玻璃体切割术联合雷珠单抗对增殖性糖尿病性视网膜病变患者视网膜功能恢复的影响

Effect of Vitrectomy Combined with Ranibizumab on Recovery of Retinal Function in Patients with Proliferative Diabetic Retinopathy

目的探究玻璃体切割术联合雷珠单抗对增殖性糖尿病性视网膜病变(PDR)患者视网膜功能恢复的影响。方法选取2019年1月至2021年12月阜阳市第五人民医院眼科收治的96例PDR患者作为研究对象,依据随机数字法分为对照组和观察组,每组48例。其中对照组采用玻璃体切割术治疗,观察组在对照组治疗的基础上联合雷珠单抗进行治疗。比较两组患者两组手术相关情况,治疗前后黄斑中心视网膜厚度(CMT)、最佳纠正视力(BCVA)、细胞间黏附因子1(ICAM-1)、血清基质细胞衍生因子1(SDF-1)及血管内皮生长因子(VEGF)水平变化,以及术后并发症发生率。结果观察组患者术中出血、医源性裂孔、电凝止血的比例低于对照组(P<0.05),手术时间短于对照组[(68±5)min比(98±9)min](P<0.01)。治疗后,两组患者的CMT、BCVA均明显低于治疗前(P<0.01),且观察组患者CMT、BCVA低于对照组[(257±18)μm比(303±17)μm、0.79±0.12比1.45±0.19](P<0.01)。治疗后,两组患者的ICAM-1、SDF-1、VEGF水平均明显低于治疗前(P<0.01),且观察组患者的ICAM-1、SDF-1、VEGF水平低于对照组[(265±28)ng/L比(413±33)ng/L、(432±24)mg/L比(625±33)mg/L、(129±16)ng/L比(193±18)ng/L](P<0.01)。术后观察组患者术后总并发症发生率低于对照组[8.3%(4/48)比27.1%(13/48)](χ^(2)=5.790,P=0.016)。结论在PDR患者手术前注射雷珠单抗治疗,可降低术中出血、医源性裂孔、电凝止血的比例,缩短手术时间,显著降低ICAM-1、SDF-1、VEGF水平及术后并发症发生率,对PDR患者的视网膜恢复有重要意义。

Objective To investigate the effect of vitrectomy combined with ranibizumab on retinal function recovery in patients with proliferative diabetic retinopathy(PDR).Methods Ninety-six patients with PDR admitted to the Department of Ophthalmology of Fuyang Fifth People′s Hospital from Jan.2019 to Dec.2021 were included,and divided into a control group and an observation group based on the random number method,with 48 cases in each group.The control group was treated with vitrectomy,and the observation group was treated with ranibizumab on the basis of the control group′s treatment.The surgery related conditions,the changes of central macular thickness(CMT)and best corrected visual acuity(BCVA),intercellular adhesion molecule-1(ICAM-1),stromal cell derived factor 1(SDF-1),vascular endothelial growth factor(VEGF)levels before and after the treatment,as well as the incidence of postoperative complications were compared between the two groups.Results The proportions of intraoperative bleeding,iatrogenic hiatus,and electrocoagulation hemostasis of the observation group were lower than those of the control group(P<0.05),and the operation time was shorter than that of the control group[(68±5)min vs(98±9)min](P<0.01).After treatment,CMT and BCVA of both groups were significantly lower than before the treatment(P<0.01),and the observation group lower than the control group[(257±18)μm vs(303±17)μm,0.79±0.12 vs 1.45±0.19](P<0.01).After treatment,ICAM-1,SDF-1 and VEGF of both groups were significantly lower than before treatment(P<0.01),and the observation group were lower than the control group[(265±28)ng/L vs(413±33)ng/L,(432±24)mg/L vs(625±33)mg/L,(129±16)ng/L vs(193±18)ng/L](P<0.01).The overall postoperative complication incidence of the observation group was lower than that of the control group[8.3%(4/48)vs 27.1%(13/48)](χ^(2)=5.790,P=0.016).Conclusion Ranibizumab injection treatment before surgery in PDR patients can reduce proportions of intraoperative hemorrhage,the iatrogenic hiatus,the electrocoagulation for hemostasis,and shorten the operation time,and significantly reduce the levels of ICAM-1,SDF-1,and VEGF as well as the incidence of postoperative complications,which is of great significance for the retinal recovery of PDR patients.