抗VEGF治疗糖尿病性黄斑水肿患者房水内细胞因子、SD-OCT影像学特征变化及相关性研究  

A study on the changes of intraocular cytokines in aqueous humor of DME patients undergoing anti-VEGF therapy and their correlation with SD-OCT imaging characteristics

作　　者：李欢 王伟 王运昌 董萍 Li Huan;Wang Wei;Wang Yunchang;Dong Ping(Department of Diabetes Ophthalmology,Hebei Eye Hospital,Hebei,Xingtai 054000,China)

机构地区：[1]河北省眼科医院/河北省眼科学重点实验室糖尿病眼科,河北邢台054000

出　　处：《疑难病杂志》2025年第3期349-353,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：河北省科技计划资助项目(20577706D);邢台市重点研发计划项目(2022ZC232)。

摘　　要：目的探讨糖尿病性黄斑水肿(DME)患者行抗血管内皮生长因子(VEGF)治疗眼内细胞因子及频域光学相干断层扫描(SD-OCT)变化情况及对预后的影响。方法选择2022年1月-2023年12月河北省眼科医院收治的DME患者80例为观察组,给予抗VEGF治疗,并根据黄斑中心凹厚度(CMT)下降率将DME患者分为治疗敏感亚组37例和治疗不敏感亚组43例,根据椭圆体带及外界膜连续性分为连续亚组31例和中断亚组49例,根据房水内VEGF水平分为VEGF正常亚组13例和VEGF升高亚组67例。另选择同期医院治疗的白内障合并糖尿病患者50例为对照组。治疗前均完善房水内细胞因子检测和SD-OCT检查,并分析其与DME患者SD-OCT影像学特征的相关性。结果观察组房水内IL-6、IL-8、TNF-α、VEGF水平高于对照组(t/P=18.836/<0.001,25.756/<0.001,7.321/<0.001,16.937/<0.001);治疗不敏感亚组DME患者房水内IL-6、IL-8、VEGF水平及高反射灶(HF)数量、外界膜连续性中断比例低于治疗敏感亚组(t/P=3.767/<0.001,2.867/0.005,2.193/0.031,3.353/0.001,7.011/0.008);中断亚组DME患者房水内VEGF水平及CMT厚度高于连续亚组(t/P=2.732/0.008,2.193/0.031);VEGF升高亚组DME患者抗VEGF治疗后CMT低于治疗前(t/P=8.999/<0.001);DME患者高反射灶(HF)数量与房水内VEGF水平呈低度正相关,与房水内IL-6、IL-8水平呈中度正相关(r/P=0.301/0.007,0.536/0.023,0.788/<0.001)。结论HF与外界膜的连续性,可以被视为评价DME患者抗VEGF治疗效果的观察指标。Objective To investigate the changes of intraocular cytokines and spectral domain optical coherence tomography(SD-OCT)in patients with diabetes macular edema undergoing anti vascular endothelial growth factor treatment,and the impact on prognosis.Methods Eighty patients with DME were selected,and cytokine detection in aqueous humor was completed before receiving anti VEGF treatment.The correlation between these factors and the SD-OCT imaging characteristics of the patients before and after treatment was analyzed.Results The levels of IL-6,IL-8,TNF-α,and VEGF in the aqueous humor of the observation group were higher than those in the control group(t/P=18.836/<0.001,25.756/<0.001,7.321/<0.001,16.937/<0.001);The levels of IL-6,IL-8,VEGF in the aqueous humor of DME patients in the treatment insensitive subgroup,as well as the number of HF and the proportion of interruption of external membrane continuity,were lower than those in the treatment sensitive subgroup(t/P=3.767/<0.001,2.867/0.005,2.193/0.031,3.353/0.001,7.011/0.008);The VEGF levels and CMT thickness in the aqueous humor of DME patients in the interrupted subgroup were higher than those in the continuous subgroup(t/P=2.732/0.008,2.193/0.031);The CMT of DME patients with elevated VEGF after anti VEGF treatment was lower than that before treatment(t/P=8.999/<0.01);The number of HF in DME patients is weakly positively correlated with VEGF levels in aqueous humor,and moderately positively correlated with IL-6 and IL-8 levels in aqueous humor(r/P=0.301/0.007,0.536/0.023,0.788/<0.001).Conclusion HF and interruption of ELM can be used as an observation indicator to evaluate the therapeutic effect of anti-VEGF.The patient's insensitivity to anti VEGF treatment may be considered as treated with hormonal drugs.

关 键 词：糖尿病性黄斑水肿 抗血管内皮生长因子 频域光学相干断层扫描 炎性因子 相关性 

分 类 号：R774.5[医药卫生—眼科]