康柏西普联合玻璃体切除术治疗糖尿病视网膜病变患者术后视力的影响因素分析  

Analysis of influencing factors of visual acuity after vitrectomy combined with conbercept in the treatment of diabetic retinopathy

作　　者：武志鹏 秦廷玉[1] 李龙[1] Wu Zhipeng;Qin Tingyu;Li Long(Department of Ophthalmology,the First Affiliated Hospital of Zhengzhou University,Henan Provincial Ophthalmic Hospital,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院眼科河南省眼科医院,郑州450052

出　　处：《中华眼外伤职业眼病杂志》2024年第6期461-467,共7页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的分析玻璃体内注射康柏西普联合玻璃体切除术(PPV)治疗增生型糖尿病视网膜病变(PDR)患者术后视力的影响因素。方法回顾性病例对照研究。收集郑州大学第一附属医院2021年2月至2023年1月诊治的PDR 122例(122眼)的临床资料。所有患者均行玻璃体内注射康柏西普联合23 G PPV治疗,观察手术时长、术中出血量、治疗前后的视力及血清指标。并根据治疗后3个月最佳矫正视力(BCVA)分为视力恢复效果良好(术后BCVA较术前提高1行及以上)组(74例)与视力恢复效果不良(BCVA无变化或较术前下降1行及以上)组(48例),采用Logistic回归模型分析影响患者视力效果的危险因素。结果所有患者术后3个月BCVA(0.22±0.08)及血清白介素(IL)-6[(32.11±3.17)ng/mL]、IL-10[(13.02±1.52)ng/mL]、C反应蛋白(CRP)[(10.25±1.14)ng/L]均低于术前,而血管生成素样蛋白4(ANGPTL 4)高于术前,不同时点比较差异具有统计学意义(F=1257.24、2827.92、1977.57、2825.65、2027.53,均P<0.05)。在术前PDR分期、术前糖化血红蛋白(HbA1c)、术前黄斑区视网膜脱离、术前视网膜椭圆体带、术前虹膜新生血管等基线资料比较中,组间差异有统计学意义(t=19.11、3.17、7.10、10.67、8.34,均P<0.05)。Logistic回归模型分析显示,DRⅥ期(OR=4.47,95%CI:1.644~12.139,P=0.003)、DRⅤ期(OR=3.97,95%CI:1.722~9.147,P=0.001)、HbAlc水平升高(OR=1.55,95%CI:1.209~1.985,P=0.001)、黄斑区视网膜脱离(OR=2.33,95%CI:1.015~5.337,P=0.046)、视网膜椭圆体带缺失(OR=4.44,95%CI:2.068~9.524,P<0.001)、虹膜新生血管(OR=2.72,95%CI:1.314~5.638,P=0.007)是影响PDR患者视力的独立危险因素。结论玻璃体内注射康柏西普联合PPV治疗PDR有利于改善术后视力。PDR分期、HbAlc、黄斑区视网膜脱离、视网膜椭圆体带及虹膜新生血管均为影响术后视力恢复的重要因素。ObjectiveTo analyze the factors influencing the visual acuity after intravitreal injection of conbercept combined with pars plana vitrectomy(PPV)in patients with proliferative diabetic retinopathy(PDR).MethodsThis was a retrospective case-control study.Clinical data of 122 cases(122 eyes)with PDR in the First Affiliated Hospital of Zhengzhou University from Feb.2021 to Jan.2023 were collected.All patients were treated with intravitreal injection of conbercept combined with 23 G PPV.The operative duration and intraoperative blood loss were observed,and the visual acuity and serum indexes before and after treatment were compared.Based on the best corrected visual acuity(BCVA)at 3 months after treatment,the patients were divided into a good visual acuity recovery group(BCVA in 74 cases improved by at least 1 row compared with before surgery)and a poor visual acuity recovery group(48 cases with no change or decreased by at least 1 row compared with before surgery).Logistic regression model was used to analyze the risk factors affecting visual acuity.ResultsAt 3 months after surgery,visual acuity(0.22±0.08),interleukin(IL)-6[(32.11±3.17)ng/mL],IL-10[(13.02±1.52)ng/mL],and C-reactive protein(CRP)[(10.25±1.14)ng/L]were lower than those before surgery,while angiopoietin-like protein 4(ANGPTL 4)was higher than that before surgery.The difference was statistically significant at different time points(F=1257.24,2827.92,1977.57,2825.65,2027.53;all P<0.05).There were statistically significant differences between groups in preoperative PDR stage,preoperative glycosylated hemoglobin(HbA1c),preoperative retinal detachment in macular area,preoperative retinal ellipsoid band,preoperative iris neovascularization and other baseline data(t=19.11,3.17,7.10,10.67,8.34;all P<0.05).Logistic regression model analysis showed that DR stageⅥ(OR=4.47,95%CI:1.644-12.139,P=0.003),DR stage V(OR=3.97,95%CI:1.722-9.147,P=0.001),increased HbA1c level(OR=1.55,95%CI:1.209-1.985,P=0.001),macular retinal detachment(OR=2.33,95%CI:1.015-5.337,P=0.04

关 键 词：糖尿病视网膜病变 康柏西普 玻璃体切除术 视力 危险因素 

分 类 号：R779.6[医药卫生—眼科] R587.2[医药卫生—临床医学]