma(NVG).Methods A total of 42 cases(42 eyes) of NVG patients treated in our hospital from January 2016 to January 2018 were selected for the study ans were divided into group A(n=21, 21 eyes) and group B(n=21, 21 eyes) according to the the random number table method. Group A was given trabeculectomy combined with intravitreal injection of Conbercept, and group B was given trabeculectomy combined with intravitreal injection of ranibizumab. The regression of neovascularization(regression time, recurrence rate) was observed in the two groups, and the best corrected visual acuity(BCVA) and intraocular pressure before intravitreous injection(T1), after injection(T2), and at 1 week(T3), 1 month(T4), 3 months(T5) and 6 months(T6) after trabeculectomy, and the levels of serum IP-10, TNF-α and VEGF at T1 and T4 were compared between the two groups. In addition, the occurrence of complications during treatment was observed in the two groups. Results The regression time of neovascularization in group A was significantly shorter than that in group B(P<0.01). There were no significant differences in the relapse rate and total incidence rate of postoperative complications between the two groups(P>0.05). The BCVA level at T4, T5 and T6 was significantly increased compared with that at T1(P<0.01), and the intraocular pressure at T3-T6 was significantly decreased compared with that at T1(P<0.01). There were no significant differences in the BCVA and intraocular pressure at different time points between the two groups(P>0.05). At T4, the serum IP-10 level in the two groups was increased compared with that at T1 while the serum levels of TNF-α and VEGF were decreased compared with those at T1, and the increases and decreases of above indexes in group A were greater than those in group B(P<0.05 or P<0.01). Conclusion Trabeculectomy combined with Conbercept or ranibizumab can regress neovascularization, effectively control intraocular pressure and improve visual acuity. Conbercept has advantages in inhibiting neovascularization and controlling inflammatory response.
引文
[1] 赵明威.新生血管性青光眼治疗面临的临床问题与思考[J].中华实验眼科杂志,2016,34(7):577-579.
[2] 黄萍,王雯倩,石砚,等.贝伐单抗联合小梁切除术或睫状体光凝术治疗晚期新生血管性青光眼疗效比较[J].中华实验眼科杂志,2015,33(4):362-366.
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[4] 赵军,胡莲娜,罗灵,等.抗VEGF治疗在新生血管性青光眼治疗中的应用[J].中国中医眼科杂志,2015,25(2):118-120.
[5] 孙怡,赵海霞,关文英.新生血管性青光眼研究进展[J].临床和实验医学杂志,2016,13(13):1344-1345.
[6] 刘鸿飞,张志明,吕杰,等.改良式小梁切除术治疗新生血管性青光眼[J].中国煤炭工业医学杂志,2008,11(7):1061.
[7] Barac I R, Pop M D, Gheorghe A I, et al. NEOVASCULAR SECONDARY GLAUCOMA, ETIOLOGY AND PATHOGENESIS[J].Rom J Ophthalmol, 2015,59(1):24-28.
[8] Matsuoka T, Asao K, Hashida N, et al. Chronic Retinal Necrosis Severely Complicated by Neovascular Glaucoma: A Case Report[J].Case Rep Ophthalmol, 2017,8(3):489-495.
[9] 黄芳,宋彩萍,于淼.新生血管性青光眼联合治疗疗效分析[J].国际眼科杂志,2016,16(12):2311-2313.
[10] Moraru A, Pinzaru G, Motoc A, et al. Incidence of ocular hypertension after intravitreal injection of anti-VEGF agents in the treatment of neovascular AMD[J].Rom J Ophthalmol, 2017,61(3):207-211.
[11] 王华,王涛,张风,等.综合治疗新生血管性青光眼疗效观察[J].中国实用眼科杂志,2015,33(4):370-373.
[12] 徐丹,秦梅.新生血管性青光眼的研究新进展[J].临床眼科杂志,2016,24(5):469-472.
[13] Kitnarong N, Sriyakul C, Chinwattanakul S. A Prospective Study to Evaluate Intravitreous Ranibizumab as Adjunctive Treatment for Trabeculectomy in Neovascular Glaucoma[J].Ophthalmol Ther, 2015,4(1):33-41.
[14] Jia X, Duan X. Application of anti-VEGF agents in treatment of neovascular glaucoma and anti-scarring in filtering surgery[J].Zhonghua Yan Ke Za Zhi, 2015,51(4):314-318.
[15] 孔繁学,马翔,范松涛,等.玻璃体腔注射雷珠单抗和康柏西普联合青光眼引流阀植入治疗新生血管性青光眼的疗效[J].吉林大学学报(医学版),2017,43(6):1237-1242.
[16] 连海燕,宋艳萍,丁琴,等.康柏西普与雷珠单抗玻璃体腔注射治疗视网膜中央静脉阻塞黄斑水肿短期疗效对比观察[J].中华眼底病杂志,2016,32(4):367-371.
[17] 唐德荣.康柏西普玻璃体内注射联合眼底激光治疗对糖尿病性黄斑水肿患者视力及黄斑中心厚度的影响[J].解放军医药杂志,2017,29(10):76-79.
[18] 肖艳辉,刘高勤,陈志刚,等.重组干扰素诱导蛋白-10对视网膜血管内皮细胞增生、迁移及管腔形成的影响[J].中华眼底病杂志,2013,29(1):58-61.
[19] 李丹.干扰素诱导蛋白-10与新生血管性眼病关系的研究进展[J].中华实验眼科杂志,2017,35(9):852-856.
[20] 童尧,郑岩,周雅丽,等.各型青光眼患者眼内TNF-α及IP-10水平及其相关性分析[J].山东大学耳鼻喉眼学报,2017,31(1):103-106.
[21] 郭飞,崔瑞.两种不同药物联合小梁切除术治疗新生血管性青光眼效果的比较[J].中华眼外伤职业眼病杂志,2017,39(4):293-296.
[2] 黄萍,王雯倩,石砚,等.贝伐单抗联合小梁切除术或睫状体光凝术治疗晚期新生血管性青光眼疗效比较[J].中华实验眼科杂志,2015,33(4):362-366.
[3] Kovacs K, Marra K V, Yu G, et al. Angiogenic and Inflammatory Vitreous Biomarkers Associated With Increasing Levels of Retinal Ischemia[J].Invest Ophthalmol Vis Sci, 2015,56(11):6523-6530.
[4] 赵军,胡莲娜,罗灵,等.抗VEGF治疗在新生血管性青光眼治疗中的应用[J].中国中医眼科杂志,2015,25(2):118-120.
[5] 孙怡,赵海霞,关文英.新生血管性青光眼研究进展[J].临床和实验医学杂志,2016,13(13):1344-1345.
[6] 刘鸿飞,张志明,吕杰,等.改良式小梁切除术治疗新生血管性青光眼[J].中国煤炭工业医学杂志,2008,11(7):1061.
[7] Barac I R, Pop M D, Gheorghe A I, et al. NEOVASCULAR SECONDARY GLAUCOMA, ETIOLOGY AND PATHOGENESIS[J].Rom J Ophthalmol, 2015,59(1):24-28.
[8] Matsuoka T, Asao K, Hashida N, et al. Chronic Retinal Necrosis Severely Complicated by Neovascular Glaucoma: A Case Report[J].Case Rep Ophthalmol, 2017,8(3):489-495.
[9] 黄芳,宋彩萍,于淼.新生血管性青光眼联合治疗疗效分析[J].国际眼科杂志,2016,16(12):2311-2313.
[10] Moraru A, Pinzaru G, Motoc A, et al. Incidence of ocular hypertension after intravitreal injection of anti-VEGF agents in the treatment of neovascular AMD[J].Rom J Ophthalmol, 2017,61(3):207-211.
[11] 王华,王涛,张风,等.综合治疗新生血管性青光眼疗效观察[J].中国实用眼科杂志,2015,33(4):370-373.
[12] 徐丹,秦梅.新生血管性青光眼的研究新进展[J].临床眼科杂志,2016,24(5):469-472.
[13] Kitnarong N, Sriyakul C, Chinwattanakul S. A Prospective Study to Evaluate Intravitreous Ranibizumab as Adjunctive Treatment for Trabeculectomy in Neovascular Glaucoma[J].Ophthalmol Ther, 2015,4(1):33-41.
[14] Jia X, Duan X. Application of anti-VEGF agents in treatment of neovascular glaucoma and anti-scarring in filtering surgery[J].Zhonghua Yan Ke Za Zhi, 2015,51(4):314-318.
[15] 孔繁学,马翔,范松涛,等.玻璃体腔注射雷珠单抗和康柏西普联合青光眼引流阀植入治疗新生血管性青光眼的疗效[J].吉林大学学报(医学版),2017,43(6):1237-1242.
[16] 连海燕,宋艳萍,丁琴,等.康柏西普与雷珠单抗玻璃体腔注射治疗视网膜中央静脉阻塞黄斑水肿短期疗效对比观察[J].中华眼底病杂志,2016,32(4):367-371.
[17] 唐德荣.康柏西普玻璃体内注射联合眼底激光治疗对糖尿病性黄斑水肿患者视力及黄斑中心厚度的影响[J].解放军医药杂志,2017,29(10):76-79.
[18] 肖艳辉,刘高勤,陈志刚,等.重组干扰素诱导蛋白-10对视网膜血管内皮细胞增生、迁移及管腔形成的影响[J].中华眼底病杂志,2013,29(1):58-61.
[19] 李丹.干扰素诱导蛋白-10与新生血管性眼病关系的研究进展[J].中华实验眼科杂志,2017,35(9):852-856.
[20] 童尧,郑岩,周雅丽,等.各型青光眼患者眼内TNF-α及IP-10水平及其相关性分析[J].山东大学耳鼻喉眼学报,2017,31(1):103-106.
[21] 郭飞,崔瑞.两种不同药物联合小梁切除术治疗新生血管性青光眼效果的比较[J].中华眼外伤职业眼病杂志,2017,39(4):293-296.