康柏西普治疗增生性糖尿病视网膜病变

doi:10.6040/j.issn.1673-3770.0.2018.005

摘要/Abstract

摘要： 目的探讨术前预防性康柏西普玻璃体腔注射对增生性糖尿病视网膜病变(PDR)手术效果的影响,并分析预后的影响因素。方法对2015年1月至2017年6月接受玻璃体切割术的40例(54眼)PDR患者进行回顾性分析。将术前应用康柏西普玻璃体注射的20例(26眼)为治疗组,未应用康柏西普的20例(28眼)为对照组,对比两组手术及预后效果。根据视力改善效果测评预后,通过单因素及多因素分析分析预后的影响因素。结果治疗组手术时间短于对照组,医源性破孔、术中出血、术中电凝、硅油填充患眼数少于对照组,差异均有统计学意义。术前两组黄斑厚度对比,差异无统计学意义;术后治疗组黄斑厚度小于对照组,差异有统计学意义。两组视网膜复位率、术后玻璃体再积血率、术后视力恢复效果对比,差异均无统计学意义。较高的术前糖化血红蛋白水平、较高的术前黄斑厚度是患者预后的独立危险因素。结论术前预防性康柏西普玻璃体腔注射,能够提升PDR患者玻璃体切割术效果减少术中并发症,但该措施对患者视力恢复无明显影响。

关键词: 糖尿病视网膜病变, 玻璃体切割术, 康柏西普, 新生血管

Abstract: Objective To investigate the effect of preoperative prophylactic injection of conbercept into the vitreous cavity on proliferative diabetic retinopathy(PDR)and to analyze the factors influencing prognosis. Methods A retrospective analysis was performed on 40 patients(54 eyes)with PDR who underwent vitrectomy from January 2015 to June 2017. Of these, 20 patients(26 eyes, the observation group)received preoperative prophylactic intravitreal injection of conbercept and 20(28 eyes)without treatment were in the control group. The surgical outcomes and prognosis were compared between the 2 groups. Prognosis was evaluated according to the effect on visual improvement, and prognostic factors were analyzed using single and multiple factor analysis. Results The duration of surgery in the observation group was much shorter than in the control group. The incidence of iatrogenic perforation or intraoperative bleeding and the need for intraoperative electrocoagulation or silicone oil filling were much less in the observation group than in the control group, and the differences were statistically significant. There was no significant difference in macular thickness between the 2 groups before surgery. After surgery, the macular thickness in the observation group was much less than that in the control group, with a statistically significant difference. There was no significant difference between the 2 groups in the rate of retinal repositioning, postoperative vitreous reaccumulation, and recovery of visual acuity. Higher preoperative glycated hemoglobin levels and higher preoperative macular thickness were independent risk factors for prognosis. Conclusion Preoperative prophylactic intravitreal injection of conbercept can improve the effect of vitrectomy for PDR patients, and can help reduce complications. However, this measure had no obvious effect on recovery of visual acuity.

Key words: Diabetic retinopathy, Vitrectomy, Conbercept, Neovascularization

中图分类号:

R587.2

刘万智,陈珺,樊长春. 康柏西普治疗增生性糖尿病视网膜病变[J]. 山东大学耳鼻喉眼学报, 2018, 32(6): 88-91.

LIU Wanzhi, CHEN Jun, FAN Changchun. Clinical study of conbercept in the treatment of proliferative diabetic retinopathy[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(6): 88-91.

参考文献

[1] Heng LZ, Comyn O, Peto T, et al. Diabetic retinopathy: pathogenesis, clinical grading, management and future developments[J]. Diabet Med, 2013, 30(6): 640-650.
[2] Dyer KH, Silva PS, Sun JK. Vascular endothelial growth factor gene polymorphisms and vitreous proteome changes in diabetic retinopathy [J]. Semin Ophthalmol, 2013, 28(5-6):347-354. DOI: 10.3109/08820538.2013. 825284.
[3] Min M, Department O. Clinical observation of the effect of chemotherapy in the treatment of advanced malignant tumor with the aid of Shen Mai Injection[J]. Mineral Dep, 2015, 16(3):357-373.
[4] 中华医学会眼科学会眼底病学组. 我国糖尿病视网膜病变临床诊疗指南(2014年)[J].中华眼科杂志, 2014, 50(11):851-865.
[5] 周学义, 李一鸣, 王美菊, 等. 25+微创玻璃体视网膜手术联合玻璃体腔注射雷珠单抗治疗增生型糖尿病视网膜病变的临床观察[J]. 山东大学耳鼻喉眼学报,2017,31(4):87-89. ZHOU Xueyi, YI Yiming, WANG Meiju, et al. The application of 25-gauge minimally invasive vitreoretinal surgery combined with intravitreal ranibizumab injections in the treatment of proliferative diabetic retinopathy[J]. J Otolaryngol Ophthalmol Shandong Univ, 2017, 31(4):87-89.
[6] 周林, 李芳芳. 玻璃体腔注射康柏西普联合23G玻璃体切割手术治疗增生型糖尿病视网膜病变疗效观察[J]. 海南医学,2017,28(15):2458-2461. ZHOU Lin, LI Fangfang. Effect of intravitreal injection of Conbercept combined with 23G vitrectomy to treat proliferative diabetic retinopathy[J]. Hainan Med J, 2017, 28(15): 2458-2461.
[7] Writing Committee for the Diabetic Retinopathy Clinical Research Network, Gross JG, Glassman AR, et al. Panretinal photocoagulation vsintravitreous ranibizumab for proliferative diabetic retinopathy: a randomized clinical trial [J]. JAMA, 2015, 314(20):2137-2146.
[8] Abu El-Asrar AM, Nawaz MI, De Hertogh G, et al. The angiogenic biomarker endocan is upregulated inproliferative diabetic retinopathy and correlates with vascular endothelialgrowth factor [J]. Curr Eye Res, 2015, 40(3):321-331.
[9] 谢婷玉, 张萃丽, 陈雪艺. 臭氧对STZ诱导的糖尿病大鼠视网膜表达VEGF, HIF-1α与PEDF的影响[J]. 国际眼科杂志, 2016, 16(2):195-200. XIE Tingyu, ZHANG Cuili, CHEN Xueyi. VEGF, HIF-1α and PEDF expression in the retina of streptozotocin-induced diabetics rats treated with ozone[J]. Int Eye Sci, 2016, 16(2):195-200.
[10] Martinez-Zapata MJ, Martí-Carvajal AJ, Solà I, et al. Anti-vascular endothelial growth factor for proliferativediabetic retinopathy[J]. Cochrane Database Syst Rev, 2014, 11:CD008721. DOI:10.1002/14651858.CD008721.pub2.
[11] 赵抒羽, 梁先军, 林英杰, 等. 增生期糖尿病视网膜病变围手术期注射雷珠单抗的临床观察[J]. 临床眼科杂志,2014,22(3):237-240. ZHAO Shuyu, LIANG Xianjun, LIN Yingjie, et al. Pars plana vitrectomy assisted with lucentis for proliferative diabetic retinopathy[J]. J Clin Ophthalmol, 2014, 22(3):237-240.
[12] Yoshida I, Shiba T, Taniguchi H, et al. Evaluation of plasma vascular endothelial growth factor levels after intravitreal injection of ranibizumab and aflibercept for exudative age-related macular degeneration [J]. Graefes Arch Clin Exp Ophthalmol, 2014, 252(9):1483-1489.
[13] 薛鹏程, 游志鹏, 付书华, 等. 23G玻璃体切割术前、术中辅助玻璃体内注射康柏西普治疗增生型糖尿病视网膜病变(PDR)的疗效分析[J]. 眼科新进展,2017,37(5):458-462. XUE Pengcheng, YOU Zhipeng, FU Shuhua. Preoperative and intraoperative adjunctive intravitreal conbercept in 23G vitrectomy for proliferati[J]. Recent Adv Ophthalmol, 2017, 37(5):458-462.
[13] 尹妮, 赵帅, 朱红娜, 等. 康柏西普预处理联合玻璃体切割术治疗增生型糖尿病视网膜病变[J]. 眼科新进展,2017,37(8):770-772. YI Ni, ZHAO Shuai, ZHU Hongna, et al. Conbercept pre-treatment combined with vitrectomy for proliferative diabetic retinopathy[J]. Recent Adv Ophthalmol, 2017, 37(8):770-772.
[14] 李建军, 张英辉, 王秀超, 等. 康柏西普眼用注射液辅助玻璃体切除术治疗进展型增殖期糖尿病性视网膜病变的临床效果[J]. 临床和实验医学杂志,2016,15(17):1730-1733. LI Jianjun, ZHANG Yinghui, WANG Xiuchao, et al. The clinical effect of compaq SEPR assisted vitrectomy for the treatment of diabetic retinopathy[J]. J Clin Exp Med, 2016, 15(17):1730-1733.

相关文章 15

[1]	郭宝,张德勇. 康柏西普联合激光治疗急进性早产儿视网膜病变[J]. 山东大学耳鼻喉眼学报, 2018, 32(6): 92-97.
[2]	周学义,李一鸣,王美菊,张苑苑,张历浊. 25+微创玻璃体视网膜手术联合玻璃体腔注射雷珠单抗治疗增生型糖尿病视网膜病变的临床观察[J]. 山东大学耳鼻喉眼学报, 2017, 31(4): 87-89.
[3]	周玮琰,王洪亚,杜秀娟,董卫红. 甘糖酯对糖尿病大鼠视网膜病变中血管生成因子VEGF表达的影响[J]. 山东大学耳鼻喉眼学报, 2017, 31(2): 90-95.
[4]	王旭川,盛艳娟,王玉. 非外伤性玻璃体积血的病因及手术疗效分析[J]. 山东大学耳鼻喉眼学报, 2017, 31(1): 107-109.
[5]	严晓腾,冯军,康欣乐. 玻璃体腔注射康柏西普治疗视网膜静脉阻塞继发黄斑水肿的临床观察[J]. 山东大学耳鼻喉眼学报, 2016, 30(4): 105-108.
[6]	邵娜,张晗. 糖尿病患者行白内障超声乳化术后视力及眼底的变化[J]. 山东大学耳鼻喉眼学报, 2016, 30(1): 83-87.
[7]	邢凯,亢泽峰. 玻璃体腔内注射康柏西普治疗视网膜分支静脉阻塞继发黄斑水肿的疗效分析[J]. 山东大学耳鼻喉眼学报, 2016, 30(1): 80-82.
[8]	李俊英. 瑞舒伐他汀联合非诺贝特对老年糖尿病视网膜病变患者血管内皮功能的影响[J]. 山东大学耳鼻喉眼学报, 2015, 29(5): 72-75.
[9]	杜祥阁, 张营春, 颜昕, 王翠, 赵博军. 下调血管内皮细胞蛋白激酶CK2表达对血管增殖影响的体外研究[J]. 山东大学耳鼻喉眼学报, 2015, 29(3): 76-80.
[10]	柴雪荣, 张士玺, 陶钰, 申家泉. 玻璃体腔注射雷珠单抗联合小梁切除术及全视网膜光凝治疗新生血管性青光眼的效果评价[J]. 山东大学耳鼻喉眼学报, 2015, 29(3): 72-75.
[11]	张营春, 杜祥阁, 颜昕, 王翠, 赵博军. 尼古丁对人RPE细胞及HUVEC的影响[J]. 山东大学耳鼻喉眼学报, 2015, 29(2): 74-80.
[12]	刘志高, 颜世龙, 胡尊霞, 孙同鑫, 杨明, 王玉. 济南市农村白内障患者糖尿病及糖尿病视网膜眼底病变患病率调查分析[J]. 山东大学耳鼻喉眼学报, 2015, 29(1): 38-39.
[13]	马栋, 郭承伟. 络治法对STZ诱导的糖尿病大鼠视网膜血管消化铺片中VCAM-1表达的影响[J]. 山东大学耳鼻喉眼学报, 2015, 29(1): 64-68.
[14]	刘海洋, 李甦雁, 张正培, 范巍. 改良膜分割与双手膜清除技术在23G玻璃体手术治疗增殖性糖尿病视网膜病变中的对比[J]. 山东大学耳鼻喉眼学报, 2015, 29(1): 52-55.
[15]	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[J]. 山东大学耳鼻喉眼学报, 2014, 28(5): 58-61.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed