45岁以下黄斑区新生血管患者抗血管内皮生长因子药物治疗预后影响因素分析  

Analysis of influencing factors for the prognosis of anti-vascular endothelial growth factor drug treatment in patients with macular neovascularization under 45 years old

作　　者：高璐 张妮娜 陈兆乾 张文芳[2] Gao Lu;Zhang Nina;Chen Zhaoqian;Zhang Wenfang(The Second Clinical College of Lanzhou University,Lanzhou 730000,China;Department of Ophthalmology,The Second Hospital of Lanzhou University,Lanzhou 730000,China)

机构地区：[1]兰州大学第二临床医学院,兰州730000 [2]兰州大学第二医院眼科,兰州730000

出　　处：《中华眼底病杂志》2025年第2期133-140,共8页Chinese Journal of Ocular Fundus Diseases

摘　　要：目的观察并分析年龄<45岁黄斑区新生血管(MNV)患者抗血管内皮生长因子(VEGF)药物治疗预后的影响因素。方法回顾性临床病例研究。2020年1月至2024年1月于兰州大学第二医院眼科检查确诊并接受抗VEGF药物治疗的MNV患者89例96只眼纳入研究。患者年龄均<45岁。所有患者均行最佳矫正视力(BCVA)、光相干断层扫描(OCT)检查;同时行OCT血管成像(OCTA)检查49只眼。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。采用OCT仪测量黄斑中心凹视网膜厚度(CMT)。采用OCTA设备自带软件测量MNV病灶大小。所有患眼给予玻璃体腔注射抗VEGF药物治疗1次,其后经评估按需给药。治疗后随访时间≥6个月。随访时采用治疗前相同设备和方法行相关检查。以末次随访为疗效判定时间点。根据MNV病灶的OCT图像特征,将患眼分为纤维瘢痕组、无纤维瘢痕组,分别为52(54.16%,52/96)、44(45.83%,44/96)只眼。根据末次随访时CMT、BCVA较基线时的变化,将患眼分为CMT减少组、CMT增加组和BCVA提升组、BCVA降低组,分别为66(68.75%,66/96)、30(31.25%,30/96)只眼和74(77.08%,74/96)、22(22.92%,22/96)只眼。组间非正态分布计量资料比较采用Mann-Whitney U检验;logistic回归分析影响MNV患者预后的独立因素。结果纤维瘢痕组、无纤维瘢痕组患者年龄(Z=−0.928)、性别构成比(χ^(2)=0.123)比较,差异均无统计学意义(P>0.05);随访时间≥36、<36个月的眼数比较,差异有统计学意义(χ^(2)=3.906,P=0.048);MNV病灶大小比较,差异有统计学意义(Z=−2.385,P=0.017);不同血管网形态的眼数比较,差异有统计学意义(χ^(2)=12.936,P=0.001)。治疗前、末次随访时,患眼CMT分别为267.50(237.25,311.75)、242.00(217.25,275.75)μm;logMAR BCVA分别为0.20(0.10,0.50)、0.35(0.16,0.60)。治疗前、末次随访时CMT、logMAR BCVA比较,差异均有统计学意义(Z=−3.311、−1.984,P=0.001、0.047)。CMT减�Objective To observe and analyze the influencing factors for the prognosis of anti-vascular endothelial growth factor(VEGF)drug treatment in patients with macular neovascularization(MNV)under 45 years old.Methods A retrospective clinical case study.A total of 89 MNV patients with 96 eyes who were diagnosed and treated with anti-VEGF drugs in Department of Ophthalmology of The Second Hospital of Lanzhou University from January 2020 to January 2024 were included in the study.The ages of all patients were<45 years old.All patients underwent best corrected visual acuity(BCVA)and optical coherence tomography(OCT)examinations;49 eyes underwent OCT angiography(OCTA)examination.The BCVA examination was carried out using the international standard visual acuity chart and was converted into the logarithm of the minimum angle of resolution(logMAR)visual acuity for statistics.The macular foveal thickness(CMT)was measured using an OCT instrument.The size of the MNV lesion was measured using the software of the OCTA self-contained device.The affected eyes were given intravitreal injection of anti-VEGF drugs once,and then the drugs were administered as needed after evaluation.The follow-up time after treatment was≥6 months.During the follow-up,relevant examinations were performed using the same equipment and methods as before treatment.The last follow-up was taken as the time point for efficacy evaluation.According to the OCT image characteristics of the MNV lesions,the affected eyes were divided into the fibrous scar group and the non-fibrous scar group,with 52(54.16%,52/96)and 44(45.83%,44/96)eyes respectively.Comparing the CMT and BCVA at the last follow-up with those at the baseline,the affected eyes were divided into the CMT reduction group,the CMT increase group,the BCVA improvement group and the BCVA reduction group,with 66(68.75%,66/96),30(31.25%,30/96)eyes and 74(77.08%,74/96),22(22.92%,22/96)eyes respectively.The Mann-Whitney U test was used for the comparison of non-normally distributed measurement data between gro

关 键 词：黄斑区新生血管 抗血管内皮生长因子 病理性近视 光相干断层扫描 影响因素 

分 类 号：R774.5[医药卫生—眼科]