玻璃体内注射康柏西普联合口眼糖网康后房水中血管内皮生长因子浓度的变化

Clinical observation of concentration of vascular endothelial growth factor in aqueous humor after Conbercept intravitreal injection combined with oral use of traditional Chinese medicine Tangwang kang for the treatment of diabetic retinopathy

目的观察非增生型糖尿病视网膜病变（NPDR）玻璃体内注射康柏西普配合口服中药糖网康后房水中血管内皮生长因子（VEGF）的浓度变化，以便于评价其临床疗效。方法糖尿病视网膜病变（DR）32例（32眼），治疗组（16例）行玻璃体内注射抗VEGF药物康柏西普及前房穿刺，同期服用中药糖网康胶囊。对照组（16例）单纯行玻璃体内注射康柏西普再行前房穿刺术。两组在第1次玻璃体内注药后间隔4、6、8及10周分别于注药前抽取房水，采用双抗体夹心酶联免疫吸附法定量检测房水中VEGF的浓度。随访观察视力、眼底情况的变化。结果32例（32眼）玻璃体内注射康柏西普DR房水标本。（1）术前房水中VEGF平均含量为（163．21±67．23）pg／ml，治疗后6周治疗组房水中VEGF含量为（118．2±3．47）pg／ml；对照组为（128．13±6．21）pg／ml。两组手术前后比较差异均具有统计学意义（P〈0．05）。治疗后两组间比较差异具有统计学意义。（2）治疗后两组视力均有显著提高，与治疗前相比，差异有统计学意义（治疗组t=4．365，P=0．031；对照组t=4．723，P=0．028）；治疗后治疗组与对照组两组之间差异有统计学意义（t=0．362，P〈0．05）。（3）术后两组眼底疗效较术前提高，术前与术后组比较差异具有统计学意义（P〈0．001）。治疗组与对照组间疗效差异也具有统计学意义（t=4．742，P〈0．05）。结论玻璃体内注射能改善眼的内环境VEGF含量以治疗DPDR；抗VEGF治疗时联合糖网康胶囊治疗，可减少眼的内环境VEGF含量，从而减少玻璃体内注射抗VEGF药物的次数，进一步推断糖网康作用途径与抗VEGF药物一致。

Objective To observe the concentration of vascular endothelial growth factor in aqueous humor after Conbercept intravitreal injection combined with oral use of Chinese traditional medicine--Tangwangkang for the treatment of diabetic retinopathy （DR）, and clinically evaluate the curative effect of this combined treatments. Methods The DR patients diagnosed from May 2013 to November 2014 were selected. Sixteen patients of treatment group received Conbercept intravitreal injection and paracentesis of anterior chamber combined with Tangwangkang capsule during the period of treatment, while other sixteen patients of control group only received Conbercept intravitreal injection and paracentesis of anterior chamber. The aqueous humor of the patients of both groups were extracted respectively 4,6,8 and 12 weeks after intravitreal injection, and the concentration of VEGF in aqueous humor was measured using double antibody sandwich enzyme linked immunosorbent assay. The vision and the variations of fundus oculi were determined by follow-up examinations. Results The samples of aqueous humor of all 32 DR patients were collected. （1） Average concentration of VEGF in DR patients was（ 163.21 ± 67.23 ） pg/ml before the treatment and 6 weeks after the treatment, the concentrations of VEGF in treatment and control group were （118.2 ± 3.47 ） pg/ml and （128.13± 6.21 ） pg/nd respectively. The differences between before and after the treatment in both two groups were statistically significant （ P 〈0.05 ）. （2） The differences between before and after the treatment in both two groups were statistically significant （treatmem group t =4. 365 ,P =0.031; control group t =4.723 ,P =0. 028） ,and the difference between the two groups after the treatment was also statistically significant（ t = 0. 362, P 〈 0.05 ）. （3） Both treatments significantly improved the fundus oculi and the differences between before and after the treatment were statistically signifieant（P 〈0.001 ）, and the difference between the two groups was also statistically significant. （ t = 4.742, P 〈 0.05 ）. Conclusion Intravitreal injection can effectively ameliorate VEGF concentration inside of the eyes to cure DPDR. A combination of intravitreal injection and Tangwangkang capsule may reduce VEGF concentration of aqueous humor and consequently decrease the injection times of anti VEGF drugs,which may suggest that the acting pathway of Tangwangkang is consistent with that of anti VEGF drugs.