四川地区早产儿视网膜病变的临床特征及抗血管内皮生长因子药物治疗分析  

Clinical characteristics and effect of anti-vascular endothelial growth factor therapy in retinopathy of prematurity in Sichuan province

作　　者：刘桂娜 胡明[1] 蒋安娜 梁莉聪 杨婷婷[1] 陆方[1] Liu Guina;Hu Ming;Jiang Anna;Liang Licong;Yang Tingting;Lu Fang(Department of Ophthalmology,West China Hospital of Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院眼科,成都610041

出　　处：《中华眼底病杂志》2023年第2期170-178,共9页Chinese Journal of Ocular Fundus Diseases

基　　金：四川省科技计划项目(重点研发项目) (2021YFS0210)。

摘　　要：目的观察四川地区早产儿视网膜病变(ROP)的临床特征,评价抗血管内皮生长因子(VEGF)药物对其的治疗效果和安全性。方法回顾性研究。2013年1月至2022年1月于四川大学华西医院眼科首次行玻璃体腔注射抗VEGF药物治疗的ROP患儿156例306只眼纳入研究。根据抗VEGF药物的种类不同,将患儿分为玻璃体腔注射雷珠单抗(IVR)组和玻璃体腔注射康柏西普(IVC)组;根据患儿就诊路径不同,将IVC组分为院内组和转诊组。治疗后门诊随访至病变退行(血管退化或视网膜完全血管化)或再次入院治疗,随访时间至少6个月。若发现病情复发或进展,则再次收治入院并根据病变的严重程度,选择抗VEGF药物、视网膜激光光凝或手术治疗。总结分析患儿的临床资料,包括一般临床特征:性别、出生胎龄(GA)、出生体重(BW)、吸氧史等;病变情况:ROP分期、分区、是否有附加病变等;治疗情况:治疗时间、首次抗VEGF药物治疗时矫正胎龄等;预后:是否再治疗、再治疗时间、再治疗方式等;不良事件:角膜水肿、晶状体混浊、眼内炎、视网膜损伤等局部不良反应以及与治疗相关的全身不良反应。组间计量资料比较采用t检验,计数资料比较采用χ^(2)检验或秩和检验。结果156例ROP患儿306只眼中,男性74例(47.44%,74/156),女性82例(52.56%,82/156);均具有出生时吸氧史。患儿GA为(28.43±2.19)(23.86~36.57)周,BW为(1129±335)(510~2600)g,首次抗VEGF药物治疗时矫正胎龄为(39.80±3.04)(31.71~49.71)周。均诊断为1型ROP,包括急进型ROP(A-ROP)26只眼(8.50%,26/306),Ⅰ区病变39只眼(12.74%,39/306),Ⅱ区病变241只眼(78.76%,241/306)。患儿确诊后于72 h内行玻璃体腔注射抗VEGF药物治疗,其中行IVR治疗68例134只眼(43.79%,134/306),行IVC治疗88例172只眼(56.21%,172/306)。IVC组患儿中,院内组34例67只眼(38.95%,67/172),转诊组54例105只眼(61.05%,105/172)。仅一次治疗后好转279只眼(91.18%,279/306),�Objective To analyze the clinical characteristics and evaluate the effect and safety of anti-vascular endothelial growth factor(VEGF)therapy in retinopathy of prematurity(ROP)in Sichuan province.Methods A retrospective study.From January 2013 to January 2022,156 patients(306 eyes)with ROP who received intravitreal anti-VEGF therapy for the first time in the Department of Ophthalmology,West China Hospital of Sichuan University were selected.According to the type of anti-VEGF drugs,the children were divided into intravitreal injection of ranibizumab(IVR)group and intravitreal injection of conbercept(IVC)group;IVC group was divided into hospital group and referral group according to the different paths of patients.After treatment,the patients were followed up until the disease degenerated(vascular degeneration or complete retinal vascularization)or were hospitalized again for at least 6 months.If the disease recurred or progressed,the patients were re-admitted to the hospital and received anti-VEGF drug treatment,laser treatment or surgical treatment according to the severity of the disease.Clinical data of these children was collected,including general clinical characteristics:gender,gestational age at birth(GA),birth weight(BW),history of oxygen inhalation;pathological condition:ROP stage,zone,whether there were plus lesions;treatment:treatment time,postmenstrual gestational age at the time of the first anti-VEGF drug treatment;prognosis:re-treat or not,time of re-treatment,mode of re-treatment;adverse events:corneal edema,lens opacity,endophthalmitis,retinal injury,and treatment-related systemic adverse reactions.The measurement data between groups were compared by t test,and the count data were compared byχ^(2) test or rank sum test.Results Of the 306 eyes of 156 children with ROP,74 were male(47.44%,74/156)and 82 were female(52.56%,82/156).Each included child had a history of oxygen inhalation at birth.The GA was(28.43±2.19)(23.86-36.57)weeks,BW was(1129±335)(510-2600)g,and the postmenstrual gestational age

关 键 词：早产儿视网膜病变 临床特征 血管生成抑制剂 雷珠单抗 康柏西普 疗效评价 

分 类 号：R722.6[医药卫生—儿科]