抗血管内皮生长因子联合地塞米松植入物治疗糖尿病黄斑水肿患者的临床观察

Clinical observation of anti-vascular endothelial growth factor combined with dexamethasone implant in the treatment of patients with diabetic macular edema

目的研究抗血管内皮生长因子(VEGF)联合地塞米松植入物(DEX)治疗糖尿病黄斑水肿(DME)患者的临床效果。方法前瞻性选择2021年1月至2022年12月贵州医科大学附属医院收治的DME患者90例(90眼),依据随机数字表法将其分为试验组(n=45)、对照组(n=45)。对照组行抗VEGF治疗,试验组行抗VEGF联合DEX治疗。观察两组治疗前及治疗3个月后黄斑中心凹视网膜厚度(CMT)、患眼最佳矫正视力(BCVA)及眼压;房水中血小板源性生长因子(PDGF)、微小RNA-377-3p(miR-377-3p)及内皮抑制素(ES)等DME相关因子,并比较2组临床疗效、术后并发症及复发情况。结果治疗3个月后,两组CMT、BCVA均较治疗前降低,且试验组CMT、BCVA分别为(286.77±31.22)μm、(0.50±0.06)logMAR,均低于对照组[(322.95±34.61)μm、(0.43±0.04)logMAR],差异均有统计学意义(P<0.05),两组眼压比较差异无统计学意义(P>0.05)。治疗3个月后,两组房水PDGF及ES水平均较治疗前降低,房水miR-377-3p水平均较治疗前升高,且试验组房水PDGF及ES水平分别为(3.80±0.40)ng/mL、(89.95±9.27)ng/L,均低于对照组[(4.65±0.48)ng/mL、(102.26±11.34)ng/L],房水miR-377-3p水平为0.57±0.07,高于对照组(0.50±0.06),差异均有统计学意义(P<0.05)。试验组总有效率为93.18%,高于对照组(73.33%),差异有统计学意义(P<0.05)。两组不良反应发生率比较差异无统计学意义(6.67%vs.4.44%)(P>0.05)。试验组复发率为2.22%,低于对照组(17.78%),差异有统计学意义(P<0.05)。结论抗VEGF联合DEX治疗DME可减小CMT,提高患眼最佳矫正视力,改善房水DME相关因子水平,疗效显著,术后并发症少,复发率低,且不显著增加眼压,值得推荐于临床。

Objective To prospectively study the clinical effect of anti-vascular endothelial growth factor(VEGF)combined with dexamethasone implant(DEX)in the treatment of patients with diabetic macular edema(DME).Methods A total of 90 cases(90 eyes)of DME patients were treated in Affiliated Hospital of Guizhou Medical University from January 2021 to December 2022 were seleted and prospectively divided into experimental group(n=45)and control group(n=45)according to random number table method.The control group was treated with anti-VEGF,and the experimental group was treated with anti-VEGF combined with DEX.The central macular thickness(CMT),best corrected visual acuity(BCVA)and intraocular pressure,platelet-derived growth factor(PDGF),micrornA-377-3p(miR-377-3p),endostatin(ES)and other DME-related factors of aqueous humor were observed before treatment and after 3 months of treatment,and the clinical effects,postoperative complications and recurrence of the two groups were compared.Results After 3 months of treatment,the CMT and BCVA of two groups were lower than those before treatment,and the CMT and BCVA of the experimental group were(286.77±31.22)μm,(0.50±0.06)logMAR,respectively,which were lower than those in the control group[(322.95±34.61)μm,(0.43±0.04)logMAR],the differences were statistically significant(P<0.05),and there was no statistically significant difference in intraocular pressure between the two groups(P>0.05).After 3 months of treatment,the levels of PDGF and ES of aqueous humorin of the two groups were lower than those before treatment,and the levels of miR-377-3p of aqueous humor in two groups were higher than those before treatment,the levels of PDGF and ES of aqueous humor in the experimental group were(3.80±0.40)ng/mL and(89.95±9.27)ng/L,respectively,which were lower than those in the control group[(4.65±0.48)ng/mL and(102.26±11.34)ng/L],the level of miR-377-3p of aqueous humor was 0.57±0.07,which was higher than that in the control group(0.50±0.06),and the differences were statistically significant(P<0.05).The total effective rate of experimental group was 93.18%,which was higher than that of control group(73.33%),and the difference was statistically significant(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(6.67%vs.4.44%)(P>0.05).The recurrence rate of experimental group was 2.22%,which was lower than that of control group(17.78%),and the difference was statistically significant(P<0.05).Conclusion Anti-VEGF combined with DEX in the treatment of DME can reduce CMT,improve the best corrected visual acuity of the affected eye,improve the level of DME-related factors in aqueous fluid,with significant efficacy,fewer postoperative complications,the recurrence rate is low,and no significant increase in IOP,it is worth recommending in clinic.