抗血管内皮生长因子玻璃体内注射治疗湿性老年性黄斑变性疗效及对房水炎性因子的影响

Efficacy of intravitreal injection of anti-vascular endothelial growth factor in treatment of wet age-related macular degeneration and its effect on inflammatory factors of aqueous humor

目的探讨抗血管内皮生长因子(VEGF)玻璃体内注射治疗湿性老年性黄斑变性(wAMD)的疗效及对房水炎性因子的影响。方法选择2018年1月至2020年9月河南科技大学第一附属医院收治的wAMD患者112例,采用随机数字表法将其分为观察组和对照组,每组56例。观察组予抗VEGF(雷珠单抗)玻璃体内注射治疗;对照组予光动力疗法(PDT)。比较两组治疗后视力改善情况。比较两组治疗前和治疗后3个月的眼压(IOP)、脉络膜新生血管(CNV)面积、黄斑中央区厚度(CMT)以及房水肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)水平。观察两组并发症发生情况。结果治疗后3个月,两组IOP、CNV面积、CMT均较治疗前显著下降(P<0.05),但两组间比较差异无统计学意义(P>0.05)。对照组房水TNF-α、IL-6、IL-10水平较治疗前无显著变化(P>0.05)。观察组房水TNF-α、IL-6水平显著低于治疗前(P<0.05),且较对照组水平更低,差异有统计学意义(P<0.05)。在治疗后3个月,两组视力改善情况无显著差异(P>0.05)。治疗后6个月,观察组视力改善情况显著优于对照组(P<0.05)。两组均无视网膜脱落等严重并发症发生,并发症发生率比较差异无统计学意义(5.36%vs 7.14%;P>0.05)。结论与PDT相比,抗VEGF玻璃体内注射治疗wAMD能更有效地控制病情,减轻房水炎性反应,改善患者视力。

Objective To investigate the efficacy of intravitreal injection of anti-vascular endothelial growth factor(VEGF)in treatment of wet age-related macular degeneration(wAMD)and its effect on inflammatory factors of aqueous humor.Methods One hundred and twelve patients with wAMD who were admitted to the First Affiliated Hospital of Henan University of Science and Technology from January 2018 to September 2020 were selected and divided into observation group and control group by random number table method,with 56 cases in each group.The observation group was treated with intravitreal injection of anti-VEGF(ranibizumab),and the control group received photodynamic therapy(PDT).The visual acuity improvement after treatment was compared between the two groups.The intraocular pressure(IOP),choroidal neovascularization(CNV)area,central macular thickness(CMT)and the levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and interleukin-10(IL-10)in aqueous humor were compared between the two groups before and 3 months after treatment.The occurrence of complications was observed in the two groups.Results The level of IOP,the CNV area and the CMT value in the two groups were significantly decreased 3 months after treatment compared with those before treatment(P<0.05),but there were no significant differences between the two groups(P>0.05).The levels of TNF-α,IL-6 and IL-10 in the aqueous humor of the control group had no significant changes compared with those before treatment(P>0.05).The levels of TNF-αand IL-6 in the aqueous humor of the observation group were significantly lower than those before treatment(P<0.05),and lower than those of the control group,and the differences were statistically significant(P<0.05).Three months after treatment,there was no significant difference in visual acuity improvement between the two groups(P>0.05).Six months after treatment,the visual acuity improvement in the observation group was significantly better than that in the control group(P<0.05).No serious complications such as retinal detachment occurred in the two groups,and there was no significant difference in the incidence of complications(5.36%vs 7.14%;P>0.05).Conclusion Compared with PDT,anti-VEGF intravitreal injection in the treatment of wAMD can more effectively control the disease,reduce the inflammatory reaction of aqueous humor,and improve the visual acuity of the patients.