抗血管内皮生长因子治疗在老年糖尿病视网膜病变中的应用及对促炎因子的影响  

Application of anti-vascular endothelial growth factor for elderly diabetic retinopathy and its impact on pro-inflammatory factors

作　　者：张新桥 李幸 刘明远[2] 张慧芹[1] 陈海婷[1] Zhang Xinqiao;Li Xing;Liu Mingyuan;Zhang Huiqin;Chen Haiting(Department of Ophthalmology,Cangzhou Central Hospital,Cangzhou 061000,Hebei Province,China;Department of Anesthesiology,Cangzhou Central Hospital,Cangzhou 061000,Hebei Province,China)

机构地区：[1]沧州市中心医院眼科,河北沧州061000 [2]沧州市中心医院麻醉科,河北沧州061000

出　　处：《中华老年多器官疾病杂志》2025年第3期207-211,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：河北省医学科学研究课题计划项目(20232109);沧州市重点研发计划指导项目(222106098)。

摘　　要：目的研究抗血管内皮生长因子(VEGF)治疗在改善老年糖尿病性视网膜病变(DR)患者预后中的价值及对促炎症因子的影响。方法将2022年1月至2023年1月沧州市中心医院收治的93例(126只眼)老年增殖性视网膜病变(PDR)患者纳为研究对象,其均拟行玻璃体切除术(PPV),按照患者PPV术前是否进行玻璃体腔注射抗VEGF药物分为观察组(33例,45只眼;注射抗VEGF药物)及对照组(60例,81只眼;未注射抗VEGF药物),在23G玻璃体切除术开始前,采集患者患眼房水,检测房水内血管内皮生长-A(VEGF-A)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、转化生长因子-β(TGF-β)水平,并观察两组PPV手术相关指标及术后视力。采用SPSS 22.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、χ^(2)检验及Fisher确切概率检验。采用Pearson线性相关分析法分析患者房水内VEGF-A与其他细胞因子间的相关性。结果观察组患眼房水内VEGF-A、IL-6以及TNF-α水平均低于对照组,差异均有统计学意义(均P<0.05)。Pearson相关分析提示,观察组房水内VEGF-A水平与IL-6及TNF-α水平之间均呈弱正相关(r=0.261,0.273;P=0.037,0.031)。观察组患者手术时间短于对照组,术中新生血管出血次数、电凝止血使用次数、术中医源性裂孔眼低于对照组,差异均有统计学意义(均P<0.05);术后2周,观察组视力提高率高于对照组;术后6个月,观察组最佳矫正视力高于对照组,且观察组术后玻璃体再积血及术后再出血眼数低于对照组,差异均有统计学意义(均P<0.05)。结论抗VEGF药物能有效减少老年PDR患者PPV术中出血,提高手术安全性;此外,抗VEGF药物还可能通过降低患眼VEGF-A及炎症因子水平,帮助控制PDR病情。Objective To assess the value of anti-vascular endothelial growth factor(VEGF)therapy in improving the prognosis of elderly patients with diabetic retinopathy(DR)and its impact on pro-inflammatory factors.Methods A total of 93 elderly patients(126 eyes)with proliferative DR(PDR)admitted to our hospital from January 2022 to January 2023 were included in the study.All of them were scheduled to undergo pars plana vitrectomy(PPV).According to whether receiving intravitreal injection of anti-VEGF drug before PPV,they were divided into observation group(33 cases,45 eyes,injection of anti-VEGF drug)and control group(60 cases,81 eyes,no such injection).Before 23 G vitrectomy,the aqueous humor was collected to detect the levels of vascular endothelial growth factor-A(VEGF-A),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and transforming growth factor β(TGF-β).The PPV-related indicators and postoperative visual acuity were observed and compared between two groups.SPSS statistics 22.0 was used for statistical analysis.Data comparison between two groups was performed using t test,χ^(2) test or Fisher's exact probability test depending on data type.Pearson linear correlation analysis was employed to analyze the correlation between VEGF-A and other cytokines in the aqueous humor.Results The levels of VEGF-A,IL-6 and TNF-αin aqueous humor were significantly lower in observation group than the control group(all P<0.05).Pearson correlation analysis suggested that the VEGF-A level in aqueous humor in observation group was weakly positively correlated with IL-6 and TNF-α levels(r=0.261,0.273;P=0.037,0.031).The observation group had obviously shorter operation time,less intraoperative neovascularization bleeding,less electrocoagulation hemostasis,and lower incidence of iatrogenic hiatus eyes breaks than the control group(all P<0.05).When compared with the control group,the visual acuity improvement rate at two weeks after surgery was better in the observation group,and at six months after surgery,the ratio of best correct

关 键 词：老年人 糖尿病视网膜病变 玻璃体切除术 细胞因子 手术效果 

分 类 号：R774.1[医药卫生—眼科] R592[医药卫生—临床医学]