抗血管内皮生长因子药物治疗息肉样脉络膜视网膜病变的临床研究

Clinical study of anti-vascular endothelial growth factor drugs in the treatment of polypoidal choroidal vasculopathy

目的观察玻璃体内注射抗血管内皮生长因子(VEGF)药物治疗息肉样脉络膜视网膜病变(PCV)的效果和血清细胞因子变化。方法回顾性病例系列研究。收集2018年2月至2023年5月河南科技大学第一附属医院收治的98例(98只眼)PCV患者的临床资料。所有患者均采用3+按需治疗(PRN)进行康柏西普玻璃体内注射。观察治疗前后视力(logMAR)、黄斑中心区视网膜厚度、血液流变学指标、炎性因子[单核细胞趋化蛋白-1(MCP-1)、白介素-8(IL-8)]及新生血管生长因子[色素上皮源性因子(PEDF)、VEGF]水平。随访时间为3~36个月。结果末次随访时患者视力(0.76±0.18)较治疗前(1.05±0.33)改善(t=7.64,P<0.001)。黄斑中心区视网膜厚度(257.81±37.63)μm较治疗前(314.66±49.28)μm下降(t=9.08,P<0.001)。血浆黏度[(1.36±0.19)mPa·s vs(1.82±0.28)mPa·s]、全血低切黏度[(10.22±0.83)mPa·s vs(13.45±1.17)mPa·s]、红细胞聚集指数[(5.16±0.82)vs(7.01±0.93)]、全血高切黏度[(4.11±0.47)mPa·s vs(7.58±0.95)mPa·s]均较治疗前下降(t=13.46、22.29、14.77、32.41,均P<0.001)。血清MCP-1[(19.94±7.27)ng/L vs(40.62±12.58)ng/L]、IL-8[(0.68±0.18)ng/L vs(1.45±0.26)ng/L]水平均较治疗前下降(t=14.09、24.11,均P<0.001)。血清VEGF水平较治疗前降低[(126.51±32.68)μg/L vs(304.25±56.33)μg/L],血清PEDF水平[(83.15±16.77)μg/L vs(64.49±11.62)μg/L]较治疗前上升(t=27.02、9.05,均P<0.001)。结论康柏西普玻璃体内注射可有效改善PCV患者视力,降低黄斑中心区视网膜厚度,并可调节血液流变学指标、炎症因子及新生血管生长因子水平。

ObjectiveTo observe the efficacy of intravitreal injection of anti-vascular endothelial growth factor(VEGF)on the treatment of polypoidal choroidal vasculopathy(PCV)and the changes of serum cytokines.MethodsThis was a retrospective case series study.The clinical data of 98 patients(98 eyes)with PCV in the First Affiliated Hospital of Henan University of Science and Technology from Feb.2018 to May 2023 were analyzed.All patients received intravitreal injection of conbercept following 3+pro re nata(PRN)regimen.Visual acuity(logMAR),central macular retinal thickness,hemorheological indicators,inflammatory factors[monocyte chemoattractant protein-1(MCP-1),interleukin-8(IL-8)]and neovascular growth factor[pigment epithelium-derived factor(PEDF),VEGF]were observed before and after treatment.The follow-up time was 3-36 months.ResultsAt the final visit,visual acuity(0.76±0.18)improved compared with the 1.05±0.33 before treatment(t=7.64,P<0.001);central macular retinal thickness(257.81±37.63)μm was lower than the(314.66±49.28)μm before treatment(t=9.08,P<0.001);plasma viscosity[(1.36±0.19)mPa·s vs(1.82±0.28)mPa·s],whole blood low shear viscosity[(10.22±0.83)mPa·s vs(13.45±1.17)mPa·s],erythrocyte aggregation index[(5.16±0.82)vs(7.01±0.93)],and whole blood high shear viscosity[(4.11±0.47)mPa·s vs(7.58±0.95)mPa·s]were significantly lower than those before treatment(t=13.46,22.29,14.77,32.41;all P<0.001).At the final visit,the levels of MCP-1[(19.94±7.27)ng/L vs(40.62±12.58)ng/L]and IL-8[(0.68±0.18)ng/L vs(1.45±0.26)ng/L]were lower than those before treatment(t=14.09,24.11;all P<0.001);serum VEGF level[(126.51±32.68)μg/L vs(304.25±56.33)μg/L]decreased,and serum PEDF level[(83.15±16.77)μg/L vs(64.49±11.62)μg/L]increased(t=27.02,9.05;all P<0.001).ConclusionIntravitreal injection of conbercept for the treatment of PCV can improve vision,reduce the central macular retinal thickness,and adjust the levels of hemorheological indicators,inflammatory factors and neovascular growth factors.