贝伐单抗联合曲安奈德治疗糖尿病黄斑水肿的Meta分析  

Effect of Bevacizumab Combined with Triamcinolone for Diabetic Macular Edema:A Meta-analysis

作　　者：成拾明[1] 李岩[2] 周霞[1] 许玲[1] 

机构地区：[1]湖北医药学院附属太和医院眼科,湖北十堰442000 [2]湖北医药学院附属东风医院眼科

出　　处：《华南国防医学杂志》2014年第12期1221-1226,共6页Military Medical Journal of South China

摘　　要：目的系统评价玻璃体腔注射贝伐单抗（intravitreal injection of bevacizumab,IVB）与IVB联合曲安奈德（intravitreal injection of bevacizumab combined with rtiamcinolone,IVB/IVT）治疗糖尿病黄斑水肿（diabetic macular edema,DME）的疗效分析。方法采用严密设计的检索策略,检索Pubmed、EMbase、Cochrane Library、万方数据库、维普数据库、中国期刊全文数据库（China national knowledge infrastructure）截止到2013-01月收录的关于IVB与IVB/IVT治疗DME疗效的文献。采用RevMan 5.1.0进行统计分析,连续性变量以加权均数差（weighted mean difference,WMD）、95%可信区间（95%CI）。结果共有8篇随机临床试验纳入研究。6周时,IVB/IVT组中央黄斑厚度（central macular thickness,CMT）降低值大于IVB组[MD=11.96μm,95%CI：-7.50~31.42,P=0.23],但差异无统计学意义。12及18周,IVB/IVT组CMT降低值大于IVB组,分别为[MD=41.55μm,95%CI：18.77~64.33,P=0.0004]和[MD=66.84μm,95%CI：40.63~93.06,P〈0.00001],差异均有统计学意义。24及48周时,两组差异均〈5μm,差异无统计学意义（P〉0/05）。IVB组与IVB/IVT组在6周、12周、18周、24及48周最佳矫正视力（best corrected visual acuity,BCVA）改善方面,两组差值均〈0.1logMAR,差异无统计学意义（P均〉0.1）。结论早期IVB/IVT较IVB可以更显著降低CMT,中远期效果两组无明显差异;两组在BCVA改善方面无明显差异。结果仍待大样本量随机临床试验进一步研究证实。Objective This system analysis was to evaluate the efficacy of bevacizumab（IVB）and bevacizumab combined with triamcinolone（IVB/IVT）for diabetic macular edema.Methods A systematic literature retrieval was conducted in the Pubmed,EMbase,Cochrane Library,WanFang Data,ChongQing WeiPu and CNKI until 2013.The efficacies of bevacizumab vs bevacizumab combined with triamcinolone for diabetic macular edema were compared.The statistical analysis was performed using RevMan 5.1.0 software.Results A total of 8 randomized clinical trials were included in the meta-analysis.IVB/IVT outweighed IVB in the reduction of CMT at 6,12 and 18 weeks.But significantly statistical difference were found at 12 weeks[MD=41.55μm,95%CI：18.77~64.33,P=0.0004]and 18 weeks[MD=66.84μm,95%CI：40.63~93.06,P〈0.00001]except at 6 weeks（WMD=11.96μm,95%CI-7.50~31.42,P=0.23）.There wre no significantly statistical differences were found between two groups at 24 and 48 weeks in the reduction of CMT（P=0.95 and P=0.79）with a difference less than 5μm.IVB/IVT showed no superiority over IVB in terms of visual acuity improvement at 6,12,18,24 and 48 weeks with no significantly statistical difference（P〉0.1）.Conclusion IVB/IVT outweighed IVB in the reduction of CMT in the short-term.But significant difference was not found between two groups in the mid or long-term.As to the change of BCVA,no significant difference was found between two groups.Randomized clinical trials with a large number of samples are needed to verify our conclusion.

关 键 词：贝伐单抗 阿瓦斯汀 曲安奈德 糖尿病黄斑水肿 META分析 

分 类 号：R774.5[医药卫生—眼科]