康柏西普预防增生型糖尿病视网膜病变手术出血的观察

Observation on Conbercept to prevent hemorrhage during operation for proliferative diabetic retinopathy

目的观察康柏西普预防增生型糖尿病视网膜病变(PDR)行玻璃体切除术术中出血的作用。方法回顾性分析2014年12月至2016年12月,玻璃体切除术治疗PDR 133例(245眼)的临床资料,患者随机分为3组,对照组47例(90眼)仅仅行玻璃体切除术,A组40例(70眼)术前行康柏西普玻璃体内注射,B组46例(85眼)手术前后均行康柏西普注射。对比各组的手术情况、眼压与视力;同时取患者外周血和房水,采用ELISA试剂盒测定血清血管内皮生长因子(VEGF)及房水炎性因子水平。结果A组和B组手术时间短,术中出血率和术后并发症发生率低(P<0.05)。时间和组别对视力、眼压、血清VEGF及房水炎性因子均有影响(P<0.05),且两者之间不存在交互作用(P>0.05)。治疗后1个月,3组眼压、血清VEGF及房水炎性因子均低于治疗前,视力优于治疗前;治疗后6个月,3组血清VEGF及房水炎性因子水平均低于治疗后1个月,视力优于治疗后1周;各参数差异均有统计学意义(P<0.05)。治疗前,3组视力、眼压、血清VEGF及房水炎性因子差异均无统计学意义(P>0.05),治疗后1个月,A组和B组视力优于对照组,且B组优于A组,A组和B组血清VEGF及房水炎性因子低于对照组,且B组低于A组;治疗后6个月,A组和B组视力优于对照组,且B组优于A组,眼压、血清VEGF及房水炎性因子低于对照组,且B组低于A组;组间差异均有统计学意义(P<0.05)。结论康柏西普能有效预防PDR患者玻璃体切除术术中出血,其作用机制可能与抑制视网膜血管增生和眼内炎性反应有关。

Objective To observe the preventive effect of Conbercept on hemorrhage during operation for proliferative diabetic retinopathy ( PDR) in vitrectomy. Methods The data of 245 eyes of 133 PDR patients were analyzed retrospectively and all cases were randomly divided into 3 groups of Conbercept. The control group, 90 eyes of 47 cases were treated with vitrectomy only, and group A, 70 eyes of 40 cases were treated with intravitreal injection of Conbercept before vitrectomy, and group B, 85 eyes of 46 cases were treated with intravitreal injection of Conbercept before and after vitrectomy. The general operation situation, intraocular pressure and visual acuity were compared among the three groups. The peripheral blood and aqueous humor were extracted to detect serum VEGF and inflammatory factor levels with ELISA methods. Results The operation time of group A B were shorter, and the rate of hemorrhage and complication rate in the two groups were lower than those of contral group, the difference were statistically significant (P<0. 05). There was influence of groups and time on visual acuity, intraocular pressure,serum VEGF and inflammatory factor level (P<0. 05), and there was no interaction between time and group (P>0. 05). At 1 month after treatment, the intraocular pressure, serum VEGF and inflammatory factor level of all groups were lower than those before treatment, the visual acuity of all groups were higher than those before treatment. At 6 months after treatment, the serum VEGF and inflammatory factor level of 3 groups were lower than those of 1 month after treatment, the visual acuity of 3 groups were higher than those of 1 month after treatment, the difference was statistically significant among the group (P<0. 05). Before treatment, the difference was not significant in visual acuity, intraocular pressure, serum VEGF and inflammatory factor levels among the three groups (P>0. 05). At 1 month after treatment, the visual acuity of group A and group B were higher than that of the control group, and that of group B was higher than group A, and the serum VEGF and inflammatory factor levels of the group A and group B were lower than those of the control group, and those of group B were lower than group A. At 6 months after treatment, the visual acuity of the group A and group B were higher than that of the control group, and the intraocular pressure, serum VEGF and inflammatory factor levels of the observation group were lower than those of the control group, the difference was statistically significant within the group (P <0. 05). Conclusion Intravitreal injection of Conbercept can prevent hemorrhage of PDR patients in vitrectomy effectively, and the mechanism may be related to the inhibition of retinal hyperplasia and intraocular inflammatory response.