雷珠单抗对增殖性糖尿病视网膜病变眼部VEGF家族及玻璃体切割术的影响

发布时间：2018-07-23 08:35

【摘要】：目的:观察玻璃体腔注射雷珠单抗(IVR)对增殖性糖尿病视网膜病变(PDR)患者房水、玻璃体液及增殖膜中血管内皮生长因子(VEGF)-A、VEGF-B和胎盘生长因子(PIGF)表达及对玻璃体切割术的影响。方法:选取临床确诊PDR患者60例60只眼纳入研究,随机分为单纯玻璃体切割手术(PPV)组和IVR联合PPV组,各30只眼。单纯手术治疗组眼于PPV手术时抽取房水、玻璃体液及剥离增殖膜;联合药物治疗组眼于IVR治疗前抽取房水及IVR治疗7天后联合PPV抽取房水、玻璃体液及剥离增殖膜;采用酶联免疫吸附测定(ELISA)法检测房水、玻璃体液中VEGF-A、VEGF-B及PIGF含量;组织化学染色测定增殖膜中VEGF-A、VEGF-B及PIGF水平;苏木素-伊红染色(HE染色)观察增殖膜中血管数目;观察两组手术时间、术中出血严重程度。结果:联合药物治疗组IVR治疗后较治疗前房水中VEGF-A含量明显降低,差异有统计学意义(P0.05);联合药物治疗组IVR治疗前后房水中VEGF-B、PIGF含量比较差异无统计学意义(P0.05)。联合药物治疗组(IVR术后)房水、玻璃体液及增殖膜中VEGF-A含量较对照组明显降低,差异有统计学差异(P0.05)。联合药物治疗(IVR术后)较单纯手术治疗组房水、玻璃体液及增殖膜中VEGF-B及PIGF含量无明显变化,差异无统计学意义(P0.05)。与单纯手术治疗组比较,联合药物治疗组增殖膜中血管数目、术中出血严重程度、手术时间明显降低,差异有统计学意义(P0.05)。结论:玻璃体腔注射雷珠单抗明显降低PDR患者房水、玻璃体液及增殖膜中VEGF-A含量并使增殖膜中血管数目明显减少,减少手术时间、减轻术中出血严重程度,提高PPV手术的安全性,雷珠单抗可以降低房水、玻璃体液及增殖膜中VEGF-B及PIGF含量但没有统计学意义。
[Abstract]:Aim: to investigate the effects of intravitreous injection of Lei Zhu McAb (IVR) on the expression of vascular endothelial growth factor (VEGF) and placental growth factor (PIGF) in aqueous humor, vitreous fluid and proliferative membrane of patients with proliferative diabetic retinopathy (PDR) and vitrectomy. Methods: 60 cases (60 eyes) of PDR were randomly divided into simple vitrectomy (PPV) group and IVR combined PPV group (30 eyes each). Aqueous humor, vitreous fluid and exfoliation of proliferative membrane were extracted from eyes of simple operation group during PPV operation, and aqueous humor, vitreous fluid and stripping of proliferative membrane were extracted from eyes of combined drug treatment group before IVR treatment and 7 days after IVR treatment. The contents of VEGF-B and PIGF in aqueous humor and vitreous fluid were detected by enzyme-linked immunosorbent assay (Elisa), the levels of VEGF-B and PIGF in proliferative membrane were detected by histochemical staining, and the number of blood vessels in proliferative membrane was observed by hematoxylin eosin staining (HE staining). The time of operation and the severity of intraoperative bleeding were observed. Results: the content of VEGF-A in aqueous humor of the combined drug treatment group was significantly lower than that before and after treatment (P0.05), but there was no significant difference between the two groups before and after IVR treatment (P0.05). The content of VEGF-A in aqueous humor, vitreous fluid and proliferative membrane in the combined drug therapy group (IVR postoperative) was significantly lower than that in the control group (P0.05). The contents of VEGF-B and PIGF in aqueous humor, vitreous fluid and proliferative membrane in IVR group were not significantly changed compared with those in simple operation group (P0.05). Compared with the simple operation group, the number of blood vessels in the proliferative membrane, the severity of intraoperative bleeding and the operation time in the combined drug group were significantly lower than those in the control group (P0.05). Conclusion: injection of Leizhu McAb into vitreous body cavity can significantly reduce the content of VEGF-A in aqueous humor, vitreous fluid and proliferative membrane in PDR patients, reduce the number of blood vessels in proliferative membrane, reduce the operation time and reduce the severity of intraoperative bleeding. In order to improve the safety of PPV, the content of VEGF-B and PIGF in aqueous humor, vitreous body fluid and proliferative membrane were decreased by Leizhu McAb, but there was no significant difference in the content of VEGF-B and PIGF.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2;R779.6

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