摘要
目的 分析玻璃体内注射康柏西普联合玻璃体切除术(PPV)治疗增生型糖尿病视网膜病变(PDR)患者术后视力的影响因素.方法 回顾性病例对照研究.收集郑州大学第一附属医院 2021 年 2 月至 2023 年 1 月诊治的PDR 122 例(122 眼)的临床资料.所有患者均行玻璃体内注射康柏西普联合23 G PPV治疗,观察手术时长、术中出血量、治疗前后的视力及血清指标.并根据治疗后 3 个月最佳矫正视力(BCVA)分为视力恢复效果良好(术后BCVA较术前提高 1 行及以上)组(74例)与视力恢复效果不良(BCVA无变化或较术前下降 1 行及以上)组(48 例),采用Logistic回归模型分析影响患者视力效果的危险因素.结果 所有患者术后 3 个月BCVA(0.22±0.08)及血清白介素(IL)-6[(32.11±3.17)ng/mL]、IL-10[(13.02±1.52)ng/mL]、C反应蛋白(CRP)[(10.25±1.14)ng/L]均低于术前,而血管生成素样蛋白 4(ANGPTL 4)高于术前,不同时点比较差异具有统计学意义(F=1 257.24、2 827.92、1 977.57、2 825.65、2 027.53,均P<0.05).在术前PDR分期、术前糖化血红蛋白(HbA1c)、术前黄斑区视网膜脱离、术前视网膜椭圆体带、术前虹膜新生血管等基线资料比较中,组间差异有统计学意义(t=19.11、3.17、7.10、10.67、8.34,均P<0.05).Logistic回归模型分析显示,DRⅥ期(OR=4.47,95%CI:1.644～12.139,P=0.003)、DRⅤ期(OR=3.97,95%CI:1.722～9.147,P=0.001)、HbAlc水平升高(OR=1.55,95%CI:1.209～1.985,P=0.001)、黄斑区视网膜脱离(OR=2.33,95%CI:1.015～5.337,P=0.046)、视网膜椭圆体带缺失(OR=4.44,95%CI:2.068～9.524,P<0.001)、虹膜新生血管(OR=2.72,95%CI:1.314～5.638,P=0.007)是影响PDR患者视力的独立危险因素.结论 玻璃体内注射康柏西普联合 PPV 治疗 PDR 有利于改善术后视力.PDR 分期、HbAlc、黄斑区视网膜脱离、视网膜椭圆体带及虹膜新生血管均为影响术后视力恢复的重要因素.
Abstract
Objective To analyze the factors influencing the visual acuity after intravitreal injection of conbercept combined with pars plana vitrectomy(PPV)in patients with proliferative diabetic retinopathy(PDR).Methods This was a retrospective case-control study.Clinical data of 122 cases(122 eyes)with PDR in the First Affiliated Hospital of Zhengzhou University from Feb.2021 to Jan.2023 were collected.All patients were treated with intravitreal injection of conbercept combined with 23 G PPV.The operative duration and intraoperative blood loss were observed,and the visual acuity and serum indexes before and after treatment were compared.Based on the best corrected visual acuity(BCVA)at 3 months after treatment,the patients were divided into a good visual acuity recovery group(BCVA in 74 cases improved by at least 1 row compared with before surgery)and a poor visual acuity recovery group(48 cases with no change or decreased by at least 1 row compared with before surgery).Logistic regression model was used to analyze the risk factors affecting visual acuity.Results At 3 months after surgery,visual acuity(0.22±0.08),interleukin(IL)-6[(32.11±3.17)ng/mL],IL-10[(13.02±1.52)ng/mL],and C-reactive protein(CRP)[(10.25±1.14)ng/L]were lower than those before surgery,while angiopoietin-like protein 4(ANGPTL 4)was higher than that before surgery.The difference was statistically significant at different time points(F=1 257.24,2 827.92,1 977.57,2 825.65,2 027.53;all P<0.05).There were statistically significant differences between groups in preoperative PDR stage,preoperative glycosylated hemoglobin(HbA1c),preoperative retinal detachment in macular area,preoperative retinal ellipsoid band,preoperative iris neovascularization and other baseline data(t=19.11,3.17,7.10,10.67,8.34;all P<0.05).Logistic regression model analysis showed that DR stage Ⅵ(OR=4.47,95%CI:1.644-12.139,P=0.003),DR stage V(OR=3.97,95%CI:1.722-9.147,P=0.001),increased HbA1c level(OR=1.55,95%CI:1.209-1.985,P=0.001),macular retinal detachment(OR=2.33,95%CI:1.015-5.337,P=0.046),retinal ellipsoid zone loss(OR=4.44,95%CI:2.068-9.524,P<0.001),and iris neovascularization(OR=2.72,95%CI:1.314-5.638,P=0.007)were independent risk factors affecting the visual acuity of patients with PDR.Conclusion Intravitreal injection of Conbercept combined with PPV is beneficial for postoperative visual acuity improvement in the treatment for PDR.PDR staging,HbA1c,macular retinal detachment,retinal elliptical zone,and iris neovascularization are all important factors affecting postoperative visual recovery.
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