玻璃体腔注射雷珠单抗联合光动力疗法治疗湿性年龄相关性黄斑变性的疗效及对房水中VEGI、IL-1β水平的影响

Efficacy of intravitreal injection of ranibizumab combined with photodynamic therapy in the treatment of wet age-related macular degeneration and its influence on the levels of vascular endothelial growth inhibitor and interleukin-1βin aqueous humor

目的研究玻璃体腔注射雷珠单抗(IVR)联合光动力疗法(PDT)治疗湿性年龄相关性黄斑变性(wAMD)的疗效及对房水中血管内皮生长抑制因子(VEGI)、白介素1β(IL-1β)水平的影响。方法选取华中科技大学协和深圳医院眼科2018年6月至2020年6月期间接诊的54例(72眼)wAMD患者作为研究对象,按照随机数表法分为研究组27例(34眼)和对照组27例(38眼)。对照组患者采用单纯玻璃体腔注射雷珠单抗治疗,研究组患者采用玻璃体腔注射雷珠单抗联合PDT治疗。治疗前和治疗3个月后,比较两组患者的眼压、最佳矫正视力、中心凹视网膜厚度(CRT);比较两组患者治疗前后房水中的VEGI、房水中IL-1β水平及治疗后不良反应发生情况。结果治疗前,两组患者的眼压、最佳矫正视力、CRT比较差异均无统计学意义(P>0.05);治疗后,两组患者的最佳矫正视力均明显提升,且研究组患者最佳矫正视力为0.57±0.23,明显高于对照组的0.45±0.18,两组患者CRT指标均明显降低,且研究组患者的CRT为(266.4±17.4)μm,明显低于对照组的(304.6±18.6)μm,差异均有统计学意义(P<0.05),而两组患者治疗前后的眼压无明显变化,差异均无统计学意义(P>0.05);治疗前,两组患者房水中的VEGI、IL-1β水平比较差异均无统计学意义(P>0.05);治疗后,两组患者房水中的VEGI水平明显提升,且研究组患者的VEGI水平为(78.6±5.4)pg/mL,明显高于对照组的(63.3±4.2)pg/mL,两组患者房水中的IL-1β水平明显下降,且研究组患者的IL-1β水平为(23.4±1.6)pg/mL,明显低于对照组的(25.7±1.8)pg/mL,差异均有统计学意义(P<0.05);研究组患者不良反应总发生率为7.41%,明显低于对照组的29.63%,差异均有统计学意义(P<0.05)。结论玻璃体腔注射雷珠单抗联合PDT治疗wAMD疗效显著,其可有效提高患者的最佳矫正视力和降低中心凹视网膜厚度,降低不良反应发生率,且VEGI、IL-1β参与了wAMD的发生与发展,对指导wAMD的治疗具有临床应用价值。

Objective To study the efficacy of intravitreal injection of ranibizumab(IVR)combined with photodynamic therapy(PDT)in the treatment of wet age-related macular degeneration(wAMD)and its effect on the levels of vascular endothelial growth inhibitor(VEGI)and interleukin-1β(IL-1β)in aqueous humor.Methods A total of 54 patients(72 eyes)with wet age-related macular degeneration(WMD)from June 2018 to June 2020 in Xiehe Shenzhen Hospital,Huazhong University of Science and Technology were selected and randomly divided into study group(27 cases,34 eyes)and control group(27 cases,38 eyes).The control group was treated with intravitreal injection of ranibizumab,while the study group was treated with intravitreal injection of ranibizumab combined with PDT.Before treatment and 3 months after treatment,intraocular pressure(IOP),best corrected visual acuity,and foveal retinal thickness(CRT)were compared between the two groups.The levels of VEGI and IL-1βin aqueous humor and the incidence of adverse reactions after treatment were compared between the two groups before and after treatment.Results Before treatment,there were no significant differences in IOP,best corrected visual acuity,and CRT between the two groups(P>0.05).After treatment,the best corrected visual acuity in both groups was significantly improved,and the best corrected visual acuity in the study group was 0.57±0.23,which was significantly higher than 0.45±0.18 in the control group.CRT indexes in both groups were significantly decreased,and the CRT in the study group was(266.4±17.4)μm,significantly lower than(304.6±18.6)μm in the control group,with statistically significant differences(P<0.05).There was no significant change in IOP before and after treatment in the two groups,and the difference was not statistically significant(P>0.05).Before treatment,there was no statistically significant difference in the levels of VEGI and IL-1βin aqueous humor between the two groups(P>0.05).After treatment,the level of VEGF in aqueous humor of the two groups was significantly increased,and the level of VEGF in the study group was(78.6±5.4)pg/mL,which was significantly higher than(63.3±4.2)pg/mL in the control group;the level of IL-1βin aqueous humor of the two groups was significantly decreased,and the level of IL-1βin the study group was(23.4±1.6)pg/mL,which was significantly lower than(25.7±1.8)pg/mL in the control group(P<0.05).The total incidence of adverse reactions in the study group was 7.41%,which was significantly lower than 29.63%in the control group(P<0.05).Conclusion Intravitreal injection of ranibizumab combined with photodynamic therapy has significant curative effect in the treatment of wet age-related macular degeneration.It can effectively improve the patient’s best corrected visual acuity and foveal retinal thickness,and reduce the incidence of adverse reactions.VEGI and IL-1βare involved in the occurrence and development of wet age-related macular degeneration,which have certain clinical application value for guiding the treatment of wAMD.