摘要
目的探讨康柏西普辅助治疗增殖性糖尿病视网膜病变(PDR)患者术前用药时机及对新生血管膜血管内皮生长因子(VEGF)的影响。方法将90例(90眼)行玻璃体切割术(PPV)的PDR患者采用随机数字表法分为A、B、C组,每组各30例,A组术前不经玻璃体注射康柏西普,B组术前3 d玻璃体注射康柏西普,C组术前5 d给予玻璃体注射康柏西普,比较3组手术情况、视力水平、房水VEGF浓度及新生血管膜VEGF阳性表达率。结果 A组2例受试者自愿退出研究,实际纳入28例,B组、C组无脱落病例。3组术中医源性裂孔及术后一过性高眼压、前房积血发生率比较,差异无统计学意义(P> 0. 05),B组、C组手术时间短于A组,电凝次数少于A组,术后3个月LogMAR BCVA(国际标准视力表)低于A组,差异均有统计学意义(P <0. 05); B组、C组玻璃体注射前VEGF浓度比较,差异无统计学意义(P> 0. 05),PPV时房水VEGF浓度显著下降(P <0. 05),B组、C组PPV时房水VEGF浓度低于A组(P <0. 05),PPV时新生血管膜VEGF总阳性表达率分别为76. 67%、73. 33%,低于A组的100. 0%,差异均有统计学意义(P <0. 05); B组、C组玻璃体再出血率分别为6. 67%、10. 0%,明显低于A组的32. 14%,差异有统计学意义(P <0. 05),但B组与C组上述指标比较差异无统计学意义(P> 0. 05)。结论 PDR患者行PPV术前玻璃体注射康柏西普可降低房水VEGF浓度及新生血管膜VEGF阳性表达率,显著改善视力水平,降低术后并发症发生率,且术前3、5 d行玻璃体注射的效果基本一致。
Objective To investigate the timing of administration of Conbercept in the treatment of proliferative diabetic retinopathy (PDR)before operation and its effect on neovascularization vascular endothelial growth factor (VEGF).Methods 90 patients (90 eyes)with PDR who underwent vitrectomy (PPV)were randomly divided into groups A,B and C ,with 30 cases in each group.Group A received no intravitreal injection of Conbercept before operation,group B received intravitreal injection of Conbercept 3 days before operation,and group C received intravitreal injection of Conberce.pt 5 days before operation.The operation condition,visual acuity level,concentration of vascular endothelial growth factor in aqueous humor and positive expression of vascular growth factor in neovascularization membrane were compared in the three groups.Results There was no significant difference in the incidence of iatrogenic hiatus during operation, transient high intraocular pressure and hyphema after operation in the three groups (P >0.05 ).Compared with group A,group B and C had shorter the operation time ,less electrocoagulation,lower LogMAR BCVA (best corrected visual acuity)three months after operation (P <0.05 ).There was no significant difference in the concentration of vascular endothelial growth factor between group B and group C before vitreous injection (P >0.05 ).The expression of VEGF in aqueous humor of group B and group C was lower than that of group A (P <0.05 ),and the total positive expression rate of VEGF in neovascularization membrane of group B and group C was 76.67% and 73.33% respectively,lower than that of group A (100.0%,P < 0.05).The vitreous re-bleeding of group B and group C was 6.67%and 10.0%,lower than that of group A (32.14%,P <0.05).While there was no significant difference between group B and group C (P > 0.05).Conclusions Vitreous injection of Conbercept before PPV in PDR patients can reduce the concentration of VEGF in aqueous humor and the positive expression rate of VEGF in neovascularization membrane,significantly improve visual acuity and reduce the incidence of postoperative complications.The effect of vitreous injection 3 and 5 days before PPV is basically the same.
作者
文晓霞
谭德文
李红军
刘有娅
蒋小均
方腾
Wen Xiaoxia;Tan Dewen;Li Hongjun;Liu Youya;Jiang Xiaojun;Fang Teng(Department of Ophthalmology,the People's Hospital of Kaizhou District,Chongqing 405400,China)
出处
《中国医师杂志》
CAS
2019年第1期89-93,共5页
Journal of Chinese Physician
