激光联合羟苯磺酸钙治疗老年Ⅲ～Ⅳ期糖尿病性视网膜病变对玻璃体PEDF、VEGI表达的影响

Effects of Joint Application of Calcium Dobesilate and Laser on Expression of Vitreous PEDF and VEGI in Elderly Patients with Stage Ⅲ-Ⅳ Diabetic Retinopathy

目的观察激光联合羟苯磺酸钙治疗老年Ⅲ~Ⅳ期糖尿病性视网膜病变的临床效果以及对玻璃体中色素上皮衍生因子(pigment epithelium-derived factor,PEDF)、血管内皮生长抑制因子(vascular endothelialgrowth inhibitor,VEGI)表达的影响。方法 2015年1月至2017年12月,老年Ⅲ~Ⅳ期糖尿病性视网膜病变患者160例220只眼,随机数字表法分为研究组80例100只眼,研究组采用激光联合羟苯磺酸钙治疗;对照组80例120只眼,仅采用激光治疗,激光波长532 nm,光斑大小100~200μm,曝光时间0.05~0.2 s;治疗功率100 mW。术后3和6个月随访,观察两组患者治疗前后的视觉恢复情况、视网膜新生血管荧光素渗漏面积、黄斑中心凹厚度(entml macular thickness,CMT)、玻璃体PEDF、VEGI表达水平以及不良反应发生情况。结果术后3和6个月,研究组视力恢复情况显著优于对照组(P<0.05);研究组视网膜新生血管荧光素渗漏面积和黄斑中心凹厚度与对照组比较均显著降低,差异具有统计学意义(P<0.05);研究组玻璃体液中PEDF及VEGI表达水平与对照组相比显著升高,且两组患者PEDF及VEGI表达水平在组间、时点间、组间和时点间的交互作用差异均具有统计学意义(P<0.05);研究组不良反应发生率(7.00%)与对照组(6.67%)相近(P>0.05)。结论采用羟苯磺酸钙联合激光治疗老年Ⅲ~Ⅳ期糖尿病性视网膜病变更具临床优势,可显著升高玻璃体液中PEDF、VEGI表达水平,改善患者视力情况。

Objective To observe the clinical effect of joint application of calcium dobesilate and laser in treating elderly patients with stageⅢ-Ⅳdiabetic retinopathy and the impact on PEDF and VEGI expression.Methods Totally 160 elderly patients(220 eyes)with stageⅢ-Ⅳdiabetic retinopathy admitted from Jan.2015 to Dec.2017 were enrolled in the study.Randomized digital table was employed to divide the patients into the study group(80 cases/100 eyes)and control group(80 cases/120 eyes).The patients in the control group were treated with laser and those in the study group with calcium dobesilate in addition to laser.The visual recovery,retinal fluorescein leakage area,entml macular thickness(CMT),vitreous PEDF,VEGI expression and adverse reactions were compared before and after the treatment.ResultsThe visual acuity recovery in the study group was significantly better than that in the control group 3 and 6 months after the operation.The fluorescein leakage area and foveal thickness of the retinal neovascularization in the study group were significantly lower than those in the control group 3 and 6 months after the operation(P<0.05).After the treatment,the expression of PEDF and VEGI in the vitreous humor of the study group was significantly higher than that of the control group after the treatment,and there were significant differences of PEDF and VEGI expression levels in the interaction between groups,time points,groups and time points(P<0.05).The adverse reaction rates occurred in the study group and control group were 7.00%and 6.67%respectively,indicating no significant difference(P>0.05).Conclusions Joint application of calcium dobesilate and laser will significantly increase the expression of PEDF and VEGI in vitreous humor and improve remarkably the visual recovery in elderly patients with stageⅢ-Ⅳdiabetic retinopathy.