摘要
目的观察康柏西普治疗不同类型糖尿病黄斑水肿(DME)的疗效。方法回顾性临床研究。2019年3月至2021年3月于西安市第三医院眼科检查确诊的DME患者136例136只眼纳入研究。其中,男性65例,女性71例;平均年龄(56.65±8.65)岁。所有患者均行最佳矫正视力(BCVA)、光相干断层扫描(OCT)检查以及糖化血红蛋白(HbA1c)水平检测。采用糖尿病视网膜病变早期治疗研究视力表行BCVA检查,统计时换算为最小分辨角对数(logMAR)视力。采用OCT仪测量黄斑中心凹视网膜厚度(CRT)。依据OCT特征,将DME分为弥漫性黄斑水肿(DRT)型、囊样黄斑水肿(CME)型、浆液性视网膜脱离(SRD)型、混合型,并据此分组,分别为30、38、33、35只眼。4组患者年龄(F=1.189 )、性别构成比(χ^(2)=1.331)、HbA1c水平(F=3.164)比较,差异均无统计学意义(P>0.05)。所有患眼均行玻璃体腔注射10 mg/ml的康柏西普0.05 ml(含康柏西普0.5 mg)治疗,每一个月1次,连续3次,其后经评估按需治疗。治疗后1、3、6个月采用与治疗前相同的设备和方法行BCVA、OCT检查。对比观察患眼治疗前后的BCVA、CRT变化。服从正态分布的计量资料,组间比较行单因素方差分析;计数资料比较行χ^(2)检验。结果治疗前,DRT型组、CME型组、SRD型组、混合型组患眼logMAR BCVA分别为0.68±0.11、0.69±0.15、0.71±0.12、0.73±0.14,CRT分别为(631.4±50.7)、(640.6±55.7)、(652.3±63.4)、(660.4±61.8)μm。与治疗前比较,治疗后1、3、6个月,DRT型组(BCVA:t=8.139、11.552、11.672;CRT:t=16.163、21.653、25.855)、CME型组(BCVA:t=8.923、9.995、13.842;CRT:t=16.163、21.653、25.855)、SRD型组(BCVA:t=5.171、7.315、6.051;CRT:t=9.099、13.731、21.306 )、混合型组(BCVA:t=5.072、6.939、7.142;CRT:t=6.920、15.352、17.538)患眼BCVA均明显提高,CRT明显下降,差异均有统计学意义(P<0.05)。治疗后6个月,4组患眼logMAR BCVA、CRT比较,差异均有统计学意义(χ^(2)=58.478、64.228,P<0.05)。DRT型组、CME型组、SRD型组、混合型组患眼平均注射次数分别为(3.37±1.35)、(3.68± 1.38)、(4.18±1.40)、(4.13±1.50)次;4组患眼平均注射次数比较,差异有统计学意义(χ^(2)=9.139 ,P=0.028 )。结论康柏西普可有效降低不同类型DME患眼CRT,提高BCVA。与SRD型、混合型比较,DRT、CME型患眼视力改善更有效,CRT降低程度更大,注射次数更少。
Objective To observe the efficacy of conbercept in the treatment of different types of diabetic macular edema(DME).Methods A retrospective clinical study.From March 2019 to March 2021,136 eyes of 136 patients with DME diagnosed in Department of Ophthalmology of Xi'an No.3 Hospital were included in the study.Among them,there were 65 males and 71 females;the average age was 56.65±8.65 years.All patients underwent best corrected visual acuity(BCVA),optical coherence tomography(OCT)examination,and glycosylated hemoglobin level(HbAlc)examination.Early Treatment Diabetic Retinopathy Study visual acuity chart was used for BCVA examination,which was converted into the logarithmic minimum angle of resolution(logMAR)visual acuity during statistics.An OCT instrument was used to measure the central retinal thickness(CRT)of the macula.According to the characteristics of OCT,DME was divided into diffuse retinal thickening(DRT)type,cystoid macular edema(CME)type,serous retinal detachment(SRD)type,mixed type,and grouped accordingly,respectively,about 30,38,33,35 eyes.There was no significant difference in age(F=1.189),sex ratio(x^(2)=1.331),and HbAlc level(F=3.164)of the four groups of patients(P>0.05).All eyes were treated with intravitreal injection of 10 mg/ml conbercept 0.05 ml(including conbercept 0.5 mg)once a month for 3 consecutive times,and then treated as needed after evaluation.BCVA and OCT examinations were performed 1,3,and 6 months after treatment with the same equipment and methods as before treatment.The changes of BCVA and CRT before and after treatment were compared and observed.For measurement data subject to normal distribution,one-way analysis of variance was performed for comparison between groups;x^(2) test was performed for comparison of count data.Results Before treatment,the logMAR BCVA of the eyes in the DRT group,CME group,SRD group,and mixed group were 0.68±0.11,0.69±0.15,0.71±0.12,0.73±0.14,and CRT was 631.4±50.7,640.6±55.7,652.3±63.4,660.4±61.8 μm.Compared with before treatment,1,3,6 months after treatment,DRT group(BCVA:t=8.139,11.552,11.672;CRT:t=16.163,21.653,25.855),CME group(BCVA:t=8.923,9.995,13.842;CRT:t=16.163,21.653,25.855),SRD type group(BCVA:t=5.171,7.315,6.051;CRT:t=9.099,13.731,21.306),mixed type group(BCVA:t=5.072,6.939,7.142;CRT:t=6.920,15.352,17.538)The BCVA of the affected eyes was significantly increased,and the CRT was significantly decreased,and the difference was statistically significant(P<0.05).At 6 months after treatment,the differences in logMAR BCVA and CRT of the 4 groups of eyes were statistically significant(x^(2)=58.478,64.228;P<0.05).The average number of injections in the eyes of the DRT group,CME group,SRD group,and mixed group were 3.37±1.35,3.68±1.38,4.18±1.40,4.13±1.50 times,respectively.Compared with the average number of injections in the eye,the difference was statistically significant(x^(2)=9.139,P=0.028).Conclusions Conbercept can effectively reduce CRT and increase BCVA in eyes with different types of DME.Compared with SRD type and mixed type,DRT and CME type eye are more effective in improving vision,CRT reduction degree is greater,and the number of injections is less.
作者
李璐希
姜钊
陈莲
李晓清
张鹏
Li Luxi;Jiang Zhao;Chen Lian;Li Xiaoqing;Zhang Peng(Department of Ophthalmology,The Affiliated Hospital of Northwest University,Xi'an No.3 Hospital,Xi'an 710018,China)
出处
《中华眼底病杂志》
CAS
CSCD
北大核心
2021年第9期702-708,共7页
Chinese Journal of Ocular Fundus Diseases
作者简介
通信作者:张鹏,Email:zhangpengfmmu@163.com。
