3种视网膜新生血管抑制药治疗湿性AMD的临床对比研究

Clinical comparison of 3 new blood vessels inhibitors against wet age-related macular degeneration

目的:比较3种视网膜新生血管抑制药治疗湿性老年黄斑变性(AMD)的临床疗效,探讨其临床应用价值。方法:按照随机数字法将2013年8月-2016年10月某院收治的114例(114眼)湿性AMD患者分为A、B、C 3组,每组38例。A组患者静脉输注维替泊芬结合光动力疗法,B组与C组患者分别玻璃体内腔注射雷珠单抗与康柏西普,均每月给药1次,治疗3个月,随访3个月。比较治疗前及治疗后1个月、3个月、6个月3组患者的裸眼视力、黄斑中心视网膜厚度、脉络膜新生血管(CNV)渗漏面积以及并发症发生情况。结果:治疗前,3组患者的裸眼视力、黄斑中心视网膜厚度及CNV渗漏面积比较差异无显著性(P>0.05),治疗后,3组患者的裸眼视力均显著提高、黄斑中心视网膜厚度及CNV渗漏面积均显著减小(P<0.05)。A组在治疗后1、3个月的裸眼视力显著低于B与C组、黄斑中心视网膜厚度及CNV渗漏面积显著大于B与C组(P<0.05),C组在治疗后1个月的裸眼视力显著低于B组、黄斑中心视网膜厚度及CNV渗漏面积显著大于B组(P<0.05);治疗后6个月,3组患者的裸眼视力、黄斑中心视网膜厚度及CNV渗漏面积比较差异无显著性(P>0.05);3组患者并发症的发生率差异无显著性(P>0.05)。结论:在湿性AMD的临床治疗中,雷珠单抗的前期效果明显,但3种药物的后期效果相当。

OBJECTIVE To compare the clinical efficacy of new blood vessels inhibitors in patients with wet age-related macular degeneration（AMD）.METHODS A total of 114 wet AMD patients（114 eyes）were divided into group A,group B and group C by random number table in a hospital from August 2015 to October 2016,34 cases in each group.Patients were treated by intravenous verteporfin combined with photodynamic therapy in group A,by vitreous intraocular parenteral ranibizumab and conbercept in group A and group B,respectively.The patients were dosed once a month for 3 moths consecutively,and followed up for 3 months.The uncorrected visual acuity,central macular foveal retinal thickness,choroidal neovascularization（CNV）leakage area and complication were compared before treatment and in the first,third,sixth month after treatment.RESULTS There was no statistical significance in uncorrected visual acuity,central macular foveal retinal thickness and CNV leakage area between three groups before treatment（P〈0.05）.The uncorrected visual acuity was significantly increased,central macular foveal retinal thickness and CNV leakage area were significantly decreased in three groups after treatment（P〈0.05）.The uncorrected visual acuity of group A was significantly lower than that of group B and group C,the central macular foveal retinal thickness and CNV leakage area of group A were significantly lesser than that of group B and group C in the first and third month after treatment（P〈0.05）.The uncorrected visual acuity of group C was significantly lower than that of group B,the central macular foveal retinal thickness and CNV leakage area of group A was significantly lesser than that of group B in the first month after treatment（P〈0.05）.There was no statistical significance in uncorrected visual acuity,central macular foveal retinal thickness and CNV leakage area between three groups in the sixth month after treatment（P〈0.05）.There was no statistical significance in complications between three groups（P〈0.05）.CONCLUSION Ranibizumab has significantly early efficacy in the treatment of wet AMD,but the late efficacy is comparable between three drugs.