湿性老年性黄斑变性病人视网膜血流的变化对预后判定的指导价值
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摘要
目的:探讨湿性老年性黄斑变性病人视网膜血流的变化对预后判定的指导价值。方法:选择湿性老年性黄斑变性病人72例(72眼)作为观察组,同期选择健康体检的老年人72名(72眼)作为对照组,对照组在体检时进行视网膜血流检测;观察组均给予玻璃体腔注射曲雷珠单抗治疗,在治疗前后进行视网膜血流的超声检测,观察预后情况。结果:观察组治疗后患眼动脉和视网膜中央动脉的舒张末期血流速度和收缩期峰值血流速度均明显高于治疗前(P<0.05～P<0.01),与对照组比较差异均无统计学意义(P>0.05);观察组治疗前后的阻力指数与对照组比较差异均无统计学意义(P>0.05)。观察组治疗后的最佳矫正视力明显好于治疗前(P<0.01);治疗期间的并发症发生率为6.9%,经过对症处理后均好转。直线相关分析显示患眼动脉和视网膜中央动脉的舒张末期血流速度和收缩期峰值血流速度均与预后视力状况呈负相关关系(P<0.05)。结论:湿性老年性黄斑变性病人视网膜的血流速度均明显降低,雷珠单抗注射液的应用治疗能有效改善视力与视网膜血流状况,同时视网膜的血流速度变化对病人疗效评估具有较重要的临床价值。
Objective:To investigate the value of the retinal blood flow change in evaluating the prognosis of patients with wet age-related macular degeneration.Methods:Seventy-two patients with wet age-related macular degeneration(72 eyes) and 72 healthy elderly(72 eyes) were divided into the observation group and control group,respectively.The vitreous chamber in observation group was injected with ranibizumab.The retinal blood flow levels in observation group before and after treatment,which in control group were observed using the ultrasound the physical examination.Results:The diastolic velocity and peak systolic velocity of ophthalmic artery and central retinal artery in observation group after treatment were significantly higher than before treatment(P<0.05 to P<0.01),and the difference of which between two groups was not statistically significant(P>0.05).The differences between the resistance index in observation group before and after treatment,and resistance index in control group were not statistically significant(P>0.05).The best corrected visual acuity in observation group after treatment was significantly better than before treatment(P<0.01).The incidence rate of complications during treatment was 6.9%,and the complication was improved after symptomatic treatment.Linear correlation analysis showed that the diastolic velocity,peak systolic velocity of ophthalmic artery and central retinal artery were negatively correlated with the vision of prognosis(P<0.05).Conclusions:The retinal blood flow velocity in patients with wet age-related macular degeneration significantly decreases,the ranibizumab injection can effectively improve the vision and retinal blood flow of patients,and the change of retinal blood flow velocity has an important value on assessing the prognosis of patients in clinic.
Objective:To investigate the value of the retinal blood flow change in evaluating the prognosis of patients with wet age-related macular degeneration.Methods:Seventy-two patients with wet age-related macular degeneration(72 eyes) and 72 healthy elderly(72 eyes) were divided into the observation group and control group,respectively.The vitreous chamber in observation group was injected with ranibizumab.The retinal blood flow levels in observation group before and after treatment,which in control group were observed using the ultrasound the physical examination.Results:The diastolic velocity and peak systolic velocity of ophthalmic artery and central retinal artery in observation group after treatment were significantly higher than before treatment(P<0.05 to P<0.01),and the difference of which between two groups was not statistically significant(P>0.05).The differences between the resistance index in observation group before and after treatment,and resistance index in control group were not statistically significant(P>0.05).The best corrected visual acuity in observation group after treatment was significantly better than before treatment(P<0.01).The incidence rate of complications during treatment was 6.9%,and the complication was improved after symptomatic treatment.Linear correlation analysis showed that the diastolic velocity,peak systolic velocity of ophthalmic artery and central retinal artery were negatively correlated with the vision of prognosis(P<0.05).Conclusions:The retinal blood flow velocity in patients with wet age-related macular degeneration significantly decreases,the ranibizumab injection can effectively improve the vision and retinal blood flow of patients,and the change of retinal blood flow velocity has an important value on assessing the prognosis of patients in clinic.
引文
[1] 张崖冰,胡善联,常精华.湿性老年性黄斑变性的疾病负担研究[J].中国卫生经济,2015,34(1):63.
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[3] 余岚,陈长征,易佐慧子,等.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[J].中华眼底病杂志,2015,31(3):256.
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[9] 黎晓新,白玉婧.重视Müller细胞在糖尿病视网膜病变中作用的基础研究[J].中华眼科杂志,2015,51(5):321.
[10] 沈琪敏,姚克,施晓琴.拉坦前列腺素联合马来酸噻吗洛尔对原发性开角型青光眼患者24 h眼压及眼血流的影响[J].中国现代医生,2015,53(5):74.
[11] KIRCHHOF B.The diseased vitreous body:malformations,developmental disorders and opacities[J].Ophthalmologe,2015,112(7):559.
[12] 刘冉,杨宇,韦春宜,等.老年性黄斑变性易感基因2单核苷酸多态性与息肉样脉络膜血管病变相关性的系统评价与meta分析[J].中华眼底病杂志,2014,30(3):299.
[13] GHANY AF,BOTROS SM,EL-RAGGAL TM.Central retinal artery resistive index and optical coherence tomography in assessment of glaucoma progression[J].Int J Ophthalmol,2015,8(2):305.
[14] 陈霄雅,赵跃华,崔建萍.利用彩色多普勒血流显像技术评价不同药物对原发性开角型青光眼视功能的保护作用[J/CD].中华眼科医学杂志(电子版),2015,1(26):32.
[15] 廖婕,葛蓁.雷珠单抗治疗湿性老年性黄斑变性临床观察[J].中国伤残医学,2015,4(13):108.
[16] WANG J,ZHAO M,LI SJ,et al.Retinal artery lesions and long-term outcome in Chinese patients with acute coronary syndrome[J].Eye (Lond),2015,29(5):643.
[17] SHCHUKO AG,ZLOBIN IV,IUR'EVA TN,et al.Comprehensive assessment of risk factors for retinal vein occlusion and derivation of classification criteria for retinal ischemia[J].Vestn Oftalmol,2014,130(5):54.
[18] 邵嘉涛,李萍,王海波,等.不同程度颈内动脉狭窄对患者眼部缺血表现及视网膜中央动脉和眼动脉血流动力学的影响[J].中华眼底病杂志,2015,31(1):49.
[2] 戚沆,陈长征.影响渗出型老年性黄斑变性患者玻璃体腔注射雷珠单抗治疗反应的临床特征与基因因素[J].中华眼底病杂志,2015,31(1):95.
[3] 余岚,陈长征,易佐慧子,等.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[J].中华眼底病杂志,2015,31(3):256.
[4] 王文吉.湿性老年性黄斑变性伴视网膜下出血的处理[J].中国眼耳鼻喉科杂志,2015,15(2):75.
[5] ABDELFATTAH NS,AMGAD M,SALAMA AA,et al.Development of an Arabic version of the National Eye Institute Visual Function Questionnaire as a tool to study eye diseases patients in Egypt[J].Int J Ophthalmol,2014,7(5):891.
[6] 赵莼,王方,陈磊,等.玻璃体腔注射雷珠单抗治疗渗出型老年性黄斑变性伴浆液性视网膜色素上皮脱离的疗效观察[J].中华眼底病杂志,2015,31(1):27.
[7] 杜宇翔,郭大东,司俊康,等.贝伐单抗和雷珠单抗治疗渗出型老年性黄斑变性有效性meta分析[J].中华眼底病杂志,2014,30(3):304.
[8] ZHANG M,ZHANG J,YAN M,et al.Recombinant anti-vascular endothelial growth factor fusion protein efficiently suppresses chofidal neovasularization in monkeys[J].MOL Vis,2008,14(6):37.
[9] 黎晓新,白玉婧.重视Müller细胞在糖尿病视网膜病变中作用的基础研究[J].中华眼科杂志,2015,51(5):321.
[10] 沈琪敏,姚克,施晓琴.拉坦前列腺素联合马来酸噻吗洛尔对原发性开角型青光眼患者24 h眼压及眼血流的影响[J].中国现代医生,2015,53(5):74.
[11] KIRCHHOF B.The diseased vitreous body:malformations,developmental disorders and opacities[J].Ophthalmologe,2015,112(7):559.
[12] 刘冉,杨宇,韦春宜,等.老年性黄斑变性易感基因2单核苷酸多态性与息肉样脉络膜血管病变相关性的系统评价与meta分析[J].中华眼底病杂志,2014,30(3):299.
[13] GHANY AF,BOTROS SM,EL-RAGGAL TM.Central retinal artery resistive index and optical coherence tomography in assessment of glaucoma progression[J].Int J Ophthalmol,2015,8(2):305.
[14] 陈霄雅,赵跃华,崔建萍.利用彩色多普勒血流显像技术评价不同药物对原发性开角型青光眼视功能的保护作用[J/CD].中华眼科医学杂志(电子版),2015,1(26):32.
[15] 廖婕,葛蓁.雷珠单抗治疗湿性老年性黄斑变性临床观察[J].中国伤残医学,2015,4(13):108.
[16] WANG J,ZHAO M,LI SJ,et al.Retinal artery lesions and long-term outcome in Chinese patients with acute coronary syndrome[J].Eye (Lond),2015,29(5):643.
[17] SHCHUKO AG,ZLOBIN IV,IUR'EVA TN,et al.Comprehensive assessment of risk factors for retinal vein occlusion and derivation of classification criteria for retinal ischemia[J].Vestn Oftalmol,2014,130(5):54.
[18] 邵嘉涛,李萍,王海波,等.不同程度颈内动脉狭窄对患者眼部缺血表现及视网膜中央动脉和眼动脉血流动力学的影响[J].中华眼底病杂志,2015,31(1):49.