息肉状脉络膜血管病变抗血管内皮生长因子(VEGF)治疗后1年的视力预后与基线特征的相关性分析  

Correlation of 1-year vision outcomes with baseline factors in polypoidal choroidal vasculopathy patients after anti-VEGF treatment

作　　者：刘子扬[1] 夏松[1] 杨景元[1] 陈有信[1] LIU Zi-Yang;XIA Song;YANG Jing-Yuan;CHEN You-Xin(From the Department of Ophthalmology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院眼科,北京市100730

出　　处：《眼科新进展》2018年第5期440-443,共4页Recent Advances in Ophthalmology

基　　金：国家自然科学基金资助(编号:81670879)

摘　　要：目的分析息肉状脉络膜血管病变(polypoidal choroidal vasculopathy,PCV)经过连续3个月的每月抗血管内皮生长因子(vescular endothelial growth factor,VEGF)治疗后1 a的视力预后与基线特征的相关性。方法回顾性队列研究。收集2015年7月至2016年12月于我院就诊的PCV患者44例(44眼),所有患者在基线时均行最佳矫正视力(bestcorrected visual acuity,BCVA)、眼压、眼底检查以及光学相干断层扫描、眼底荧光素血管造影和吲哚青绿血管造影检查。所有患者在确诊后均行连续3个月的每月1次抗VEGF(包括雷珠单抗和康柏西普)注射,随后按需治疗,记录第1次抗VEGF治疗后随访1 a的BCVA并与基线BCVA比较,依据BCVA变化分为BCVA提高组和未提高组,单因素和Logistic回归分析BCVA预后与基线特征的相关性。结果单因素分析结果显示,BCVA提高组比BCVA未提高组具有较短的发病时间、较小的病灶最大线性尺寸(P=0.045、0.037)。Logistic回归结果显示,脉络膜高渗透性和病灶最大线性尺寸是视力预后的独立相关因素(回归系数为0.963和0.001;P=0.010、0.012;比值比为0.083和1.002;95%的可信区间为0.013～0.549和1.001～1.004μm)。结论合并脉络膜血管高渗透性可能是经抗VEGF治疗的PCV患眼视力预后不佳的预测指标,同时病灶的最大线性尺寸和发病时间也与PCV经抗VEGF治疗后的BCVA预后相关。Objective To analyze the correlation between baseline factors and the best corrected visual acuity(BCVA)after 3 monthly anti-vescular endothelial growth factor(VEGF)therapy in naive polypoidal choroidal vasculopathy(PCV).Methods This was a retrospective cohort study in 44 naive PCV patients(44 eyes)treated in our hospital between July 2015 and December 2016,and BCVA,optical coherence tomography(OCT)and fundus fluorescein angiography(FFA)+indocyanine green angiography(ICGA)examinations were performed at first.All patients were treated with monthly anti-VEGF(including ranibizumab and conbercept)injections for 3 consecutive months,followed by the needed retreatment,and BCVA at the 12th month during follow-up after the first anti-VEGF treatment was recorded,following the comparison with baseline BCVA,and then the patients were divided into improved and unimproved groups according to BCVA changes.Finally,univariate and logistic regression analysis were used to analyze the correlation between the baseline factors and BCVA.Results The univariate analysis showed that the improved group had shorter onset time,smaller greatest linear dimension(P=0.045 and 0.037,respectively).Logistic regression showed the difference in choroidal vascular hyperpermeability and greatest linear dimension was statistically significant,suggesting that they were the independent predictors of visual outcome(regression coefficient=0.963 and 0.001,P=0.010 and 0.012,odds ratios=0.083 and 1.002,95%confidence interval=0.013-0.549 and 1.001-1.004,respectively).Conclusion Choroidal vascular hyperpermeability may be a predictor for poor visual acuity prognosis in PCV patients after anti-VEGF,and greatest linear dimension and the time of onset are also related to postoperative visual acuity in PCV patients after anti-VEGF.

关 键 词：息肉状脉络膜血管病变 血管内皮生长因子 最佳矫正视力 脉络膜血管高渗透性 

分 类 号：R773.4[医药卫生—眼科]