玻璃体内注射抗VEGF药物对糖尿病黄斑水肿患者疗效的影响因素分析

Influencing factors for therapeutic effect of intravitreal injection of anti-vascular endothelial growth factor agents in patients with diabetic macular edema

目的 探讨玻璃体内注射抗血管内皮生长因子(VEGF)药物对糖尿病黄斑水肿(DME)患者疗效的影响因素。方法 收集2020年1月至2021年8月于郑州市第二人民医院眼科接受玻璃体内注射抗VEGF药物治疗的100例(100眼)DME患者的临床资料。依据患者DME病理学类型将患者分为3组,浆液性视网膜脱离组(40眼)、囊样黄斑水肿组(35眼),弥漫性视网膜增厚组(25眼)。以末次抗VEGF治疗后1个月CMT下降率≥20%为患者黄斑水肿消退疗效达标,反之为未达标。以BCVA提高2行及以上为患者视力提高疗效达标,反之为未达标。比较治疗前及末次治疗后1个月三组患眼最佳矫正视力(BCVA)、黄斑中心凹视网膜厚度(CMT)。收集所有患者的基本资料、血糖相关指标、血压、血脂指标及生化指标、眼科相关指标。分别采用单因素及多因素Logistic回归分析筛选影响抗VEGF玻璃体内注射对DME患者疗效的独立危险因素。结果 末次治疗后1个月3组患者BCVA(logMAR)、CMT均较治疗前降低,差异均有统计学意义(均为P<0.05)。黄斑水肿消退疗效未达标患者舒张压、高密度脂蛋白(HDL)、基线CMT、感光细胞外节长度均小于疗效达标患者,收缩压(SBP)、基线BCVA(logMAR)、椭圆体带(EZ)破坏比例均大于疗效达标患者,差异均有统计学意义(均为P<0.05)。视力提高疗效未达标患者HbA1c、载脂蛋白(apoA)、基线BCVA均大于疗效达标患者,基线CMT小于疗效达标患者,差异均有统计学意义(均为P<0.05)。高SBP、低HDL、基线CMT薄、EZ破坏是DME患者抗VEGF治疗后黄斑水肿消退未达标的独立影响因素(均为P<0.05)。高apoA水平、基线BCVA(logMAR)高是DME患者抗VEGF治疗后视力提高未达标的独立影响因素(均为P<0.05)。结论 高SBP、低HDL、基线CMT薄、EZ破坏、高apoA水平、基线BCVA(logMAR)高是DME患者抗VEGF治疗后短期疗效不佳的独立影响因素。

Objective To discuss the factors that may affect the therapeutic effect of intravitreal injection of anti-vascular endothelial growth factor(VEGF)drugs in diabetic macular edema(DME)patients.Methods Totally 100 DME patients(100 eyes)treated with intravitreal injection of anti-VEGF drugs in the Department of Ophthalmology,Zhengzhou Second Hospital from January 2020 to August 2021 were included.The patients were divided into the following 3 groups according to the pathological type of DME:serous retinal detachment(SRD)group(40 eyes),cystoid macular edema(CME)group(35 eyes),and diffuse retinal thickening(DRT)group(25 eyes).The reduction rate of the central macular thickness(CMT)≥20%one month after the last anti-VEGF treatment means satisfied macular edema regression;otherwise,it is dissatisfied.An increase in best corrected visual acuity(BCVA)for 2 or more lines means satisfied visual acuity enhancement,and vice versa.The BCVA and CMT of eyes were compared among the three groups before and one month after the last treatment.The basic data,blood glucose,blood pressure,blood fat and ophthalmology-related indexes and biochemical indexes of all patients were collected.The independent risk factors affecting the therapeutic effect of intravitreal anti-VEGF drug injection on DME patients were analyzed by univariate and multivariate logistic regression analysis.Results BCVA(logMAR)and CMT were lower in three groups one month after the last treatment than those before treatment,and the differences were statistically significant(all P<0.05).Diastolic blood pressure(DBP),high-density lipoprotein(HDL),baseline CMT,and length of photoreceptor cell outer segment of patients with dissatisfied therapeutic effect on macular edema regression were smaller than those of patients with satisfied therapeutic effect,and the systolic blood pressure(SBP),baseline BCVA(logMAR),and ellipsoid zone(EZ)disruption ratio were larger than those of patients with satisfied therapeutic effect,with statistically significant differences(all P<0.05).The hemoglobin A1c,apolipoprotein A(apoA)and baseline BCVA of patients with dissatisfied therapeutic effect on visual acuity improvement were greater than those of patients with satisfied therapeutic effect,and baseline CMT was less than that of patients with satisfied therapeutic effect,with statistically significant differences(all P<0.05).High SBP,low HDL,thin baseline CMT,and EZ disruption were independent factors that caused the failure to achieve satisfied macular edema regression after anti-VEGF treatment(all P<0.05).High apoA level and baseline BCVA(logMAR)were independent influence factors on the failure to achieve satisfied visual acuity improvement after anti-VEGF treatment(both P<0.05).Conclusion High SBP,low HDL,thin baseline CMT,EZ disruption,high apoA level,and high baseline BCVA(logMAR)are independent influencing factors for the poor short-term outcome of anti-VEGF therapy in DME patients.