不同OCT分型糖尿病性黄斑水肿对玻璃体腔注射康柏西普的疗效差异及相关因素分析

Efficacy of intravitreal injection of conbercept for different types of diabetic macular edema based on optical coherence tomography and risk factors analysis

目的观察不同相干光层析成像术(OCT)分型糖尿病性黄斑水肿(DME)对玻璃体腔注射康柏西普的疗效差异及相关因素分析。方法回顾性病例研究。接受康柏西普玻璃体腔注射治疗的DME 61例(78只眼)纳入研究。根据眼底彩色照相及OCT检查结果明确DME诊断和分型。将DME分为弥漫增厚型(DRT)、囊样黄斑水肿型(CME)和浆液性视网膜脱离型(SRD)3种类型。测量患眼最佳矫正视力(BCVA),频域OCT测量患眼黄斑中心凹厚度(CFT),并通过OCT灰度图观察患眼椭圆体带(EZ)和视网膜外界膜(ELM)的完整性。运用单因素方差分析判断不同亚型DME中临床特征和眼部参数的分布是否有统计学差异;运用多因素logistics回归分析检验与应答良好存在相关性的临床和影像学因素。结果最终61例(78只眼)纳入本研究。年龄(63.4±10.5)岁(31~79岁)。其中DRT型28只眼,CME型21只眼,SRD型29只眼。3组间基线时在DME病程,CFT以及ELM和EZ的完整性上有统计学差异;不同DME分型接受了康柏西普玻璃体腔注射6个月后3组间CFT下降值差异有统计学意义(P=0.001),并且3组间BCVA(logMAR)改变值(P=0.02)和累计眼内注射次数(P=0.03)的差异也具有统计学意义,DRT型BCVA改善最大,累计注射次数最少;DRT型,CME型和SRD型患者中应答良好的比例分别为15/28(53.57%),5/21(23.81%)和7/29(24.14%),差异有统计学意义(P=0.01),DRT型应答最好;logistic回归分析结果显示合并SRF(OR=0.85,P=0.003)和VMT(OR=0.92,P=0.007)以及基线ELM不完整(OR=1.96,P=0.03)是DME对抗VEGF治疗应答良好的危险因素。结论不同OCT分型的DME接受抗VEGF治疗6个月后CFT下降值,BCVA改变值和累计眼内注射次数差异有统计学意义,SRD型CFT下降最明显,DRT型BCVA改善最大并且累计注射次数最少;不同分型DME接受抗VEGF治疗6个月的应答反应之间也有显著差异,DRT型应答最好。合并SRF和VMT以及基线ELM不完整是DME对抗VEGF治疗应答良好的危险因素。

Objective To observe the efficacy of intravitreal injection of conbercept(IVC)for different types of diabetic macular edema(DME)based on optical coherence tomography(OCT)and to assess risk factors for treatment response.Methods A total of 78 eyes with DME which had received IVC intravitreal injection were included in the analysis.According to the color fundus photography and morphological characteristics of OCT,DME was divided into 3 types,including the diffuse retinal thickening(DRT),cystoid macular edema(CME)and serous retinal detachment(SRD).Best-corrected visual acuity(BCVA)was measured in the affected eye.Frequency-domain OCT was used to measure the central foveal thickness(CFT),integrity of ellipsoidal zone(EZ)and external limiting membrane(ELM).The differences in clinical characteristics and ocular parameters among DME subtypes were analyzed by one-way ANOVA analysis.Multivariate logistic regression was used to analyze relevant clinical and imaging factors for good treatment response of IVC.Results In total,78 eyes of 61 patients(28 eyes with DRT,21 eyes with CME and 29 eyes with SRD,mean age 63.4±10.5 years)were included in the analysis.Significant differences were found in the DME duration,CFT,as well as the integrity of EZ and ELM among the three DME subtypes at baseline.After six months,significant differences were observed in the CFT decrease among the three groups(P=0.001),as well as in the BCVA change(P=0.02)and amount of injection times(P=0.03).The DRT group had the largest improvement in BCVA and the least injection times.The proportion of patients with good treatment response for IVC was 15/28(53.57%),5/21(23.81%)and 7/29(24.14%)in the DRT,CME,and SRD group respectively,and the difference was statistically significant(P=0.01).The good response rate was highest in the DRT group.Logistic regression analysis showed that the SRF(OR=0.85,P=0.003),VMT(OR=0.92,P=0.007),and disrupted ELM(OR=1.96,P=0.03)at baseline were independent risk factors for good treatment response.Conclusions There were significant differences in the change of BCVA,injection times,and CFT decrease among the three subtypes of DME.The CFT decrease was largest in the SRD subtype.The DRT group had the best BCVA and least injection times.The treatment response at six months after intravitreal IVC injection was also different among different DME types,and was the best in the DRT subtype.The SRF,VMT,and disrupted ELM were independent risk factors for good treatment response.