光凝联合抗VEGF用药治疗黄斑水肿对患者房水血管活性分子表达的影响

Effects of photocoagulation combined with anti VEGF drugs on the expression of vasoactive molecules in aqueous humor of patients with macular edema

目的分析光凝联合抗VEGF用药治疗黄斑水肿的临床疗效及对患者房水血管活性分子表达的影响。方法前瞻性将2016年1月至2017年3月间收治的100例ME患者随机分为观察组及对照组。对照组采用光凝疗法治疗,观察组采用光凝联合抗VEGF用药(康柏西普)治疗;治疗前及治疗后1周、4周、8周时检查最佳矫正视力及黄斑厚度,第一次及第二次注射康柏西普时采集房水。对照组同期采集房水,并使用酶联免疫吸附法检测两组患者房水中白细胞介素-6(IL-6)、血管内皮生长因子(VEGF165b)及单核细胞趋化蛋白-1(MCP-1)水平,并观察并发症发生情况。结果经治疗后观察组患者最佳矫正视力检查结果明显提高,黄斑中心厚度明显降低,且各时间点均显著低于对照组(P<0.05),但治疗后1周对照组患者黄斑中心厚度升高,且显著高于治疗前(P<0.05);治疗后各时间点两组患者IL-6、VEGF165b及MCP-1水平均显著降低(P<0.05),且观察组各指标水平显著低于对照组(P<0.05);所有患者均未出现眼内炎、出血、视网膜脱离、白内障等不良反应,且无全身性不良反应发生。结论黄斑水肿患者采用光凝联合抗VEGF用药治疗可有效提高临床疗效,并改善房水中血管活性分子表达水平。

Objective To analyze the clinical efficacy of photocoagulation combined with anti VEGF drugs in the treatment of macular edema and its influence on the expression of vasoactive molecules in the aqueous humor of patients. Methods From January 2016 to March 2017,100 cases of ME patients were randomly divided into observation group and control group. The control group were given photocoagulation therapy,observation group were treated with photocoagulation combined with anti VEGF therapy; before and after treatment in 1,4 and 8 weeks,the best corrected visual acuity and macular thickness were checked. The aqueous humor was collected at the time of operation and the two time of the injection,while the control group received the aqueous humor at the same time. The levels of IL-6,VEGF165 b and MCP-1 in the aqueous humor were detected by enzyme-linked immunosorbent assay,and the incidence of complications was observed. Results After treatment,the best corrected visual acuity examination results and macular thickness of the patients in the observation group were significantly reduced,and which at each time point was significantly lower than that of control group（ P 〈 0. 05）. 1 weeks after treatment,the best corrected visual acuity and central macular thickness of patients in the control group increased,and were significantly higher than those before treatment（ P 〈 0. 05）. After treatment,IL-6 VEGF165 b and MCP-1 levels in the two groups were significantly decreased（ P 〈 0. 05）. Each index level of the observation group was significantly lower than that of the control group（ P 〈 0. 05）. Adverse reactions of endophthalmitis,hemorrhage,retinal detachment,cataract and so on were not found in all patients,and no systemic adverse reactions happened. Conclusion Photocoagulation combined with anti VEGF therapy can effectively improve the clinical efficacy and improve the expression level of vasoactive molecules in aqueous humor of patients with macular edema.