抗血管内皮生长因子药物治疗特发性脉络膜新生血管长期疗效及影响因素分析  

Predictors of long-term efficacy and recurrence of anti-vascular endothelial growth factor therapy for idiopathic choroidal neovascularization

作　　者：吴倩如 陈晓勇[1] 封康[1] 刘瑜玲[1] 张纯[1] 赵琳[1] Wu Qianru;Chen Xiaoyong;Feng Kang;Liu Yuling;Zhang Chun;Zhao Lin(Department of Ophthalmology,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院眼科眼部神经损伤的重建保护与康复北京市重点实验室,100191

出　　处：《中华眼底病杂志》2021年第9期709-714,共6页Chinese Journal of Ocular Fundus Diseases

基　　金：北京大学交叉种子基金。

摘　　要：目的观察玻璃体腔注射抗血管内皮生长因子(VEGF)药物治疗特发性脉络膜新生血管(ICNV)的临床效果及其影响预后的因素。方法回顾性临床分析。2012年7月至2017年10月于北京大学第三医院眼科中心检查确诊的ICNV患者27例27只眼纳入研究。患眼均行玻璃体腔注射贝伐单抗(1.25 mg)或雷珠单抗(0.05 mg)治疗,必要时重复治疗。平均随访时间168周。观察患眼最佳矫正视力(BCVA)、黄斑中心凹视网膜厚度(CRT)的恢复情况。初始治疗后每一个月随访1次,直至病灶完全吸收或瘢痕化(第一阶段)。其后每12周进行1次随访,观察病灶复发情况(第二阶段长期随访)。第一阶段末次注射治疗后1个月时,根据脉络膜新生血管(CNV)病灶消退情况,将患眼分为形态学改善显著组(改善显著组)、形态学改善不显著组(改善不显著组),分析年龄、病程、药物种类、注射次数、基线BCVA和CRT对CNV病灶消退的影响。根据长期随访结果,将患眼分为复发组及未复发组,分析影响CNV病灶复发的因素。组间计量资料比较采用独立样本t检验或非参数检验;计数资料比较采用χ^(2)检验。采用logistic回归分析法分析影响病灶消退及复发的因素。结果基线、第一阶段末次注射治疗后1个月时,患眼平均BCVA分别为(55.70±15.21 )、(73.59±12.08)个字母;CRT分别为(338.3±89.32)、(264.5±47.47)μm。两个时间点患眼BCVA、CRT比较,差异均有统计学意义(Z=-3.886、-4.061,P<0.001)。改善显著组、改善不显著组患眼BCVA分别为(65.38±17.27)、(51.63±12.61)个字母;两组BCVA比较,差异有统计学意义(t=-2.316,P=0.029)。长期随访结果显示,27只眼中,复发6只眼;平均复发时间(90.83±49.02)周。再次行玻璃体腔注射抗VEGF药物治疗后,CNV病灶消退。复发组、未复发组患眼平均注药次数分别为(3.67±0.816 )、(2.24±0.768)次;复发组患眼平均注射次数显著高于未复发组,差异有统计学意�Objective To investigate the clinical effects and influence factors of intravitreal injection of anti-vascular endothelial growth factor(VEGF)drugs in the treatment of idiopathic choroidal neovascularization(ICNV).Methods This retrospective study involved 27 patients(27 eyes)with ICNV from July 2012 to July 2015.Patients received intravitreal bevacizumab(1.25 mg),ranibizumab(0.05 mg),additional injection was provided if it was needed.The average follow-up time was 168 weeks.The recovery of best corrected visual acuity(BCVA)and central foveal retinal thickness(CRT)of the affected eye was observed.Follow up once a month after the initial treatment until the lesion was completely absorbed or scarred(the first follow-up period).Follow up every 12 weeks was performed to observe the recurrence of the lesions(the second stage of long-term follow-up).One month after the last injection of the first follow-up period,according to the regression of choroidal neovascularization(CNV),the affected eyes were divided into a significant improvement group(significant improvement group)and an insignificant improvement group(non-significant improvement group),to analyze the effects of age,course of disease,type of drugs,number of injections,baseline BCVA and CRT on the regression of CNV lesions.According to the results of long-term follow-up,the eyes were divided into recurrence group and non-recurrence group,and the factors affecting the recurrence of CNV lesions were analyzed.Measurement data between groups was compared by using independent sample t test or non-parametric test;count data was compared by using/2 test.Logistic regression analysis was used to analyze the factors affecting the regression and recurrence of the lesion.Results At baseline and 1 month after the last injection in the first stage,the average BCVA of the eyes were 55.70±15.21 and 73.59±12.08 letters;CRT was 338.3±89.32 and 264.5±47.47 pm,respectively.The BCVA and CRT of the affected eyes were compared at the two time points,and the differences were statis

关 键 词：脉络膜新生血管化 玻璃体内注射 血管生成抑制剂 复发 预后 

分 类 号：R773.4[医药卫生—眼科]