非诺贝特联合雷珠单抗球内注射对糖尿病性视网膜神经纤维层损伤的保护作用  

Protective effect of fenofibrate combined with intravitreal injection of ranibizumab on diabetic retinal nerve fiber layer injury

作　　者：石蕊[1] 李迪[1] 秦静[1] 刘明[2] 杨乐[1] 张雪梅[1] 车选义[1] SHI Rui;LI Di;QIN Jing;LIU Ming;YANG Le;ZHANG Xue-mei;CHE Xuan-yi(Ophthalmology Department,Shaanxi Provincial People's Hospital,Xi'an 710068;Ophthalmology Department,Xi'an No.1 Hospital,Xi'an 710002,China)

机构地区：[1]陕西省人民医院眼科,陕西西安710068 [2]西安市第一医院眼科,陕西西安710002

出　　处：《临床医学研究与实践》2020年第19期5-7,12,共4页Clinical Research and Practice

基　　金：陕西省科技厅社会发展(攻关)计划(No.2017SF-249)。

摘　　要：目的观察口服非诺贝特对接受多次雷珠单抗球内注射的糖尿病性黄斑水肿(DME)患者视网膜神经纤维层(RNFL)厚度及黄斑区硬性渗出的影响。方法回顾性分析就诊于我院的63例DME患者(105眼)的临床资料,将患者按照是否口服非诺贝特分为非诺贝特组(F组,n=29,44眼)、DME组(D组,n=34,61眼),正常对照组(N组,n=20,40眼)。F组及D组患者接受球内注射雷珠单抗,随访6个月,比较各组的治疗效果,并分析抗VEGF治疗后RNFL变薄的危险因素。结果治疗后6个月,F组的各方位RNFL、AMT及CFT厚度均与N组无显著差异(P>0.05),但明显厚于D组,渗出总面积明显小于D组(P<0.05)。Logistic回归分析显示,糖尿病病史、高甘油三酯为抗VEGF治疗后RNFL变薄的独立危险因素,而口服非诺贝特的年限为保护性因素(P<0.05)。结论口服非诺贝特可辅助DME的治疗,对DME造成的视网膜神经损伤具有明显的保护作用。Objective To observe the effects of oral fenofibrate on retinal nerve fiber layer(RNFL)thickness and hard exudates in macular region of diabetic macular edema(DME)patients who received multiple intravitreal injections of ranibizumab.Methods The clinical data of 63 patients(105 eyes)with DME admitted in our hospital were analyzed retrospectively.The patients were divided into fenofibrate group(group F,n=29,44 eyes),DME group(group D,n=34,61 eyes)according to whether the patients took fenofibrate orally and normal control group(group N,n=20,40 eyes).The patients in the group F and group D received intravitreal injection of ranibizumab,after 6 months follow-up,the therapeutic effects of each group were compared,and the risk factors of RNFL thinning after anti-VEGF treatment were analyzed.Results Six months after treatment,There were no significant differences in thickness of RNFL,AMT and CFT between the group F and the group N(P>0.05),but those were significantly thicker than the group D,and the total area of exudates was significantly smaller than that in the group D(P<0.05).Logistic regression analysis showed that history of diabetes and high triglyceride were independent risk factors for RNFL thinning after anti-VEGF treatment,while time of oral fenofibrate was a protective factor(P<0.05).Conclusion Oral fenofibrate can assist the treatment of DME,and has a significant protective effect on neuroretinal injury caused by DME.

关 键 词：非诺贝特 糖尿病性黄斑水肿 神经视网膜损伤 硬性渗出 球内注射 

分 类 号：R774.1[医药卫生—眼科]