康柏西普辅助微创玻璃体视网膜手术治疗严重增生性糖尿病视网膜病变的临床研究

发布时间：2018-04-29 17:13

本文选题：严重增生性糖尿病视网膜病变 + 康柏西普　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的观察微创玻璃体视网膜手术(VRS)不同时机玻璃体腔内注射抗血管内皮生长因子(vascular endothelial growth factor,VEGF)药物康柏西普(intravitreal conbercept,IVC)对严重增生性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)的临床疗效。探索VRS术前及术中注射抗VEGF药物的临床适应症。方法1、前瞻性非随机临床对照研究方法。选取2014年12月至2016年3月天津市眼科医院收治的严重PDR共112例(120只眼)纳入研究。根据患者眼部及全身情况分为拟术前注药组和拟术中注药组。告知所有患者IVC的治疗目的及风险,由患者决定是否注药。按照两组IVC与否和时间分为术前注药组及相应对照组1,术中注药组及相应对照组2。术前注药组于VRS术前3-7天行IVC,然后行23G微创VRS;术中注药组于23G微创VRS术毕行IVC,两组conbercept用量均为0.05ml;两对照组均仅行23G VRS。2、对比分析两注药组与对照组术后一过性高眼压、早晚期玻璃体积血(vitreous hemorrhage,VH)、视网膜前增殖膜及牵拉性视网膜脱离(tractional retinal detachment,TRD)、新生血管性青光眼(neovascular glaucoma,NVG)等并发症,术后黄斑中心凹视网膜厚度(central retinal thickness,CRT)、最小分辨角对数(logMAR)最佳矫正视力(best corrected visual acuity,BCVA)情况。3、应用SPSS21.0软件对所有数据进行统计分析。经正态性检验和方差齐性检验,计量资料采用(均数±标准差)表示,使用独立样本t检验;计数资料使用Personχ2检验、连续性校正χ2检验或Fisher精确检验。术后log MAR BCVA采用重复测量两因素方差分析。以α=0.05为检验水准,P0.05为有统计学差异。结果1、术前基本情况术前注药组及其对照组1、术中注药组及其对照组2性别、年龄、糖尿病病程、高血压史、PDR分期、视网膜激光光凝史、logMAR BCVA、眼压比较,均无统计学差异(P0.05)。术前注药组与术中注药组平均年龄分别为(49.27±8.45)、(57.32±6.25)岁,差异有统计学意义(t=-4.00,P0.05)。两注药组平均糖尿病病程分别为(6.58±3.10)、(9.96±3.35)年,有统计学差异(t=-3.85,P0.05)。两组PDRⅤ期和Ⅵ期分别有25/5,18/12只眼,有统计学差异(χ2=4.02,P0.05)。2、术后并发症统计结果两注药组与其相应对照组术后早期VH发生率相比,注药组早期VH发生率低于其相应对照组,有统计学差异(χ2=4.71,4.63,P0.05)。两注药组晚期VH与相应对照组相比均无显著统计学差异(χ2=0.27,0.00,P0.05)。两注药组与相应对照组术后一过性高眼压、视网膜前增殖膜、NVG等并发症情况,差异均无统计学意义(P0.05)。术前注药组和术中注药组术后一过性高眼压,早、晚期VH发生率,视网膜前增殖膜,NVG等并发症相比,差异均无统计学意义(P0.05)。3、logMAR BCVA、CRT变化情况两注药组与其相应对照组两次CRT测量平均下降幅度相比,注药组均明显低于对照组,差异有统计学意义(t=-3.04,-4.14,P0.05)。不同时间点logMAR BCVA呈现显著的随时间变化趋势(F时间=177.71,133.20,P0.05)。组间比较,注药组术后6个月logMAR BCVA均比其相应对照组同期显著改善,差异有统计学意义(F=4.86,4.26,P0.05)。两注药组术后1周、术后1个月CRT及两者下降幅度相比,差异均无统计学意义(t=-0.38,0.50,1.42,P0.05)。不同时间点logMAR BCVA呈现显著的随时间变化趋势(F时间=195.25,P0.05),组间无明显统计学差异(F=0.47,P0.05)。结论1、康柏西普辅助23G微创VRS治疗严重PDR安全有效,可减少术后早期出血,减轻黄斑水肿,提高术后视力。2、对于新生血管活跃或范围较大的PDR患者,可选择VRS术前注射抗VEGF药物;而对于新生血管部分消退尤其是伴有陈旧性TRD的患眼,可选择术中注射抗VEGF药物。3、康柏西普可抑制术后新生血管的生成,减轻黄斑水肿,在病人知情同意的情况下,可作为辅助VRS的有效选择。4、VRS不同时机注射抗VEGF药物的适应症目前尚无定论,术前和术中注药各有利弊,应综合考虑患者眼部及全身情况采取相应手术方式。
[Abstract]:Objective To observe the clinical efficacy of intravitreous injection of anti - vascular endothelial growth factor ( IVC ) in patients with severe proliferative diabetic retinopathy ( PDR ) . There was no statistical difference between the two groups ( 49.27 卤 8.45 ) , ( 57.32 卤 6.25 ) years old and the difference was statistically significant ( t = - 4.00 , P0.05 ) . The mean diabetic duration of the two groups was ( 6.58 卤 3.10 ) and ( 9.96 卤 3.35 ) years , respectively ( t = - 3.85 , P0.05 ) . Compared with the control group , there was no significant difference between the two groups ( 蠂2 = 4.71 , 4.63 , P0.05 ) . There was no significant difference between the two groups ( 蠂2 = 4.71 , 4.63 , P0.05 ) . There was no significant difference in logMAR BCVA between the two groups ( F = - 0.38 , 0.50 , 1.42 , P0.05 ) . There was no significant difference in logMAR BCVA between the two groups ( F = - 0.38 , 0.50 , 1.42 , P0.05 ) . There was no significant difference between the two groups ( F = 0.47 , P0.05 ) . Conclusion : 1 . The treatment of acute PDR is safe and effective , which can reduce early postoperative hemorrhage , reduce macular edema and improve vision after operation .

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R779.6

【参考文献】