血管内皮生长因子(VEGF)基因启动子区多态性与抗VEGF药物治疗黄斑水肿疗效的相关性  

Study on the correlation between polymorphisms in the vascular endothelial growth factor gene promoter and the efficacy of anti-vascular endothelial growth factor drugs in the treatment of macular edema

作　　者：何艺岚 成仲夏[2] 王国栋 王瑞霞 聂海燕 曾芝付 宋永砚 HE Yilan;CHENG Zhongxia;WANG Guodong;WANG Ruixia;NIE Haiyan;ZENG Zhifu;SONG Yongyan(Institute of Basic and Forensic Medicine,North Sichuan Medical College,Nanchong 637000,Sichuan Province,China;Department of Ophthalmology,Affiliated Hospital of Chengdu University,Chengdu 610000,Sichuan Province,China;Clinical Medical College of Chengdu University,Chengdu 610000,Sichuan Province,China;Central Laboratory,Affiliated Hospital of Chengdu University,Chengdu 610000,Sichuan Province,China)

机构地区：[1]川北医学院基础医学与法医学研究所,四川省南充市637000 [2]成都大学附属医院眼科,四川省成都市610000 [3]成都大学临床医学院,四川省成都市610000 [4]成都大学附属医院中心实验室,四川省成都市610000

出　　处：《眼科新进展》2023年第8期612-617,共6页Recent Advances in Ophthalmology

基　　金：四川省自然科学基金项目(编号:2022NSFSC0740);成都大学临床医学院/附属医院院级科研课题(编号:Y2021010)。

摘　　要：目的探讨血管内皮生长因子(VEGF)基因启动子区多态性与抗VEGF药物治疗黄斑水肿疗效的相关性。方法选取2020年9月至2022年3月在成都大学附属医院经荧光素眼底血管造影和光学相干断层扫描确诊的黄斑水肿患者145例(190眼),给予所有患者抗VEGF药物治疗1个月,根据视力提升情况将145例患者分为有效组(提升≥5个字母)和无效组(提升<5个字母)。收集两组患者临床资料并进行VEGF基因启动子区多态性分型,对各组数据进行统计学分析。结果本研究有效组患者64例(81眼),无效组患者81例(109眼)。有效组患者视网膜分支静脉阻塞发生率、基线最小分辨角对数(logMAR)视力及基线黄斑中心凹视网膜厚度(CMT)均高于无效组(均为P<0.05);有效组患者年龄相关性黄斑变性发生率、低密度脂蛋白胆固醇、载脂蛋白B、血糖及单核细胞数均低于无效组,差异均有统计学意义(均为P<0.05)。有效组rs13207351多态性A等位基因频率高于无效组,差异有统计学意义(P<0.05)。AA及AG基因型患者血糖水平均低于GG基因型患者,差异均有统计学意义(均为P<0.05)。AG基因型患者胱抑素C水平高于AA及GG基因型患者(均为P<0.05)。AA及AG基因型患者抗VEGF药物治疗后小数视力、字母视力及logMAR视力均优于治疗前,且AA基因型患者视力改善程度稍优于AG基因型患者(均为P<0.05);AA及AG基因型患者抗VEGF药物治疗后CMT均低于治疗前,差异均有统计学意义(均为P<0.05)。GG基因型患者抗VEGF药物治疗后CMT较治疗前降低,差异有统计学意义(P<0.05)。结论VEGF基因启动子区rs13207351多态性与抗VEGF药物治疗黄斑水肿疗效显著相关,A等位基因携带者抗VEGF药物治疗后疗效较好,其机制可能与A等位基因携带者血糖水平降低有关。Objective To investigate the relationship between the vascular endothelial growth factor(VEGF)gene promoter polymorphism and the efficacy of anti-VEGF drugs in macular edema treatment.Methods Totally 145 patients(190 eyes)with macular edema diagnosed by fundus fluorescein angiography and optical coherence tomography in the Affiliated Hospital of Chengdu University from September 2020 to March 2022 were enrolled.All patients were treated with anti-VEGF drugs for one month and divided into the effective group(visual acuity improvement≥5 letters)and the ineffective group(visual acuity improvement<5 letters).Clinical data of patients in the two groups were collected,the polymorphisms in the VEGF gene promoter were genotyped,and statistical analysis was conducted on the relevant data.Results In this study,there were 64 patients(81 eyes)in the effective group and 81 patients(109 eyes)in the ineffective group.The incidence rate of branch retinal vein occlusion,baseline logarithm of the minimum angle of resolution(logMAR),and baseline central macular thickness(CMT)in the effective group were higher than those in the ineffective group(all P<0.05);the incidence rate of age-related macular degeneration,levels of low-density lipoprotein cholesterol,apolipoprotein B and blood glucose,and number of monocytes in the effective group were lower than those in the ineffective group(all P<0.05).The frequency of A allele of the rs13207351 polymorphism in the effective group was higher than that in the ineffective group(P<0.05).The patients with the AA and AG genotypes had a lower level of blood glucose than those with the GG genotype(both P<0.05).The patients with the AG genotype had a higher level of cystatin C than those with the AA and GG genotypes(both P<0.05).The decimal visual acuity,letter visual acuity and logMAR of the patients with the AA and AG genotypes after treatment with anti-VEGF drugs were better than those before treatment,and the improvement of vision in patients with the AA genotype was slightly better than that

关 键 词：黄斑水肿 血管内皮生长因子 抗血管内皮生长因子药物 基因多态性 

分 类 号：R774[医药卫生—眼科]