抗VEGF、PRP对增生性糖尿病性视网膜病变疗效的Meta分析

Meta-analysis of the Efficacy of Anti-VEGF and PRP on Proliferative Diabetic Retinopathy

目的 评估抗血管内皮生长因子(vascular endothelial growth factor,VEGF)单独治疗、全视网膜激光光凝(panretinal photocoagulation,PRP)及联合治疗对增生性糖尿病性视网膜病变(proliferative diabetic retinopathy,PDR)的疗效。方法 检索Pubmed、The Cochrane Library、中国知网,选取符合的随机对照研究(randomized controlled trial,RCT)进行数据提取,采用改良Jadad量表评价所纳入研究的质量,使用Review Manager软件(版本5.4)进行Meta分析。结果 共纳入8篇RCT。对于视力提高程度,抗VEGF优于PRP,差异有统计学意义[MD=3.87,95%CI(2.32,5.41),P<0.000 01],抗VEGF优于联合治疗,差异无统计学意义[MD=2.20,95%CI(-0.38,4.78),P=0.1],联合治疗优于PRP,差异有统计学意义[MD=5.47,95%CI(2.63,8.31),P=0.000 2]。新生血管消退比较,抗VEGF优于PRP,但差异无统计学意义[OR=1.17,95%CI(0.73,1.88),P=0.51],联合治疗优于抗VEGF治疗,但差异无统计学意义[OR=0.43,95%CI(0.15,1.24),P=0.12],联合治疗优于PRP,差异有统计学意义[OR=0.32,95%CI(0.13,0.76),P=0.01]。结论 与PRP治疗相比,单独抗VEGF及联合疗法更有利于PDR患者视功能恢复和新生血管消退,而联合治疗的疗效又略胜于单独抗VEGF治疗,这可能为将来增生性糖尿病性视网膜病变治疗的专家共识制定提供一定参考依据。但仍希望有更多高质量的研究出现以提供更加可靠的证据。

Objective Assessment of vascular endothelial growth factor(VEGF) treatment alone,panretinal photocoagulation(PRP)and combined treatment on the effect of proliferative diabetic retinopathy(PDR).Methods Pubmed,Cochrane library and CNKI were searched.Selecting qualified RCT for data extraction.Modified the Jadad scale were used to evaluate the quality of the eligible studies.Review Manager(RevMan) 5.4 fo Mac was used to analyze the data.Results Eighht RCTs were included.In visual acuity,antiVEGF was superior to the PRP,and two groups had statistical significance [MD =3.87,95%CI(2.32,5.41),P<0.000 01],anti-VEGF group was superior to the combination group,but two groups had no statistical significance [MD = 2.2 0,9 5 %CI(-0.3 8,4.7 8),P = 0.1 ],the combination group was superior to PRP group [MD =5.47,95%CI(2.63,8.31),P =0.000 2].In regression of neovascularizatio,anti-VEGF was superior to PRP,but there was no statistically significant difference [OR =1.17,95%CI(0.73,1.88),P =0.51],the combination group was superior to anti-VEGF group,but there was no statistically significant difference [OR =0.43,95%CI(0.15,1.24),P =0.12],and the combination group was superior to PRP group [OR =0.32,95%CI(0.13,0.76),P =0.01].Conclusion Compared with PRP treatment,anti-VEGF alone and combination therapy were more beneficial to visual function recovery and neovascularization of PDR patients,while the efcacy of combination therapy was slightly better than that of anti-VEGF alone,which may provide some reference for the expert consensus on the treatment of proliferative diabetic retinopathy in the future.But it is hoped that more high-quality studies will emerge to provide more reliable evidence.