雷珠单抗与康柏西普对湿性年龄相关性黄斑变性的短期疗效对比

发布时间：2018-02-14 19:29

  本文关键词： 雷珠单抗 康柏西普 湿性年龄相关性黄斑变性 脉络膜新生血管　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:分析比较湿性年龄相关性黄斑变性患者玻璃体腔内分别注射雷珠单抗和康柏西普三个月内,患者黄斑中心凹处内界膜到基底膜的垂直距离(central macularthickness,CMT)的变化、视力变化、注射次数及其安全性的短期差异。为患者提供更有效的药物选择。方法:本文采取了回顾性对照研究方法,选取了 2015年1月至2017年2月就诊于大连医科大学附属第一医院并确诊为湿性年龄相关性黄斑变性的患者58例,58眼。根据患者选取的玻璃体腔注射药物不同,将患者分为R、C两组:R组:玻璃体腔注射雷珠单抗 IVR(IntravitrealRanibizumab),一次 0.5mg(0.05ml),30例,30眼;C组:玻璃体腔注射康柏西普眼用注射液IVC(Intravitrealconbercept),一次0.5mg(0.05ml),28例,28眼。按照按需1+PRN的方案治疗。收集入选患者的基本信息,包括性别、年龄、既往史,术前进行眼部荧光血管造影(fundus fluorescein angiography,FFA)或吲哚青绿血管造影(indocyanine green angiography,ICGA)及光学相干断层扫描(optical coherence tomography,OCT)确诊,收集视力用球镜和柱镜完全矫正(best corrected visual acuity,BCVA)、用裂隙灯及眼底镜检查眼前后节一般情况、非接触式眼压(intraocularpressure,IOP)检查,应用OCT检测患者CMT。分别检测并记录两组患者术前、第1次注射术后1w、1mo、2mo和3mo的BCVA、IOP、CMT值及注射次数。数据分析采用SPSS22.0统计软件,应用独立样本t检验、配对样本t检验等统计方法比较两组患者BCVA、CMT、注射次数组内及组间的差异,同时比较两组随访三个月内并发症的发生率。结果:本次研究共收集了 58例患者,共58只眼。其中R组30例(30只眼),男16例(16眼),女14例(14眼)。C组28例(28只眼),男11例(11眼),女17例(17眼)。第1次注射3个月后,R组平均BCVA(log MAR)从术前基线0.92±0.47提高到了 0.65±0.40。C组平均BCVA(logMAR)从术前基线0.96±0.48提高到了 0.73±0.38。采用配对样本T检验分别得出两组组内BCVA(log MAR)变化差异P0.05,两组内BCVA(logMAR)变化差异均具有统计学意义,说明两组平均BCVA较治疗前都有显著提高。R组平均CMT(μm)从术前基线503.63±188.64 下降到了 387.80± 164.84。C 组平均 CMT(μm)从术前基线 432.29±241.68下降到了 328.14±201.55。采用配对样本T检验分别得出两组组内平均CMT(μm)变化差异P0.05,两组内平均CMT(μm)变化差异均具有统计学意义,说明两组平均CMT(μm)较治疗前都有显著提高。R组平均IOP(mmHg)从术前基线16.37±2.82 下降到了 15.27±2.80。(C组平均 IOP(mmHg)从术前基线 16.04±2.38 下降到了 15.79±2.77。两治疗组组内采用配对样本T检验均得出P＞0.05,两组内IOP(mmHg)变化差异均无统计学意义。采用独立样本T检验两治疗组间术前的平均BCVA(logMAR)变化,差异无统计学意义(P0.05)。两治疗组间的平均CMT(μm)变化,差异无统计学意义(P0.05)。两治疗组组间采用独立样本T检验。第1次注射术后lw,平均BCVA(log MAR)变化(R组:0.81±0.40,C组:0.89±0.42,P=0.458),差异无统计学意义(P0.05);平均CMT(μm)变化(R组:435.47±179.93,C 组:377.04±193.95,P=0.239),差异无统计学意义(P＞0.05)。术后 1mo,平均 BCVA(log MAR)变化(R 组:0.75±0.42,C 组:0.84±0.43,P=0.425),差异无统计学意义(P0.05);平均CMT(μm)变化(R组:429.93± 199.11,C组:429.93±199.11,P=0.061),差异无统计学意义(P0.05)。术后 2mo,平均 BCVA(logMAR)变化(R 组:0.71±0.43,C 组:0.77±0.38,P=0.585),差异无统计学意义(P＞0.05);平均 CMT(μm)变化(R 组:411.27± 180.21,C 组:328.75± 191.76,P= 0.097),差异无统计学意义(P0.05)。术后3mo,平均BCVA(logMAR)变化(R 组:0.65±0.40,C 组:0.73±0.38,P=0.475)差异无统计学意义(P0.05);平均CMT(μm)变化(R组:387.80±164.84,C组:328.14±201.55,P=0.221),差异无统计学意义(P＞0.05)。随访3个月内两组平均注射次数(R组:2.83±0.38,C组:2.43±0.50,P=0.001),C组平均注射次数比R组少,差异具有统计学意义(P0.05)。随访3个月内R组出现短暂性眼压升高1例,R组30只眼术后第1天出现短暂性术眼眼压升高1例,并发症(或不良反应)发生机率为3.3%。C组28只眼术后出现球结膜下出血1例,并发症(或不良反应)发生机率为3.4%。所有在组患者均未出现孔源性视网膜脱离、医源性外伤性白内障、葡萄膜炎、头痛、血压升高等局部及全身并发症。结论:1.玻璃体内注射雷珠单抗或康柏西普对治疗湿性年龄相关性黄斑变性均有效。2.短期内玻璃体内注射雷珠单抗或康柏西普对治疗湿性年龄相关性黄斑变性的CMT及视力的变化无明显差异,但康柏西普注射次数更少。
[Abstract]:Objective: To compare the wet age-related macular degeneration patients were injected intravitreal ranibizumab and Compaq SEPR within three months, the vertical distance from the fovea with internal limiting membrane to the basement membrane (central macularthickness, CMT) changes, changes in vision, short-term differences in the number of injections and provide security. More effective drugs for patients. Methods: This paper adopts the method of retrospective study, from January 2015 to February 2017 in Dalian Medical University Hospital of wet age-related macular changes in 58 cases, the patients in the First Affiliated Hospital and were diagnosed in 58 eyes. According to the intravitreal injection of drugs were selected, the patients were divided into R. C two group: R group: intravitreal ranibizumab injection of IVR (IntravitrealRanibizumab), a 0.5mg (0.05ml), 30 cases, 30 eyes; group C: Intravitreal injection of Xipu ophthalmic injection IVC (Compaq Int Ravitrealconbercept), a 0.5mg (0.05ml), 28 cases, 28 eyes. According to the treatment of 1+PRN. According to the basic information, collect the patients including gender, age, medical history, preoperative ocular fundus fluorescein angiography (fundus fluorescein angiography, FFA) or indole green angiography (indocyanine green angiography, ICGA) and optical coherence tomography (optical coherence tomography, OCT) were collected with vision spherical and cylinder complete correction (best corrected visual acuity, BCVA), anterior and posterior section generally by slit lamp and ophthalmoscope examination, non-contact intraocular pressure (intraocularpressure, IOP), application of OCT detection in patients with CMT. were detected respectively. And record the two groups of patients before surgery and first after injection 1W, 1Mo, 2Mo and 3Mo, BCVA, IOP, CMT value and the number of injections. Data were analyzed by SPSS22.0 statistical software, using independent samples t test, paired samples t 妫，

本文编号：1511434