阿柏西普联合全视网膜激光光...脉阻塞伴黄斑水肿的临床价值_杨水平.pdf

阿柏西普联合全视网膜激光光凝治疗缺血型视网膜中央静脉阻塞伴黄斑水肿的临床价值杨水平陈振文郑春荣基金项目:广西省科学研究与技术开发计划课题(编号:20205003)作者单位:545007广西柳州柳州市人民医院眼科 摘要 目的探讨阿柏西普联合全视网膜激光光凝治疗缺血型视网膜中央静脉阻塞(CVO)伴黄斑水肿(ME)的疗效及其对患者视网膜血流和房水血管内皮生长因子(VEGF)、基质细胞衍生因子 1(SDF 1)的影响。方法选择柳州市人民医院2018 年 3 月至 2020 年 12 月收治的 96 例缺血型 CVO 伴 ME 患者，采用随机数字表法分为观察组及对照组，各 48 例。观察组给予阿柏西普联合全视网膜激光光凝治疗，对照组单纯实施全视网膜激光光凝治疗。连续治疗 12 周，比较治疗前和治疗 12 周后两组最佳矫正视力(BCVA)采用最小分辨角对数(log MA)视力记录，黄斑中心凹厚度(CMT)，视网膜血流参数 视网膜浅层毛细血管丛(SCP)血流密度、黄斑中心凹无血管区(FAZ)，以及房水 VEGF、SDF 1 水平。并根据 BCVA 改善情况、出血吸收情况、黄斑区荧光素渗漏消失情况、无灌注区消失情况、ME 消失情况以及 CMT 恢复情况评价两组治疗效果，并评价安全性。记录两组治疗过程中不良反应情况，包括局部球结膜下出血、一过性眼压升高等。结果观察组总有效率(93 75%)高于对照组(75%)，差异有统计学意义(P 0 05)。两组总体不良反应发生率比较，差异无统计学意义(P 0 05)。两组治疗前 logMA BCVA、CMT 比较，差异均无统计学意义(P 0 05)。观察组 logMA BCVA、CMT 治疗前后差值均高于对照组，差异均有统计学意义(P 0 05)。两组治疗前SCP 血流密度和 FAZ 面积比较，差异均无统计学意义(P 0 05)。观察组 SCP 血流密度治疗前后差值高于对照组，差异有统计学意义(P 0 05)。两组 FAZ 面积治疗前后差值比较，差异无统计学意义(P 0 05)。两组治疗前房水 VEGF、SDF 1 含量比较，差异均无统计学意义(P 0 05)。观察组房水 VEGF、SDF 1 含量治疗前后差值均高于对照组，差异均有统计学意义(P 0 05)。结论阿柏西普联合全视网膜激光光凝治疗能安全有效地提高缺血型 CVO 伴 ME 的临床疗效，且患者视力恢复良好，ME 消退明显，其作用可能与下调房水 VEGF、SDF 1 的表达水平有关。关键词 阿柏西普;全视网膜激光光凝;缺血型视网膜中央静脉阻塞;黄斑水肿;视网膜血流;血管内皮生长因子;基质细胞衍生因子 1doi:10.3969/j.issn.1000 0399.2023.03.002Effect of Abersip s combined full retinal laser photocoagulation on patients with ischemic retinal central vein obstruction withmacular edema and level of retinal blood flow and room water VEGF and SDF 1YANG Shuiping，CHEN Zhenwen，ZHENG ChunrongDepartment of Ophthalmology，Liuzhou Peoples Hospital，Liuzhou 545007，ChinaFunding project:Scientific esearch and Technology Development Program of Guangxi Province(No 20205003)Abstract ObjectiveTo investigate the clinical efficacy of Abersip s combination of full retinal laser photocoagulation to treat is-chemic retinal central venous obstruction(CVO)with macular edema(ME)and its effect on patientsretinal blood flow and endothelialendothelial growth factor(VEGF)，matrix cell derivative factor 1(SDF 1)MethodsThe 96 patients with ISCHEMIC CVO compan-ion ME admitted to our hospital from March 2018 to December 2020 were selected and divided into two groups using random numerical tablemethod，with 48 cases in each The observation group was given Abersip joint full retinal laser photocoagulation therapy，and the controlgroup simply implemented full retinal laser photocoagulation therapy After 12 weeks of continuous treatment，the two groups was compared interms of of optimal corrective vision(BCVA)(the minimum resolution angle log MA)，the macular center concave thickness(CMT)，theretinal blood flow parameters retinal shallow capillary(SCP)blood flow density，macular center concave no blood vessel area(FAZ)androom water VEGF，SDF 1 level The treatment effect of the two groups were evaluated according to the improvement of BCVA，bleeding ab-sorption，the disappearance of fluorescein leakage in macular area，no perfusion area，ME and the recovery of CMT Adverse reactions inboth groups，including local subconjunctival hemorrhage and transient intraocular pressure increase，were recorded esultsThe total effec-tive rate of observation group was 93 75%，significantly higher than that of control group(75 00%，P 0 05)There was no significantdifference in logMA BCVA and CMT between the two groups before treatment(P 0 05)The difference in logMA BCVA and CMT be-252安徽医学第 44 卷第 3 期Anhui Medical Journal2023 年 3 月fore and after treatment in the observation group was higher than that in the control group，with statistical significance(P 0 05)Therewere no significant differences in SCP blood flow density and FAZ area between the two groups before treatment(P 0 05)The differencein SCP blood density of the observation group before and after treatment was higher than that of the control group，with statistical significance(P 0 05)There was no significant difference in FAZ area between the two groups before and after treatment(P 0 05)There was nosignificant difference in VEGF and SDF 1 content in aqueous humor between the two groups before treatment(P 0 05)The differencesin VEGF and SDF 1 in aqueous humor of the observation group before and after treatment were higher than those of the control group，withstatistical significance(P 0 05)ConclusionsThe combination of Abersip s full retinal laser photocoagulation treatment can improve theclinical efficacy of ISCHEMIC CVO companion ME，and the patientsvision recovery is good，ME recedes obviously，and its effect may berelated to the lowering of the expression level of VEGF and SDF 1 Key words Alprazolam;Panretinal laser photocoagulation;Ischemic central retinal vein obstruction;Macular edema;etinal bloodflow;Vascular endothelial growth factor;Stromal cell derived factor 1缺血型视网膜中央静脉阻塞(central retinal veinocclusion，CVO)是一种严重的眼底血管病。黄斑水肿(macular edema，ME)是缺血型 CVO 的常见并发症之一，也是导致患者视力下降甚至失明的重要原因1。全视网膜激光光凝是常用的治疗 CVO 伴 ME 的方法，但单用时整体效果欠佳2。研究3 4 证实，血管内皮生长因子(vascular endothelial growth factor，VEGF)的过度表达与视网膜静脉阻塞(retinal vein occlusion，VO)的发生及病情进展密切相关，抗 VEGF 药物在VO 的治疗中发挥重要作用。阿柏西普是一种新型抗 VEGF 药物，能有效降低血管通透性、抑制脉络膜血管新生，在 CVO 等各种原因所致 ME 的治疗中均发挥良好的治疗效果。目前，阿柏西普、全视网膜