玻璃体腔注射rAAV2-ND4对遗传性视神经病变的影响

Effect of intravitreal injection of rAAV2-ND4 on hereditary optic neuropathy

目的 分析玻璃体腔注射重组腺相关病毒-2还原型辅酶Ⅰ脱氢酶4(rAAV2-ND4)对遗传性视神经病变(LHON)的影响。方法 采用自身对照研究,以延安大学医学院2018年1月-2022年1月60例LHON患者的左眼为对照组(n=60),给予针灸治疗;以患者的右眼为观察组(n=60),在针灸治疗的基础上在玻璃体腔内注射重组腺相关病毒-2还原型辅酶Ⅰ脱氢酶4(rAAV2-ND4)治疗。对比两组治疗前、治疗第1个月、治疗第3个月、治疗第6个月的BCVA、眼压、电生理P100波潜时、视野水平和治疗第6个月的临床疗效和并发症的异同。结果 治疗前两组的BCVA、眼压、电生理P100波潜时、视野水平比较,差异无统计学意义(P>0.05),治疗第1个月、第3个月、第6个月两组的BCVA水平均降低,且观察组均高于对照组(P<0.05);治疗第1个月、第3个月、第6个月两组的眼压、视野MS水平均升高,且观察组均高于对照组(P<0.05);治疗第1个月、第3个月、第6个月两组的电生理P100波潜时水平均降低,且观察组均低于对照组(P<0.05)。治疗第6个月观察组的临床总有效率(60.00%vs 41.67%)高于对照组(P<0.05)。治疗第6个月两组的并发症(10.00%vs 8.33%)比较,差异无统计学意义(P>0.05)。结论 玻璃体腔注射联合针灸治疗LHON能够较好地改善患者的BCVA、眼压、电生理P100波潜时、视野水平,改善临床疗效,且无明显并发症。

Objective To analyze the effect of intravitreal injection of recombinant adeno-associated virus-2 reduced coenzyme I dehydrogenase 4(rAAV2-ND4)on hereditary optic neuropathy(LHON).MethodsA self controlled study was conducted.The left eye of 60 patients with LHON from January 2018 to January 2022 in the Medical College of Yan′an University was taken as control group(n=60),and acupuncture and moxibustion was given;The right eye of the patient was taken as observation group(n=60).On the basis of acupuncture and moxibustion treatment,recombinant adeno-associated virus-2 reduced coenzyme I dehydrogenase 4(rAAV2-ND4)was injected into the vitreous cavity for treatment.Compare the differences and similarities in(best corrected visual acu)BCVA,intraocular pressure,electrophysiological P100 wave latency,visual field level,clinical efficacy and complications between two groups before the treatment,at the first month of the treatment,at the third month of the treatment,and at the sixth month of the treatment.ResultsBefore the treatment,there was no statistically significant difference in BCVA,intraocular pressure,electrophysiological P100 wave latent time and visual field level between the two groups(P>0.05).After the treatment,the BCVA levels in both groups were decreased at the 1st,3rd and 6th months,and the observation group was higher than the control group(P<0.05);At the 1st,3rd and 6th month after the treatment,the intraocular pressure and visual field MS levels in both groups were increased,and observation group was higher than control group(P<0.05);At the 1st,3rd and 6th month after the treatment,the electrophysiological P100 wave latency levels in both groups were decreased,and observation group was lower than control group(P<0.05).The total clinical effective rate of observation group after the treatment(60.00%vs 41.67%)was higher than that of control group(P<0.05).There was no statistically significant difference(P>0.05)in the incidence of complications between the 2 groups after the treatment(10.00%vs 8.33%).Conclusion Vitreous cavity injection combined with acupuncture and moxibustion can better improve BCVA,intraocular pressure,electrophysiological P100 latency and visual field level of the patients with LHON,and improve the clinical efficacy without obvious complications.