摘要
目的 分析多点扫描模式广泛视网膜激光光凝术(PRP)联合玻璃体内注射雷珠单抗治疗糖尿病视网膜病变(DR)患者术后脉络膜厚度的分布特征.方法 回顾性病例对照研究.纳入2021 年 4 月至 2022 年 4 月在商丘市第一人民医院就诊的重度非增生型DR患者 98 例.依据治疗方法的不同将其分为对照组(48 例)和观察组(50 例),对照组行多点扫描模式PRP,观察组则接受多点扫描模式PRP联合玻璃内注射雷珠单抗治疗.随访时间6 个月比较两组患者疗效及治疗前、治疗1、3、6 个月后脉络膜厚度分布特征,包括黄斑中心凹下脉络膜厚度(SFCT)、下方脉络膜厚度(ICT)、上方脉络膜厚度(SCT)、鼻侧脉络膜厚度(NCT).结果 观察组治疗后 1、3、6 个月的 SFCT 分别为(251.05±28.41)、(220.32±15.08)和(214.00±12.36)μm,均低于对照组的[(268.14±32.05)、(235.16±25.14)和(220.65±20.00)μm](F组间=44.02、F交互=18.19、F时点=159.40,均P<0.001);观察组治疗后 1、3、6 个月的ICT分别为(258.14±25.67)、(220.17±15.63)和(195.30±9.85)μm,均低于对照组的[(274.30±30.11)、(251.66±21.63)和(230.61±10.23)μm](F组间=190.00、F交互=10.30、F时点=67.22,均P<0.001);观察组治疗后 1、3、6 个月的 SCT 分别为(227.68±15.00)、(195.68±10.23)和(155.69±8.26)μm,均低于对照组的[(241.32±18.63)、(218.53±14.50)和(204.13±11.63)μm](F组间=149.40、F交互=34.84、F时点=443.90,均P<0.001);观察组治疗后 1、3、6 个月的NCT分别为(186.23±14.62)、(180.23±12.57)和(166.27±10.14)μm,均低于对照组的[(200.42±18.63)、(191.28±14.00)和(184.32±12.45)μm](F组间=245.60、F交互=5.09、F时点=39.28,均P<0.001);观察组治疗有效率 94.00%(47/50)高于对照组的 79.17%(38/48)(χ2=4.68,P=0.003).结论 多点扫描模式PRP联合玻璃体内注射雷珠单抗治疗重度非增生型DR可降低脉络膜厚度.
Abstract
Objective To analyze the distribution characteristics of choroidal thickness in patients with diabetic retinopathy(DR)treated by multi-scan mode pan retinal laser photocoagulation(PRP)combined with intravitreal injection of ranibizumab.Methods This was a retrospective case-control study.Ninety-eight patients with severe non-proliferative DR treated in the First People's Hospital of Shangqiu from Apr.2021 to Apr.2022 were included.Based on different treatment methods,they were divided into a control group(48 cases)and an observation group(50 cases).The control group received multi-scan mode PRP,and the observation group received multi-scom mode PRP and intravitreal injection with ranibizumab.After 6 months of follow-up,the efficacy and the distribution characteristics of choroid thickness before treatment,at 1,3 and 6 months after treatment were compared between the two groups,including subfoveal choroid thickness(SFCT),inferior choroid thickness(ICT),superior choroid thickness(SCT)and nasal choroid thickness(NCT).Results The choroidal thickness measurements of the two groups at 1,3 and 6 months after treatment were compared.SFCT of the observation group at 1,3 and 6 months after treatment was(251.05±28.41),(220.32±15.08)and(214.00±12.36)μm,respectively,all of which were lower than those of the control group[(268.14±32.05),(235.16±25.14)and(220.65±20.00)μm](Fgroup=44.02,Finteraction=18.19,Ftime=159.40;all P<0.001).ICT of the observation group at 1,3 and 6 months after treatment was(258.14±25.67),(220.17±15.63)and(195.30±9.85)μm,respectively,all of which were lower than those of the control group[(274.30±30.11),(251.66±21.63)and(230.61±10.23)μm](Fgroup=190.00,Finteraction=10.30,Ftime=67.22;all P<0.001).Of the observation group,SCT at 1,3 and 6 months after treatment was(227.68±15.00),(195.68±10.23)and(155.69±8.26)μm,respectively,all of which were lower than those of the control group[(241.32±18.63),(218.53±14.50)and(204.13±11.63)μm](Fgroup=149.40,Finteraction=34.84,Ftime=443.90;all P<0.001).NCT of the observation group at 1,3 and 6 months after treatment was(186.23±14.62),(180.23±12.57)and(166.27±10.14)μm,respectively,all of which were lower than those of the control group[(200.42±18.63),(191.28±14.00)and(184.32±12.45)μm](Fgroup=245.60,Finteraction=5.09,Ftime=39.28;all P<0.001).The effective rate of the two groups was 79.17%(38/48)and 94.00%(47/50),respectively,and the observation group was higher than the control group(χ2=4.68,P=0.003).Conclusion Multi-point scanning mode panretinal laser photocoagulation combined with intravitreal injection of ranibizumab can reduce choroidal thickness in the treatment of severe non-proliferative DR.
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