抗血管内皮生长因子药物治疗合并玻璃体积血的X连锁视网膜劈裂症疗效分析  

Anti-vascular endothelial growth factor treatment in X-linked retinoschisis with vitreous hemorrhage

作　　者：麻婧[1] 李松峰[1] 刘敬花[1] 邓光达[1] 李亮[1] 原铭贞 周丹[1] 卢海[1] Ma Jing;Li Songfeng;Liu Jinghua;Deng Guangda;Li Liang;Yuan Mingzhen;Zhou Dan;Lu Hai(Beijing Tongren Hospital,Capital Medical University,Beijing Tongren Eye Center,Key Laboratory of Beijing Ophthalmology and Visual Science,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院、北京同仁眼科中心、北京市眼科学与视觉科学重点实验室,北京100730

出　　处：《中华眼底病杂志》2023年第1期34-40,共7页Chinese Journal of Ocular Fundus Diseases

基　　金：首都医科大学附属北京同仁医院"扬帆"重点医学专业发展计划(TRZDYXZY201703);首都医科大学附属北京同仁医院青年人才培养计划种子基金(2018-YJJ-ZZL-025)。

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X连锁视网膜劈裂症(XLRS)合并玻璃体积血(VH)的疗效。方法回顾性临床研究。2016年3月1日至2022年4月1日于首都医科大学附属北京同仁医院眼科检查确诊的XLRS合并VH患者18例19只眼纳入研究。患者均为男性;年龄(7.05±3.85)岁。所有患眼均行最佳矫正视力(BCVA)、广角眼底彩色照相检查。BCVA检查采用国际标准视力表进行,统计时换算为最小分辨角对数(logMAR)视力。依据是否接受玻璃体腔注射雷珠单抗(IVR)治疗,将患者分为注药组、观察组,分别为10例11只眼、8例8只眼。注药组患眼玻璃体腔注射10 mg/ml的雷珠单抗0.025 ml(含雷珠单抗0.25 mg)。治疗后随访时间(24.82±20.77)个月。观察注药组患眼治疗后VH吸收时间、视力变化以及并发症发生情况。VH前后、IVR治疗前后BCVA比较采用配对样本t检验;注药组与观察组之间VH吸收时间比较采用独立样本t检验。结果VH前后患眼logMAR BCVA分别为0.73±0.32、1.80±0.77;VH后BCVA显著降低,差异有统计学意义(t=-3.620,P=0.006)。注药组患眼VH后、IVR治疗后logMAR BCVA分别为1.87±0.55、0.62±0.29;IVR治疗后BCVA显著提高,差异有统计学意义(t=6.684,P<0.001)。治疗前后均有BCVA记录5只眼,VH后、IVR治疗后logMAR BCVA分别为0.58±0.31、0.48±0.20,差异无统计学意义(t=1.000,P=0.374);治疗后BCVA提高1只眼,无变化4只眼。观察组8只眼中,VH前、VH吸收后均有BCVA记录5只眼。VH前、VH吸收后患眼logMAR BCVA分别为0.88±0.28、0.90±0.26,差异无统计学意义(t=-1.000,P=0.374);VH吸收后,BCVA无变化、降低分别为4、1只眼。注药组、观察组患眼VH吸收时间分别为(1.80±1.06)、(7.25±5.04)个月;注药组患眼VH吸收时间较观察组显著缩短,差异有统计学意义(t=-3.005,P=0.018)。多因素线性回归分析结果显示,是否IVR治疗与VH吸收时间显著相关(B=-6.66,95%可信区间-10.93~-2.39,t=-Objective To review the outcome of intravitreous anti-vascular endothelial growth factor(VEGF)treatment in patients with X-linked retinoschisis(XLRS)complicated with vitreous hemorrhage(VH).Methods A retrospective clinical study.From March 1,2016 to April 1,2022,18 patients(19 eyes)diagnosed with XLRS complicated with vitreous hemorrhage in Beijing Tongren Hospital,Capital Medical University of Eye Center were included.All the patients were male,with a median age of 7.05±3.8 years.Best corrected visual acuity(BCVA)and wide-angle fundus photography were performed in all the patients.BCVA was carried out using international standard visual acuity chart,and converted into logarithm of minimum resolution angle(logMAR)in statistics analysis.According to whether the patients received intravitreal injection of ranibizumab(IVR),the patients were divided into injection group and observation group,with 11 eyes in 10 cases and 8 eyes in 8 cases,respectively.In the injection group,0.025 ml of 10 mg/ml ranibizumab(including 0.25 mg of ranibizumab)was injected into the vitreous cavity of the affected eye.Follow-up time after treatment was 24.82±20.77 months.The VH absorption time,visual acuity changes and complications were observed in the injection group after treatment.Paired sample t test was used to compare BCVA before and after VH and IVR treatment.Independent sample t test was used to compare the VH absorption time between the injection group and the observation group.Results LogMAR BCVA before and after VH were 0.73±0.32 and 1.80±0.77,respectively.BCVA decreased significantly after VH(t=-3.620,P=0.006).LogMAR BCVA after VH and IVR were 1.87±0.55 and 0.62±0.29,respectively.BCVA was significantly improved after IVR treatment(t=6.684,P<0.001).BCVA records were available in 5 eyes before and after IVR,and the BCVA values after VH and IVR were 0.58±0.31 and 0.48±0.20,respectively,with no statistically significant difference(t=1.000,P=0.374).BCVA increased in 1 eye and remained unchanged in 4 eyes after treatment.BCVA

关 键 词：X连锁视网膜劈裂症 玻璃体积血 血管生成抑制剂 雷珠单抗 

分 类 号：R774.1[医药卫生—眼科]