玻璃体内注射康柏西普联合25G玻璃体微创术治疗糖尿病视网膜病变的临床研究

Clinical study on conbercept combined with minimally invasive vitrectomy in the treatment of patients with diabetic retinopathy

目的 探讨玻璃体内注射康柏西普联合25 G玻璃体微创手术在糖尿病视网膜病变患者中的应用效果.方法 选取2015年9月至2017年6月长治市人民医院收治的糖尿病视网膜病变患者81例,按照随机数字表法分组,对照组40例采用25 G玻璃体微创手术治疗,观察组41例给予玻璃体内注射康柏西普联合25 G玻璃体微创手术治疗,观察比较两组眼内填充物填充率及手术前后眼压、最佳矫正视力（BCVA）、视网膜厚度变化情况,并统计两组手术前后血清基质细胞衍生因子-1（SDF-1）、β2-糖蛋白Ⅰ（β2-GPⅠ）水平变化情况及并发症发生情况.结果 观察组眼内填充物填充率为12.20％（5/41）,低于对照组的30.00％（12/40）,差异有统计学意义（χ^2=0.871,P=0.049）;术后3个月观察组BCVA高于对照组,视网膜厚度小于对照组,差异均有统计学意义（t1=4.352,P1=0.000;t2=9.709,P2=0.000）;观察组术后5 d血清β2-GPⅠ、SDF-1水平均低于对照组,差异均有统计学意义（t1=22.978,P1=0.000;t2=26.875,P2=0.000）;观察组并发症发生率为7.32％（3/41）,低于对照组的25.00％（10/40）,差异有统计学意义（χ^2=0.699,P=0.030）.结论 玻璃体内注射康柏西普联合25 G玻璃体微创手术可降低糖尿病视网膜病变患者视网膜厚度及血清β2-GPⅠ、SDF-1水平,术中患者眼内填充物填充率低,有助于改善患者视功能,降低并发症发生率.

Objective To investigate the application effect of conbercept combined with minimally invasive vitrectomy in the treatment of patients with diabetic retinopathy .Methods From September 2015 to June 2017 , A total of 81 cases （81 eyes） of diabetic retinopathy in the People＇s Hospital of Changzhi were divided into two groups according to the random number table ,40 cases in the control group treated with 25 G minimally invasive vitrectomy , and 41 cases in the observation group treated with intravitreal injections of conbercept ＋25G minimally invasive vitrectomy.The filling rate of intraocular fillers,intraocular pressure （IOP）,best corrected visual acuity （BCVA）,and the change of retinal thickness before and after operation were observed and compared in two groups .The changes of serum levels of stromal cell derived factor -1 （ SDF-1 ） and β2-glycoprotein Ⅰ（β2-GPⅠ） before and after operation and complications were compared between the two groups .Results The filling rate of intraocular fillers in the observation group was 12.20%（5/41）,which was lower than that in the control group [30.00%（12/40）],and the difference was statistically significant （χ^2=3.871,P=0.049）.Three months after operation ,the BCVA in the observation group was higher than that in the control group ,and the thickness of the retina was smaller than that in the control group,the differences were statistically significant （t1=4.352,P1 =0.000;t2 =9.709,P2 =0.000）.The serum levels of β2-GP I and SDF-1 in the observation group were lower than those in the control group at 5 days after operation,and the differences were statistically significant （t1=22.978,P1=0.000;t2=26.875,P2=0.000）. The incidence rate of complication in the observation group was 7.32% （3/41）,which was lower than that in the control group 25.00% （10/40）,and the difference was statistically significant （χ^2=4.699,P =0.030）.＆nbsp;Conclusion Conbercept combined with minimally invasive vitrectomy in the treatment of patients with diabetic retinopathy can reduce the thickness of retina and the serum levels of β2-GP Ⅰ and SDF -1.The filling rate of intraocular fillers in the patients is low ,and it can help to improve the visual function of the patients and reduce the incidence of complications .