糖尿病性黄斑水肿患者抗VEGF药物疗效与尿蛋白含量的相关性研究  

Correlation between urinary protein content and anti-VEGF drug efficacy in diabetic macular edema

作　　者：胡寒英 游志鹏[1] HU Hanying;YOU Zhipeng(Department of Ophthalmology,the Second Affiliated Hospital of Nanchang University,Nanchang 330000,Jiangxi Province,China)

机构地区：[1]南昌大学第二附属医院眼科,江西省南昌市330000

出　　处：《眼科新进展》2020年第7期653-658,共6页Recent Advances in Ophthalmology

摘　　要：目的观察不同尿蛋白含量下糖尿病性黄斑水肿(diabetic macular edema,DME)患者行抗血管内皮生长因子(vascular endothelial growth factor,VEGF)药物治疗的疗效差异并进行影响因素分析。方法前瞻性研究。选取2018年1月至2018年12月于南昌大学第二附属医院内分泌科及眼科住院或门诊已确诊为2型DME患者82例,根据尿肾功能检查结果将患者分为三组尿白蛋白含量小于30 mg为正常蛋白尿组(19例),尿白蛋白含量30~300 mg为微量蛋白尿组(16例),尿白蛋白含量大于300 mg为大量蛋白尿组(47例)。收集患者年龄、糖尿病病程、高血压病史、肾功能检验结果尿蛋白、尿微量白蛋白、N-乙酰-β-D-氨基葡萄糖苷(N-acetyl-β-D-glucosaminidase,NAG)酶、血生化检验结果血肌酐、估算肾小球滤过率(estimated glomerular filtration rate,EGFR)、糖化血红蛋白、糖尿病视网膜病变程度、基线最佳矫正视力(best corrected visual acuity,BCVA)、基线黄斑中心凹视网膜厚度(center macular thickness,CMT)。所有患眼玻璃体内注射康柏西普,均为每月注射1次,连续注射3次,随访3个月。对比分析三组患者治疗后1周、1个月、2个月、3个月的BCVA及CMT资料;以CMT降低≥20%为黄斑水肿消退疗效敏感,反之为疗效不敏感;以BCVA提高2行及以上为视力提高疗效敏感,反之为疗效不敏感。单因素及二分类Logistics回归分析影响三组患者行抗VEGF药物治疗后视力提高疗效及水肿消退疗效的因素。结果三组患者行抗VEGF治疗后1周、1个月、2个月、3个月的视力提高疗效、黄斑水肿消退疗效敏感率正常蛋白尿组为68.0%、100.0%、94.7%、94.7%和10.5%、73.7%、100.0%、100.0%,微量蛋白尿组为50.0%、87.5%、87.5%、87.5%和0、62.5%、87.5%、93.8%,大量蛋白尿组为19.0%、42.6%、42.6%、31.9%和0、25.5%、36.2%、23.4%;尿蛋白含量越低,治疗后视力提高疗效、黄斑水肿消退疗效越敏感;三组患者治疗后不同时间�Objective To observe the difference in the efficacy of anti-VEGF drugs in patients with diabetic macular edema(DME)under different renal function.Methods Prospective study was performed in 82 patients with type 2 DME who were diagnosed in the Department of Endocrinology and Ophthalmology Hospital or Outpatient Department of the Second Affiliated Hospital of Nanchang University from January 2018 to December 2018.According to the results of renal urinalysis,the patients were divided into three groups normal albuminuria group with urinary albumin content less than 30 mg(19 patients),micro-albuminuria group with urinary albumin content between 30 mg and 300 mg(16 patients),and macro-albuminuria group with urinary albumin content greater than 300 mg(47 patients).Clinical data were collected and analyzed,including the patients’age,duration of diabetes,hypertension,urine kidney function test results Urine protein,urine microprotein,N-acetyl-amino-d-glucosidase(NAG)enzyme,blood biochemical examination results serum creatinine,and estimated glomerular filtration rate(EGFR),degree of glycated hemoglobin(HbA1c),degree of diabetic retinopathy,baseline best corrected visual acuity(BCVA),baseline macular center concave thickness(CMT).After the approval of the ethics committee of the hospital and the informed consent of the patient,all patients were given intravitreal injection of conbercept,with one injection per month for three consecutive months,and followed up for 3 months.The BCVA and CMT of the three groups of patients were compared and analyzed after treatment one week,one month,two months and three months.Reduction of CMT≥20%is sensitive to the remission of macular edema,whereas it was not;improvement of BCVA for 2 lines or more is to improve the effect of visual acuity sensitive,otherwise is not sensitive.Uivariate and bivariate logistic regression analysis were used to determine the factors affecting the efficacy of intravitreal injection of anti-VEGF drug therapy in patients with DME.Results The sensitivity of vi

关 键 词：肾功能 糖尿病性黄斑水肿 血管生成抑制剂 危险因素 

分 类 号：R774.5[医药卫生—眼科]