雷珠单抗辅助治疗增生型糖尿病视网膜病变的疗效和血清Apelin水平的观察

Therapeutic Effect of Ranibizumab in Treatment of Proliferative Diabetic Retinopathy and Its Effect on Serum Apelin Level

目的探讨雷珠单抗辅助治疗对增生型糖尿病视网膜病变的临床治疗效果,以及其对血清Apelin水平的影响。方法 2017年6月至2018年7月,增生型糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)患者78例94只眼,采用随机数字表法随机分为两组,对照组患者39例45只眼,采用全视网膜激光光凝治疗(panretinal photoc-oagulation,PRP),不给予雷珠单抗辅助治疗;观察组患者39例49只眼,在PRP治疗前5~7 d给予雷珠单抗治疗。比较两组患者治疗前及治疗后1、3和6个月,检测患者最佳矫正视力(best corrected visual acuity,BCVA)、黄斑中心凹厚度(central macular thickness,CMT)及视网膜新生血管面积;同时,记录两组患者治疗期间激光治疗参数(功率、光斑数以及功率密度);治疗前后血清Apelin水平改变;以及两组患者接受治疗至治疗后6个月内眼压升高、视网膜脱离、眼内炎等不良反应发生情况。结果治疗后各时间点两组患者BCVA、CMT水平及视网膜新生血管面积的比较,差异均有统计学意义(P <0. 05),且观察组患者各时间点BCVA、CMT水平及视网膜新生血管面积均明显低于对照组(P<0. 05);治疗期间观察组所需激光能量密度、光斑个数显著低于对照组(P<0. 05);治疗后,两组患者的血清Apelin水平均显著下降(P<0. 05),观察组显著低于对照组(P<0. 05);两组患者从开始接受治疗至治疗后6个月内不良反应发生率比较,差异无统计学意义(P>0. 05)。结论雷珠单抗辅助治疗糖尿病视网膜病变(Diabetic retinopathy,DR)能降低患者BCVA、CMT水平及新生血管面积,改善视力,可降低激光对视网膜的损伤并提高疗效,并能降低患者血清Apelin水平且安全性较好,值得推广应用。

Objective To investigate the clinical effect of Ranibizumab as an adjuvant treatment on proliferative diabetic retinopathy and its effect on serum Apelin levels.Methods Totally 78 patients(94 eyes)with proliferative diabetic retinopathy(PDR)treated from Jun. 2017 to Jul. 2018 were randomly divided into the control group(39 patients,45 eyes)and observation group(39 patients,49 eyes). The patients in the control group were given panretinal photocoagulation(PRP),and those in the observation group were treated with ranibizumab 5-7 d before the PRP. After the treatment,their 1-month,2-month and 6-month best corrected visual acuity(BCVA),central macular thickness(CMT)and retinal neovascularization were compared. The PRP parameters(power energy,number of spots,energy density)during the treatment and serum levels of Apelin before and after the treatment were monitored. Adverse reactions such as elevated intraocular pressure,retinal detachment and endophthalmitis were followed for 6 months after the treatment.Results There were significant differences in BCVA,CMT and retinal neovascularization between the two groups at each time point after the treatment(P<0. 05). Additionally,the BCVA,CMT and retinal neovascularization were lower in the observation group(P<0. 05). The power energy,number of spots and power density of the observation group were significantly lower than those of the control group during the PRP. After the treatment,the serum Apelin levels of both groups dropped significantly(P<0. 05),but the level was much lower in the observation than in the control group(P<0. 05). No significant difference in the incidence of adverse reactions between the two groups were observed within 6 months after the treatment(P>0. 05).Conclusions Raychem monoclonal antibody as an adjuvant therapy will reduce BCVA,CMT level and neovascular area,improve visual acuity,reduce laser damage to the retina and improve curative effect while causing the drop of serum Apelin level.