玻璃体腔注射康柏西普治疗糖尿病黄斑水肿的影响因素分析及疗效观察

The effect of intravitreous injection of compaCI:llin in the treatment of diabetes mellitus macular edema

目的评价和分析糖尿病黄斑水肿(DME)玻璃体腔注射康柏西普后的影响因素及短期疗效观察。方法前瞻性病例研究。收集我院接受玻璃体腔注射康柏西普治疗的DME患者94例(94只眼)为研究对象,时间设定为2022年10月至2023年10月,采集患者年龄、性别、体重指数(BMI)、糖尿病病程、黄斑水肿病程、黄斑水肿分型、注射次数等一般信息;糖化血红蛋白(HbA1c)、总胆固醇、血肌酐水平、低密度脂蛋白、甘油三酯、血尿素氮、血葡萄糖等生化指标;基线视力、基线中央视网膜厚度(CRT)等影像学指标。对比分析患眼玻璃体腔注射康柏西普后短期疗效:视力改善值,以最佳矫正视力(BCVA)提高2行及以上视力定义为达标组,反之为未达标组。运用单因素分析及二元Logistic回归分析DME患者治疗后短期疗效的影响因素,以比值比(OR)及95%可置信区间(CI)表示。并按照水肿形态特征分型分为弥漫性组32例(32只眼)、囊样组和视网膜下液组各31例(31只眼)三组,比较三组患者的短期疗效。结果单因素分析结果可得:年龄、BMI、糖尿病病程、黄斑水肿病程、黄斑水肿分型、血肌酐水平、HbA1c、基线视力与治疗后视力改善值均有统计学意义(均P<0.05)。总胆固醇、基线CRT、低密度脂蛋白、甘油三酯、血尿素氮、血葡萄糖、性别、注射次数均无统计学意义(均P>0.05)。二元Logistic回归分析结果可得:年龄(OR=0.903,95%CI:0.8270.987)、血肌酐水平(OR=0.955,95%CI:0.9130.999)、HbA1c(OR=0.438,95%CI:0.2010.954)、囊样水肿分型(OR=0.013,95%CI:0.0080.564)、视网膜下液分型(OR=0.005,95%CI:0.0580.421)均是治疗后视力未达标的独立危险因素(均P<0.05);基线视力(OR=12.423,95%CI:1.95618.054)是治疗后视力达标的保护因素(P<0.05)。总胆固醇、基线CRT、低密度脂蛋白、甘油三酯、血尿素氮、血葡萄糖等其他指标对治疗后视力改善值均无统计学意义(均P>0.05)。通过对三组患者玻璃体腔注射康柏西普后疗效的比较,与治疗前相比,三组患者经玻璃体腔注射康柏西普治疗后的最佳矫正视力均下降(均P<0.05);弥漫性组患者与囊样组、视网膜下液组相比,治疗后1、3、6个月的最佳矫正视力下降更快,差异均有统计学意义(均P<0.05);囊样组与视网膜下液组治疗后1、3、6个月最佳矫正视力差异无统计学意义(P>0.05)。与治疗前相比,三组患者经玻璃体腔注射康柏西普治疗后的CRT均下降(均P<0.05);弥漫性组患者与囊样组、视网膜下液组相比,治疗后1、3、6个月的CRT下降更快,差异均有统计学意义(均P<0.05);囊样组与视网膜下液组治疗后1个月CRT差异无统计学意义(P>0.05),囊样组与视网膜下液组治疗后3、6个月CRT差异均有统计学意义(均P<0.05)。结论年龄、HbA1c、血肌酐水平、黄斑水肿囊样型及视网膜下液型是玻璃体腔注射康柏西普治疗DME疗效的独立危险因素,基线视力升高是玻璃体腔注射康柏西普治疗DME疗效的独立保护因素;玻璃体腔注射康柏西普治疗不同形态特征分型的DME患者都有效,弥漫性组治疗效果最佳,对于囊样组和视网膜下液组治疗的疗效差异不大。

Objective To evaluate and analyze the influence factors and short-term curative effect of intravitreal injection of Compaplexipes in diabetic macular edema(DME).Methods Prospective study.94 eyes of 94 patients with DME who received intravitreal injection of Compaercep in our hospital were collected as the study objects,and the time was set to be from October 2022 to October 2023.General information such as age,gender,body mass index(BMI),diabetes course,macular edema course,macular edema classification,and injection frequency were collected.Glycated hemoglobin(HbA1c),total cholesterol,serum creatinine level,low density lipoprotein,triglyceride,blood urea nitrogen,blood glucose and other biochemical indicators;Baseline vision,baseline CRT and other imaging indicators.Short-term efficacy after intravitreal injection of Compaercept was compared and analyzed.Visual acuity improvement value was defined as the qualified group with BCVA improving visual acuity for 2 or more lines,and the non-qualified group with BCVA was defined as the non-qualified group.Univariate analysis and binary Logistic regression were used to analyze the factors affecting the short-term efficacy of DME patients after treatment,expressed as odds ratio(OR)and 95%confidence interval(CI).According to the morphological characteristics of edema,the patients were divided into diffuse group(32 cases,32 eyes),cystic group(31 cases,31 eyes)and subretinal fluid group(31 cases,31 eyes).Results Univariate analysis showed that age,BMI,duration of diabetes,duration of macular edema,type of macular edema,serum creatinine level,HbA1c,baseline visual acuity and improved visual acuity after treatment were statistically significant(all P<0.05).There was no statistical significance in total cholesterol,baseline CRT,low density lipoprotein,triglyceride,blood urea nitrogen,blood glucose,gender,and injection times(all P>0.05).Binary Logistic regression analysis results can be obtained:Age(OR=0.903,95%CI:0.827-0.987),serum creatinine level(OR=0.955,95%CI:0.913-0.999),HbA1c(OR=0.438,95%CI:0.201-0.954),type of cystoid edema(OR=0.013,95%CI:0.008-0.564)and subretinal fluid type(OR=0.005,95%CI:0.058-0.421)were independent risk factors for visual acuity failure after treatment(all P<0.05).Baseline visual acuity(OR=12.423,95%CI:1.956-18.054)was a protective factor for visual acuity attainment after treatment(P<0.05).Total cholesterol,baseline CRT,low density lipoprotein,triglyceride,blood urea nitrogen,blood glucose and other indicators had no statistical significance on the improvement of visual acuity after treatment(all P>0.05).Compared with before treatment,the best corrected visual acuity of the three groups of patients after intravitreal injection of Compaercept decreased(all P<0.05).Compared with saccoid group and subretinal fluid group,the best corrected visual acuity in diffuse group decreased faster at 1 month,3 months and 6 months after treatment,and the differences were statistically significant(all P<0.05).There was no significant difference in the best corrected visual acuity between the cystoid group and the subretinal fluid group at 1,3 and 6 months after treatment(P>0.05).Compared with before treatment,CRT in all three groups after intravitreal injection of Compaplomb decreased(all P<0.05).CRT in diffuse group decreased faster at 1 month,3 months and 6 months after treatment compared with saccoid group and subretinal fluid group,and the differences were statistically significant(all P<0.05).There was no significant difference in CRT between cystoid group and subretinal fluid group 1 month after treatment(P>0.05),while there was significant difference in CRT between cystoid group and subretinal fluid group 3 months and 6 months after treatment(all P<0.05).Conclusions Age,HbA1c,serum creatinine level,cystic type and subretinal fluid type of macular edema were independent risk factors for the efficacy of intravitreal injection of Compaplcept for DME,and increased baseline visual acuity was independent protective factor for the efficacy of intravitreal injection of Compaplcept for DME.Intravitreal injection of Compaercept was effective in the treatment of DME patients with different morphological characteristics,the diffuse group had the best therapeutic effect,and there was no significant difference between the saccoid group and the subretinal fluid group.