中华眼底病杂志

中华眼底病杂志

玻璃体腔注射康柏西普治疗糖尿病黄斑水肿疗效影响因素研究

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目的观察分析玻璃体腔注射康柏西普治疗糖尿病黄斑水肿(DME)疗效的影响因素。方法回顾性研究。接受玻璃体腔注射康柏西普治疗的DME患者51例76只眼纳入研究。采集患者年龄、性别、体重指数、吸烟史、饮酒史等一般信息;糖尿病病程、空腹血糖、糖化血红蛋白(HbA1c)等血糖指标;高血压病史、收缩压、舒张压等血压指标;血清总胆固醇(TC)、高密度脂蛋白(HDL)、载脂蛋白A(APOA)等血脂指标;血中性粒细胞浓度、血红蛋白(HB)、血肌酐(Scr)等生化指标。对比分析患眼玻璃体腔注射康柏西普治疗前与治疗后第7天的最佳矫正视力(BCVA)和黄斑中心视网膜厚度(CMT)。以CMT降低≥20%为水肿疗效达标,反之为未达标。以BCVA提高2行及以上为视力疗效达标,反之为未达标。采用单因素分析及多因素logistic回归分析得出影响DME患者玻璃体腔注射康柏西普治疗效果的因素,以比值比(OR)及95%可信区间(CI)表示。结果单因素分析结果显示,舒张压、HDL、血中性粒细胞浓度、基线CMT及基线BCVA与治疗后水肿消退效果有关(P<0.05);HbA1c与治疗后视力提高效果有关(P<0.05)。多因素logistic回归分析结果显示,有吸烟史(OR=0.122,95%CI 0.017~0.887)、舒张压低(OR=0.850,95%CI0.748~0.966)、HDL低(OR=0.007,95%CI0.000 1~0.440)、基线CMT薄(OR=0.986,95%CI0.977~0.995)是治疗后水肿疗效未达标的独立危险因素(P<0.05);糖尿病病程长(OR=1.191,95%CI1.011~1.404)、APOA高(OR=1.007,95%CI1.000~1.013)是治疗后视力疗效未达标的独立危险因素;年龄、空腹血糖、收缩压、TC、HB、Scr等其他指标对治疗后水肿、视力疗效均无影响(P>0.05)。结论有吸烟史、糖尿病病程长、舒张压低、HDL水平低、APOA高水平、基线CMT薄是玻璃体腔注射康柏西普治疗DME疗效的独立危险因素。

ObjectiveTo analyze the influencing factors on clinical response to conbercept for diabetic macular edema (DME).MethodsA total of 51 patients (51 eyes) with DME who underwent intravitreal injection of conbercept were included in this retrospective study. The general information (age, sex, body mass index, smoking history, drinking history), blood glucose indicators (duration of diabetes, fasting blood glucose, HbA1c), blood pressure indicators (history of hypertension, systolic blood pressure, diastolic blood pressure), lipid indicators [total cholesterol (TC), high-density lipoprotein (HDL), apolipoprotein A (APOA)], biochemical indicators [neutrophil concentration, hemoglobin (HB), serum creatinine (Scr)] were collected. The best corrected visual acuity (BCVA) and macular central macular thickness (CMT) before and after treatment were comparatively analyzed. CMT reduced not less than 20% and BCVA increased by 2 lines as effective standards. Univariate analysis and multivariate logistic regression analysis were used to determine the factors affecting the efficacy of intravitreal injection of conbercept in patients with DME.ResultsUnivariate analysis showed that diastolic blood pressure, HDL, serum neutrophil concentration, baseline CMT and baseline BCVA were associated with edema regression (P<0.05); HbA1c was associated with vision improvement (P<0.05). Multivariate logistic regression analysis showed that there was a history of smoking (OR=0.122, 95% CI 0.017 − 0.887), low diastolic blood pressure (OR=0.850, 95%CI0.748 − 0.966), low HDL (OR=0.007, 95%CI 0.000 1 − 0.440), thin baseline CMT (OR=0.986, 95%CI0.977 − 0.995) were independent risk factors for failure outcome of edema regression (P<0.05); long duration of diabetes (OR=1.191, 95%CI 1.011 − 1.404), high APOA (OR=1.007, 95% CI 1.000 − 1.013) were independent risk factors for failure outcome of vision improvement. Age, fasting blood glucose, systolic blood pressure, TC, HB, Scr and other indicators had no effect on the efficacy of edema regression and vision improvement after treatment (P>0.05).ConclusionsSmoking history, long duration of diabetes, low diastolic blood pressure, low HDL level, high APOA level and thin baseline CMT are independent risk factors for the treatment of DME with intravitreal injection of conbercept.

关键词: 糖尿病视网膜病变/并发症; 黄斑水肿/药物疗法; 血管生成抑制剂/治疗应用; 抗体,单克隆/治疗应用

Key words: Diabetic retinopathy/complications; Macular edema/drug therapy; Angiogenesis inhibitors/therapeutic use; Antibodies, monoclonal/therapeutic use

引用本文: 朱婷婷, 王权, 赵蓉, 刘勇, 陈威, 赵燕燕, 罗玲, 接传红, 田天, 姜彩辉. 玻璃体腔注射康柏西普治疗糖尿病黄斑水肿疗效影响因素研究. 中华眼底病杂志, 2018, 34(5): 436-442. doi: 10.3760/cma.j.issn.1005-1015.2018.05.005 复制

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