曲安奈德在玻璃体切割术治疗PDR中的止血作用及机制
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摘要
目的:分析曲安奈德在玻璃体切割术治疗增殖性糖尿病视网膜病变(PDR)中的止血作用及机制。方法:将2013-01/2014-03于我院因PDR进行治疗的400例800眼患者作为研究对象。将所有患者按照治疗方式进行分组,其中对照组直接行玻璃体切割术治疗,观察组在术前4～14d注射曲安奈德后行玻璃体切割术治疗。对比两组患者术后尿激酶纤溶酶原激活物(u-PA)、组织纤溶酶原激活物(t-PA)和纤溶酶原激活物抑制剂(PAI-1)等凝血相关因子的表达水平及术中、术后并发症的差异。结果:观察组u-PA、t-PA表达水平显著低于对照组,而PAI-1表达水平显著高于对照组(P<0.01);观察组手术时间、术中出血量均显著低于对照组(P<0.01);观察组术中剥膜出血发生率显著低于对照组(P<0.05);术后黄斑水肿发生率显著低于对照组(P<0.01)。结论:PDR患者采用玻璃体切割术常伴随有出血和各类并发症,曲安奈德可通过对患者玻璃体腔内多项凝血因子水平进行调节,从而直接发挥止血作用,减少出血量,可增加手术安全性,减少并发症发生率。
·AIM: To analyze the hemostatic effect and mechanism of triamcinolone acetonide in the treatment of proliferative diabetic retinopathy(PDR).·METHODS: Totally 400 patients were treated in our hospital for PDR between January 2013 and March 2014. All subjects were divided into groups. The control group was treated with vitrectomy directly. The observation group was treated with triamcinolone acetonide at 4-14 d before surgery. The differences of the indexes and complications in postoperative vision correction were compared between the two groups.·RESULTS: The expression levels of u-PA, t-PA and PAI-1 in the observation group were significantly higher than those in the control group(P<0.01). The operation time and blood loss during the observation period were significantly lower in the observation group than in the control group(P<0.01). The incidence of retinal breaks and vitreous hemorrhage in the group was significantly lower than that in the control group(P<0.05). The incidence of macular edema after the operation was significantly lower than that in the control group(P<0.01).·CONCLUSION: Vitrectomy in patients with PDR is often accompanied by hemorrhage and various complications. The use of triamcinolone acetonide can regulate the level of multiple clotting factors in the vitreous cavity of the patient, thereby reducing the amount of bleeding or directly exerting hemostasis, increasing surgical safety, reducing the incidence of complications, which is worthy of clinical application.
·AIM: To analyze the hemostatic effect and mechanism of triamcinolone acetonide in the treatment of proliferative diabetic retinopathy(PDR).·METHODS: Totally 400 patients were treated in our hospital for PDR between January 2013 and March 2014. All subjects were divided into groups. The control group was treated with vitrectomy directly. The observation group was treated with triamcinolone acetonide at 4-14 d before surgery. The differences of the indexes and complications in postoperative vision correction were compared between the two groups.·RESULTS: The expression levels of u-PA, t-PA and PAI-1 in the observation group were significantly higher than those in the control group(P<0.01). The operation time and blood loss during the observation period were significantly lower in the observation group than in the control group(P<0.01). The incidence of retinal breaks and vitreous hemorrhage in the group was significantly lower than that in the control group(P<0.05). The incidence of macular edema after the operation was significantly lower than that in the control group(P<0.01).·CONCLUSION: Vitrectomy in patients with PDR is often accompanied by hemorrhage and various complications. The use of triamcinolone acetonide can regulate the level of multiple clotting factors in the vitreous cavity of the patient, thereby reducing the amount of bleeding or directly exerting hemostasis, increasing surgical safety, reducing the incidence of complications, which is worthy of clinical application.
引文
1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
2 Kwon JW, Jee D, La TY. Neovascular glaucoma after vitrectomy in patients with proliferative diabetic retinopathy. Medicine 2017;96(10):e6263
3刘涛,谢安明,田哓燕,等. 药物辅助下玻璃体切除术治疗增生性糖尿病视网膜病变. 国际眼科杂志2008;8(8):1681-1684
4 Balakrishnan D, Jain B, Nayaka A,et al. Role of tamponade in vitrectomy for proliferative diabetic retinopathy with vitreous hemorrhage. Semin Ophthalmol 2017;32(4):488-491
5刘百臣,张卯年,彭秀军. 玻璃体切除联合曲安奈德治疗增生性糖尿病视网膜病变. 重庆医学2010;39(7):832-833
6阳桥生. 糖尿病性视网膜病变的诊断. 医学综述2009;15(3):426-428
7孙丽珍,倪志军,滕玉明,等. 玻璃体切除术中应用曲安奈德治疗增生性糖尿病视网膜病变. 中华眼外伤职业眼病杂志2011;33(11):866-867
8李龙,李秋明,王梦华. 曲安奈德辅助玻璃体切除术治疗增生性糖尿病视网膜病变. 河南医学研究2014;23(3):23-25
9赵宪孟,郭玉强,韩二营,等. 玻璃体切除联合半量曲安奈德玻璃体内注射治疗增生性糖尿病视网膜病变. 中华眼外伤职业眼病杂志2015;37(2):121-124
10陈忠平,唐罗生,刘二华. 糖尿病视网膜病变玻璃体切割术中应用曲安奈德的双重效果. 中南医学科学杂志2010;38(1):77-79
11刘蓓,朱忠桥,杜善双,等. 前期激光及曲安奈德应用对增殖性糖尿病视网膜病变玻璃体切割手术的影响. 山东大学耳鼻喉眼学报2013;27(2):66-68
12许立帅,刘东敬,兰长骏,等. 玻璃体切除联合曲安奈德治疗增生性糖尿病视网膜病变. 国际眼科杂志2010;10(12):2346-2347
13孙佑波,孙中胜,王兴岭. 玻璃体视网膜手术联合曲安奈德治疗增生性糖尿病视网膜病变. 中华眼外伤职业眼病杂志2010;32(7):515-517
14 Banerjee PJ, Moya R, Bunce C,et al. Long-Term Survival Rates of Patients Undergoing Vitrectomy for Proliferative Diabetic Retinopathy. Ophthal Epidemiol 2016;23(2):94
15刘鸿飞. 曲安奈德在增生性糖尿病视网膜病变玻璃体切除术中的应用. 国际眼科杂志 2010;10(4):766-768
2 Kwon JW, Jee D, La TY. Neovascular glaucoma after vitrectomy in patients with proliferative diabetic retinopathy. Medicine 2017;96(10):e6263
3刘涛,谢安明,田哓燕,等. 药物辅助下玻璃体切除术治疗增生性糖尿病视网膜病变. 国际眼科杂志2008;8(8):1681-1684
4 Balakrishnan D, Jain B, Nayaka A,et al. Role of tamponade in vitrectomy for proliferative diabetic retinopathy with vitreous hemorrhage. Semin Ophthalmol 2017;32(4):488-491
5刘百臣,张卯年,彭秀军. 玻璃体切除联合曲安奈德治疗增生性糖尿病视网膜病变. 重庆医学2010;39(7):832-833
6阳桥生. 糖尿病性视网膜病变的诊断. 医学综述2009;15(3):426-428
7孙丽珍,倪志军,滕玉明,等. 玻璃体切除术中应用曲安奈德治疗增生性糖尿病视网膜病变. 中华眼外伤职业眼病杂志2011;33(11):866-867
8李龙,李秋明,王梦华. 曲安奈德辅助玻璃体切除术治疗增生性糖尿病视网膜病变. 河南医学研究2014;23(3):23-25
9赵宪孟,郭玉强,韩二营,等. 玻璃体切除联合半量曲安奈德玻璃体内注射治疗增生性糖尿病视网膜病变. 中华眼外伤职业眼病杂志2015;37(2):121-124
10陈忠平,唐罗生,刘二华. 糖尿病视网膜病变玻璃体切割术中应用曲安奈德的双重效果. 中南医学科学杂志2010;38(1):77-79
11刘蓓,朱忠桥,杜善双,等. 前期激光及曲安奈德应用对增殖性糖尿病视网膜病变玻璃体切割手术的影响. 山东大学耳鼻喉眼学报2013;27(2):66-68
12许立帅,刘东敬,兰长骏,等. 玻璃体切除联合曲安奈德治疗增生性糖尿病视网膜病变. 国际眼科杂志2010;10(12):2346-2347
13孙佑波,孙中胜,王兴岭. 玻璃体视网膜手术联合曲安奈德治疗增生性糖尿病视网膜病变. 中华眼外伤职业眼病杂志2010;32(7):515-517
14 Banerjee PJ, Moya R, Bunce C,et al. Long-Term Survival Rates of Patients Undergoing Vitrectomy for Proliferative Diabetic Retinopathy. Ophthal Epidemiol 2016;23(2):94
15刘鸿飞. 曲安奈德在增生性糖尿病视网膜病变玻璃体切除术中的应用. 国际眼科杂志 2010;10(4):766-768