抗VEGF类药物治疗CRVO-ME效果的系统评价  

Efficacy of Anti-VEGF Drugs on Visual Acuity in Patients with Macular Edema Secondary to Central Retinal Vein Occlusion: A Systematic Review

作　　者：郭别川 柯敏[1] 田朕[1] 王萍[1] 乔晨[1] 

机构地区：[1]武汉大学中南医院,武汉430071

出　　处：《中国循证医学杂志》2014年第1期44-51,共8页Chinese Journal of Evidence-based Medicine

基　　金：国家自然科学基金面上项目"高糖诱导的内质网应激在Müller细胞损伤中的作用及其信号转导机制"(编号:81271024)

摘　　要：目的系统评价抗血管内皮生长因子(VEGF)药物治疗视网膜中央静脉阻塞继发的黄斑水肿(CRVOME)的临床疗效。方法计算机检索PubMed、h e Cochrane Library(2012年第11期)、EMbase、CBM、CNKI、VIP和WanFang Data,查找关于抗VEGF药物治疗CRVO-ME的随机或非随机对照试验。检索时限均为从建库到2012年12月。由2位研究者根据纳入与排除标准独立筛选文献、提取资料并评价质量后,采用RevMan 5.1软件进行Meta分析,然后采用GRADEpro 3.6软件对证据质量进行分级。结果共纳入9个RCT,包括1072例患者,1072只眼。Meta分析结果显示:①短期疗效:两组在最佳矫正视力(BCVA)改变[MD=16.27,95%CI(9.98,22.55),P<0.00001]、视网膜黄斑厚度(CFT)改变[MD=245.25,95%CI(136.02,354.48),P<0.0001]和BCVA上升≥15个字母比例[OR=4.43,95%CI(2.23,8.83),P<0.0001]方面差异均有统计学意义;②长期疗效:两组在BCVA上升≥15个字母方面差异有统计学意义[OR=2.25,95%CI(1.56,3.23),P<0.0001]。证据质量为:短期疗效BCVA改变为中等级,其余短期和长期结局证据等级为低等级。结论抗VEGF药物可明显改善患者的视功能,可将其作为CRVO-ME的推荐疗法。限于纳入研究数量较少,质量参差不齐,尚需开展大样本、多中心、高质量的RCT,以进一步验证抗VEGF药物对CRVO-ME的疗效。ObjectiveTo systematically review anti-vascular endothelial growth factor （VEGF） drugs on visual acuity in patients with central vetinal vein occlnsion-macular edema （CRVO-ME）. MethodsDatabases including PubMed, The Cochrane Library （Issue 11, 2012）, EMbase, CBM, CNKI, VIP and WanFang Data were electronically searched for the randomized controlled trials （RCTs） about anti-VEGF drugs on visual acuity in patients with CRVO-ME from the date of establishment of the databases to December 2012. Two reviewers independently screened literature according to the inclusion and exclusion criteria, and evaluated the included studies. Then, meta-analysis was performed using RevMan 5.1 software. The quality of evidence was analyzed using GRADEpro 3.6 software. ResultsA total 9 trials involving 1 072 patients （1 072 eyes） were included. The results of meta-analysis showed that, anti-VEGF injection, compared with sham injection, increased BCVA score measured by ETDRS （MD=16.27, 95%CI 9.98 to 22.55, P〈0.000 01）; decreased CFT score measured by OCT （MD=245.25, 95%CI 136.02 to 354.48, P〈0.000 1）; gained more than 15 letters in BCVA （OR= 4.43, 95% CI 2.23 to 8.83, P〈0.000 1）; and the long term anti-VEGF effect index, gained no less than 15 letters in BCVA （OR=2.25, 95% CI 1.56 to 3.23, P〈0.000 1）. The score of short term BCVA changes was of intermediate quality, while another three outcomes were of low quality in the GRADE system. ConclusionCurrent evidence shows that, anti-VEGF drugs could improve the visual acuity of patients with CRVO-ME. The clinicians could recommend this kind of drugs to the patients. Due to the limitations of the included studies, more large-sample multicentre high-quality RCTs are required to verify its effectiveness.

关 键 词：视网膜中央静脉阻塞 黄斑水肿 血管内皮生长因子 系统评价 Meta分析 随机对照试验 

分 类 号：R774.5[医药卫生—眼科]