不同中医证型wAMD抗VEGF治疗前后房水细胞因子变化分析

Analysis of Cytokine Changes in Aqueous Humor Before and After Anti-VEGF Treatment in Wet Age-related Macular Degeneration Patients with Different Traditional Chinese Medicine Syndrome Types

目的:通过分析湿性年龄相关性黄斑变性(wAMD)患者中医证型分布特点以及比较不同证型wAMD患者抗血管内皮生长因子(VEGF)治疗前后房水中相关细胞因子浓度的差异,探讨wAMD患者抗VEGF治疗敏感性的差异。方法:纳入wAMD患者(观察组)及年龄相关性白内障患者(对照组)各30例(30只眼),观察组根据中医辨证,分为3型:脾虚湿困型、肝肾亏虚型、痰瘀互结型。分别收集观察组患者抗VEGF治疗前及治疗1个月后的房水,对照组患者房水于白内障术中收集,用Luminex技术进行房水10种细胞因子浓度检测。结果:①观察组中脾虚湿困型患者13例(13只眼,43%),肝肾亏虚型患者9例(9只眼,30%),痰瘀互结型患者8例(8只眼,27%),以脾虚湿困型患者多见;②抗VEGF治疗前后,观察组中医证型间患者房水细胞因子浓度基本一致,差异无统计学意义(P>0.05)。其中,痰瘀互结型患者经抗VEGF治疗后房水中的胎盘生长因子浓度较治疗前升高,差异具有统计学意义(P<0.05);③抗VEGF治疗前,观察组患者房水中白细胞介素-8、单核细胞趋化蛋白-1、血管生成素样蛋白4浓度明显高于对照组,差异均有统计学意义(P<0.05);两组其余细胞因子的浓度差异无统计学意义(P>0.05);④抗VEGF治疗后,观察组患者房水中仅VEGF-A浓度较治疗前明显下降,差异具有统计学意义(P<0.05)。结论:wAMD以脾虚湿困型患者居多,不同中医证型间抗VEGF治疗前后房水细胞因子水平基本一致,房水细胞因子IL-8、MCP-1、ANGPTL4可能参与wAMD疾病的发生。

Objective:To analyze the distribution of traditional Chinese medicine(TCM)syndrome types in wet age-related macular degeneration(wAMD)patients,to compare the differences in the concentrations of relevant cytokines in aqueous humor before and after anti-vascular endothelial growth factor(anti-VEGF)treatment in different syndrome types of wAMD patients,and to explore the differences in the sensitivity of anti-VEGF treatment in wAMD patients.Methods:Patients(30 eyes)with wAMD were included in the observation group,and patients with age-related cataract(30 eyes)were included in the control group,30 patients in each group.Patients in the observation group were divided into three types according to the TCM syndrome differentiation:spleen deficiency and dampness retention,deficiency of liver and kidney,and mixed phlegm and blood stasis.Aqueous humor of patients in the observation group before anti-VEGF treatment and 1 month after treatment were collected,and aqueous humor of patients in the control group were collected during cataract surgery.Luminex technology was applied to detect the concentrations of 10 cytokines in the aqueous humor.Results:①In the observation group,there were 13 patients(13 eyes,43%)of spleen deficiency and dampness retention syndrome,9 patients(9 eyes,30%)of liver and kidney deficiency syndrome,and 8 patients(8 eyes,27%)of mixed phlegm and blood stasis syndrome.②Before and after anti-VEGF treatment,the concentrations of aqueous humor factor in the observation group were the same,without difference among the TCM syndrome types(P>0.05).In the observation group,the concentration of placental growth factor(PIGF)in aqueous humor increased after anti-VEGF treatment in the mixed phlegm and blood stasis syndrome type,with statistical significance(P<0.05).③Before anti-VEGF treatment,the levels of interleukin-8(IL-8),macrophage chemoattractant protein-1(MCP-1)and angiopoietin-like 4(ANGPTL4)in the aqueous humor of patients in the observation group were significantly higher than those in the control group,with statistically significance(P<0.05).There were no significance on the other cytokines in the aqueous humor between the two groups,without statistical significance(P>0.05).④After anti-VEGF treatment,only the concentration of VEGF-A in the aqueous humor of the observation group decreased significantly compared with that before treatment,with statistical significance(P<0.05).Conclusions:Most wAMD patients were of spleen deficiency and dampness retention syndrome,and the cytokine levels in aqueous humor were usually the same before and after anti-VEGF treatment in different TCM syndrome types,and cytokines in aqueous humor such as IL-8,MCP-1 and ANGPTL4 might involve in the occurrence of wAMD.