雷珠单抗联合光动力疗法治疗wAMD的效果
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摘要
目的:探讨湿性年龄相关性黄斑变性(wAMD)患者采用雷珠单抗联合光动力疗法的临床效果及对患者血清新生血管调控因子的影响。方法:回顾性分析。选取2014-01/2016-06我院治疗的wAMD患者68例68眼进行分析,其中采取光动力疗法治疗(对照组)34眼、采用雷珠单抗联合光动力疗法治疗(治疗组)34眼,对比两组患者治疗前后BCVA、视网膜平均厚度、黄斑中心凹视网膜厚度(CMT)值及血清新生血管调控因子情况。结果:治疗前,两组患者的BCVA、视网膜平均厚度、CMT值比较差异无统计学意义(P>0.05);治疗后3、6、12mo,两组患者的BCVA值、视网膜平均厚度、CMT值较本组治疗前均显著降低,差异有统计学意义(P<0.05);治疗组患者的BCVA值、视网膜平均厚度、CMT值均显著低于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者血清中VEGF、PDGF、TIMP-1、ES值差异无统计学意义(P>0.05);治疗后3mo,两组患者血清中的VEGF、PDGF、ES值较本组治疗前均显著降低,差异有统计学意义(P<0.05);治疗组患者的VEGF、PDGF、ES值均显著低于对照组,差异有统计学意义(P<0.05)。结论:雷珠单抗联合光动力疗法治疗wAMD患者能取得更加显著的临床效果,更有效地降低血清中新生血管调控因子水平。
AIM:To investigate the clinical effect of Ranibizumab combined with photodynamic therapy( PDT) for wet type age-related macular degeneration( wAMD) and the effect on the serum neovascularization factors.METHODS:Totally 68 cases( 68 eyes) of wAMD patients treated with PDT in our hospital from January2014 to June 2016 were analyzed retrospectively. Among them,34 patients were treated by photodynamic therapy( control group) and 34 patients were treated by combination of photodynamic therapy and ranibizumab( treatment group). Comparison of BCVA,mean retinal thickness and central macular thickness( CMT) and serum neovascularization regulatory factors before and after treatment were taken between the two groups.RESULTS:Before treatment,there was no significant difference on the BCVA,the average retinal thickness and the CMT value between the two groups( P >0. 05). At 3,6 and 12 mo after treatment, the BCVA, average retinal thickness and CMT in both groups were significantly lower than those before treatment( P <0. 05). At 3,6 and 12 mo after treatment,the BCVA,the average retinal thickness and the CMT value of the patients in the treatment group were significantly lower than those in the control group( P < 0. 05). There was no significant difference of vascular endothelial growth factor( VEGF), platelet derived growth factor( PDGF), matrix metallo-proteinase inhibitor( TIMP)-1 and endostatin( ES) between the two groups before treatment( P > 0. 05). Three months after treatment,VEGF,PDGF and ES in both groups were significantly lower than those before treatment( P <0. 05).Three months after treatment,the levels of VEGF,PDGF and ES in the treatment group were significantly lower than those in the control group( P <0. 05).CONCLUSION:The wAMD patients treated with ranibizumab combined with photodynamic therapy can achieve a more significant clinical effect, and more effectively reduce the level of serum neovascularization regulators.
AIM:To investigate the clinical effect of Ranibizumab combined with photodynamic therapy( PDT) for wet type age-related macular degeneration( wAMD) and the effect on the serum neovascularization factors.METHODS:Totally 68 cases( 68 eyes) of wAMD patients treated with PDT in our hospital from January2014 to June 2016 were analyzed retrospectively. Among them,34 patients were treated by photodynamic therapy( control group) and 34 patients were treated by combination of photodynamic therapy and ranibizumab( treatment group). Comparison of BCVA,mean retinal thickness and central macular thickness( CMT) and serum neovascularization regulatory factors before and after treatment were taken between the two groups.RESULTS:Before treatment,there was no significant difference on the BCVA,the average retinal thickness and the CMT value between the two groups( P >0. 05). At 3,6 and 12 mo after treatment, the BCVA, average retinal thickness and CMT in both groups were significantly lower than those before treatment( P <0. 05). At 3,6 and 12 mo after treatment,the BCVA,the average retinal thickness and the CMT value of the patients in the treatment group were significantly lower than those in the control group( P < 0. 05). There was no significant difference of vascular endothelial growth factor( VEGF), platelet derived growth factor( PDGF), matrix metallo-proteinase inhibitor( TIMP)-1 and endostatin( ES) between the two groups before treatment( P > 0. 05). Three months after treatment,VEGF,PDGF and ES in both groups were significantly lower than those before treatment( P <0. 05).Three months after treatment,the levels of VEGF,PDGF and ES in the treatment group were significantly lower than those in the control group( P <0. 05).CONCLUSION:The wAMD patients treated with ranibizumab combined with photodynamic therapy can achieve a more significant clinical effect, and more effectively reduce the level of serum neovascularization regulators.
引文
1葛坚,何明光,赵家良,等.我国九省眼病调查中广东省阳西县50岁及以上人群盲和中、重度视力损伤患病率及致病原因调查.中华眼科杂志2014;50(3):167-172
2王翠,赵博军.年龄相关性黄斑变性的治疗进展.眼科新进展2016;36(5):489-493
3 Thompson RB,Reffatto V,Bundy JQ,et al.Identification of hydroxyapatite spherules provides new insight into subretinal pigment epithelial deposit formation in the aging eye.Proc Natl Acad Sci USA2015;112(5):1565-1570
4中华医学会眼科学分会眼底病学组中国老年性黄斑变性临床指南与临床路径制订委员会.中国老年性黄斑变性临床诊断治疗路径.中华眼底病杂志2013;29(4):343-355
5 Schmid MK,Bachmann LM,Fas L,et al.Efficency and adverse events of aflibercept,ranibizumab and bevacizumab in age-related macular degeneration:a trade-off analysis.Br J Ophthalmol 2015;99(2):141-146
6李娜,孙先勇.年龄相关性黄斑变性的发病机制及治疗研究现状.中国全科医学2016;16(9):724-728
7Knickelbein JE,Chew EY,Sen HV.Intraocular inflammation following intravitreal injection of anti-VEGF Medications for veovascul:agerelated macular egeneration.Ophthalmic Epidemiol 2016;23(2):69-70
8毕延峰.雷珠单抗眼内注射治疗湿性老年黄斑变性的视力变化对比分析.中国实用医药2015;10(1):117-119
9余试,陈长征,易佐慧子.玻璃体腔注射康柏西普治疗渗出型老年性黄斑变性的疗效观察.中华眼底病杂志2015;31(3):256-259
10 Owsley C,Clark ME,Huisingh CE,et al.Visual function in older eyesin vormal macular health:association with incident early agerelated macular degeneration 3 years later.Invest Ophthalmol Vis Sci2016;57(4):1782-1789
11胡军平,杨华,李国栋,等.光动力疗法联合玻璃体内注射雷珠单抗治疗湿性年龄相关性黄斑变性后黄斑区中心视野的改变.眼科新进展2015;35(11):1039-1043
12徐奕爽,戚沆,易佐慧子,等.光动力联合玻璃体腔注射雷珠单抗治疗息肉样脉络膜血管病变疗效观察.中国实用眼科杂志2015;33(9):1054-1058
13龚斌,范传峰,王玉.抗VEGF药物(雷珠单抗)治疗不同病程湿性年龄相关性黄斑变性62例.山东大学耳鼻喉眼学报2014;28(5):58-61
14何苗,曹奎.雷珠单抗联合光动力疗法对湿性年龄相关性黄斑变性患者视觉功能、敏感度及血清VEGF含量的影响.海南医学院学报2016;22(17):2066-2068,2072
15 Holz FG,Dugel PUL,Weissgerber G,et al.Single chain anti body fragment VEGF inhibitor RTH258 for neovascul:age related macular degeneration:A Randomized controlled study.Ophthalmology 2016;123(5):1080-1089
16洪勇,袁苓,罗娜,等.雷珠单抗玻璃体腔注射辅助显微手术治疗对新生血管性青光眼患者血管内皮生长因子和血小板衍生生长因子含量的影响.血栓与止血学2017;23(6):975-977
17陈烨,李薇薇,于小蕊,等.渗出型年龄相关性黄斑变性患者血清新生血管调控细胞因子水平变化及意义.中华实用诊断与治疗杂志2015;29(6):568-570
2王翠,赵博军.年龄相关性黄斑变性的治疗进展.眼科新进展2016;36(5):489-493
3 Thompson RB,Reffatto V,Bundy JQ,et al.Identification of hydroxyapatite spherules provides new insight into subretinal pigment epithelial deposit formation in the aging eye.Proc Natl Acad Sci USA2015;112(5):1565-1570
4中华医学会眼科学分会眼底病学组中国老年性黄斑变性临床指南与临床路径制订委员会.中国老年性黄斑变性临床诊断治疗路径.中华眼底病杂志2013;29(4):343-355
5 Schmid MK,Bachmann LM,Fas L,et al.Efficency and adverse events of aflibercept,ranibizumab and bevacizumab in age-related macular degeneration:a trade-off analysis.Br J Ophthalmol 2015;99(2):141-146
6李娜,孙先勇.年龄相关性黄斑变性的发病机制及治疗研究现状.中国全科医学2016;16(9):724-728
7Knickelbein JE,Chew EY,Sen HV.Intraocular inflammation following intravitreal injection of anti-VEGF Medications for veovascul:agerelated macular egeneration.Ophthalmic Epidemiol 2016;23(2):69-70
8毕延峰.雷珠单抗眼内注射治疗湿性老年黄斑变性的视力变化对比分析.中国实用医药2015;10(1):117-119
9余试,陈长征,易佐慧子.玻璃体腔注射康柏西普治疗渗出型老年性黄斑变性的疗效观察.中华眼底病杂志2015;31(3):256-259
10 Owsley C,Clark ME,Huisingh CE,et al.Visual function in older eyesin vormal macular health:association with incident early agerelated macular degeneration 3 years later.Invest Ophthalmol Vis Sci2016;57(4):1782-1789
11胡军平,杨华,李国栋,等.光动力疗法联合玻璃体内注射雷珠单抗治疗湿性年龄相关性黄斑变性后黄斑区中心视野的改变.眼科新进展2015;35(11):1039-1043
12徐奕爽,戚沆,易佐慧子,等.光动力联合玻璃体腔注射雷珠单抗治疗息肉样脉络膜血管病变疗效观察.中国实用眼科杂志2015;33(9):1054-1058
13龚斌,范传峰,王玉.抗VEGF药物(雷珠单抗)治疗不同病程湿性年龄相关性黄斑变性62例.山东大学耳鼻喉眼学报2014;28(5):58-61
14何苗,曹奎.雷珠单抗联合光动力疗法对湿性年龄相关性黄斑变性患者视觉功能、敏感度及血清VEGF含量的影响.海南医学院学报2016;22(17):2066-2068,2072
15 Holz FG,Dugel PUL,Weissgerber G,et al.Single chain anti body fragment VEGF inhibitor RTH258 for neovascul:age related macular degeneration:A Randomized controlled study.Ophthalmology 2016;123(5):1080-1089
16洪勇,袁苓,罗娜,等.雷珠单抗玻璃体腔注射辅助显微手术治疗对新生血管性青光眼患者血管内皮生长因子和血小板衍生生长因子含量的影响.血栓与止血学2017;23(6):975-977
17陈烨,李薇薇,于小蕊,等.渗出型年龄相关性黄斑变性患者血清新生血管调控细胞因子水平变化及意义.中华实用诊断与治疗杂志2015;29(6):568-570