玻璃体腔注射雷珠单抗联合生蒲黄汤治疗黄斑区脉络膜新生血管的疗效观察  

Effect of intravitreal injection of ranibizumab combining Shengpuhuang decoction on choroid neovascularization in macular area

作　　者：郑淼[1] 郑燕林[2] ZHENG Miao;ZHENG Yanlin(Chengdu Universi-ty of Traditional Chinese Medicine,Chengdu 610000,China)

机构地区：[1]成都中医药大学,成都610000 [2]成都中医药大学附属医院,成都610000

出　　处：《中国中医眼科杂志》2018年第4期223-228,共6页China Journal of Chinese Ophthalmology

摘　　要：目的探讨玻璃体腔注射雷珠单抗联合生蒲黄汤(陈达夫《中医眼科六经法要》)治疗黄斑区脉络膜新生血管(CNV)的临床疗效。方法中医辨证为络伤出血证的黄斑区CNV 52例(53只眼),随机数字表法分为2组。观察组采用玻璃体腔注射雷珠单抗联合生蒲黄汤治疗,对照组予玻璃体腔注射雷珠单抗治疗。分别于治疗前、治疗后1周,以及治疗后1~10个月每个月,采用早期糖尿病视网膜病变治疗研究(ETDRS)视力表记录其最佳矫正视力(BCVA),光学相干断层扫描(OCT)测量黄斑中心视网膜厚度(CRT)变化情况。两组均采用1+PRN治疗方案,再次注射标准参考Pr ONTO研究中所制定的标准。观察终点视力提高≥5个字母者为有效,视力提高<5个字母及下降者为无效。结果观察组纳入28例(29只眼),脱落3例(3只眼),对照组纳入28例(28只眼),脱落1例(1只眼)。两组术后视力均较术前有不同程度的提高,术后视力变化与术前视力有关。术前ETDRS字母数<47者,观察组术后视力平均增加了14.6~23.8个字母,始终优于对照组,对照组视力平均增加4.0~12.5个字母,波动不大,但有随时间增加轻微的下降趋势(重复测量资料的方差分析,F_(时间×分组)=3.014,P时间×分组=0.042)。术前ETDRS字母数≥47者,观察组术后视力平均增加5.5~11.0个,对照组平均增加7.1~8.8个,两组数值较为接近,观察组表现为先升高后降低,对照组术后视力较为稳定(F_(时间×分组)=2.684,P_(时间×分组)=0.029)。随访终点时,观察组有效率为80.77%(21/26),对照组有效率为62.96%(17/27)。两组CRT变化值总体上较为接近,均呈现为先降低后轻度增加,术后5个月后,两组CRT变化情况趋于一致(重复测量资料的方差分析,F_(时间×分组)=2.125,P_(时间×分组)=0.044)。观察组与对照组玻璃体腔注射雷珠单抗注射次数差异无统计学意义(Mann-Whittney U检验,Z=-0.875,P=0.391)。结论玻璃体腔注射雷珠单抗联合�OBJECTIVE To investigate the effect of Shengpuhuang decoction combined with intravitreal injection of ranibizumab on macular area choroid neovascularization（CNV）.METHODS A total of 53 cases of CNV were divided into observation group and control group according to the random number table. The observation group was treated by Shengpuhuang decoction combined with intravitreal injection of ranibizumab while the control group was treated by intravitreal injection of Ranibizumab. All cases were tested by ophthalmofundoscopy, fundus fluorescein angiograph（FFA） and（or） indocyanine green angiography（ICGA） and optical coherence tomography（OCT）. All cases were treated with 0.05 ml（0.5 mg/0.05 ml） intravitre al rannibizumab. Best-corrected visual acuity（BCVA） from eearly treatment of diabetic retinopathy study, OCT and ophthalmoscope examination were assessed before intervention and from the first month to the tenth 1-10 after initial injection at one month interval. All of the patients received an initial intravi-treal injection of ranibizumab and followed by repeated injections over the 10 months follow-up on the basis of central retina thickness（CRT） and angiographic features. Using SPSS 20.0 statistical software to compared the variation of the BCVA and CRT before and after treatment. It is effective if vision doesn＇t improved less than 5 letters at the end of 10 monthes follow-up period, otherwise the opposite. RESULTS Twenty-eight cases（29 eyes） were included in the observation group and 3 cases（3 eyes） dropped out, and 28 cases（28 eyes） were included in the control group and 1 case（1 eye） dropped out. Postoperative visual acuity improved in different degrees in both groups and the variation was related to preoperative visual acuity. For patients with preoperative ETDRS result less than 47 letter, result of these in observation group after intervention increased by 14.6~23.8 in average and the other ones in control group only increased by 4.0 ~12.5 which was lower than

关 键 词：脉络膜新生血管 雷珠单抗 生蒲黄汤 

分 类 号：R774.5[医药卫生—眼科]