中华眼外伤职业眼病杂志2024，Vol.46Issue(10) ：768-774.DOI:10.3760/cma.j.cn116022-20240601-00108

甲钴胺联合PRP治疗重度非增生型糖尿病视网膜病变的效果观察

Observation on the efficacy of mecobalamin combined with panretinal laser photocoagulation in treating severe nonproliferative diabetic retinopathy

杨铮 任雁鹏 高延庆
中华眼外伤职业眼病杂志2024，Vol.46Issue(10) ：768-774.DOI:10.3760/cma.j.cn116022-20240601-00108
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甲钴胺联合PRP治疗重度非增生型糖尿病视网膜病变的效果观察

Observation on the efficacy of mecobalamin combined with panretinal laser photocoagulation in treating severe nonproliferative diabetic retinopathy

杨铮 1任雁鹏 1高延庆1
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作者信息

  • 1. 郑州市第二人民医院眼科,郑州 450006
  • 折叠

摘要

目的 观察甲钴胺联合广泛视网膜激光光凝(PRP)治疗重度非增生型糖尿病视网膜病变(DR)的效果.方法 前瞻性随机对照研究.纳入郑州市第二人民医院 2022 年 1 月至 2023年 10 月的重度非增生型DR进行治疗的 124 例(124 眼)患者.按照随机数字表法分为两组,每组各 62 例(62 眼).其中对照组采用PRP治疗,1 次/2 周,共 4 次治疗;观察组行PRP联合甲钴胺口服,0.5 mg/次,3 次/d,治疗 2 个月.比较两组患者的最佳矫正视力(BCVA,logMAR)及黄斑区中心区视网膜厚度(CMT)、炎症因子水平、有效率及不良反应.结果 两组治疗后BCVA均较治疗前改善(观察组:治疗前 0.52±0.23,治疗后 0.30±0.17,t=10.24,P<0.001;对照组:治疗前 0.53±0.22,治疗后 0.38±0.17,t=17.08,P<0.001),且观察组治疗后BCVA优于对照组(t=2.94,P=0.004);两组治疗后 CMT均降低[观察组:治疗前(324.48±24.36)μm,治疗后(248.37±19.84)μm,t=22.43,P<0.001;对照组:治疗前(329.24±22.51)μm,治疗后(286.75±20.72)μm,t=10.63,P<0.001],且治疗后观察组CMT下降更明显(t=10.54,P<0.001);两组治疗后肿瘤坏死因子-α均降低[观察组:治疗前(57.64±6.28)ng/L,治疗后(30.18±1.32)ng/L,t=33.40,P<0.001;对照组:治疗前(57.45±6.51)ng/L,治疗后(39.16±2.77)ng/L,t=18.76,P<0.001],且治疗后观察组降低更显著(t=22.97,P<0.001);两组治疗后白细胞介素-1β均降低[观察组:治疗前(27.43±1.35)pg/mL,治疗后(11.87±0.30)pg/mL,t=84.81,P<0.001;对照组:治疗前(27.22±1.46)pg/mL,治疗后(16.42±0.68)pg/mL,t=53.52,P<0.001],且治疗后观察组降低更明显(t=48.39,P<0.001);对照组总有效率(75.81%,47/62)低于观察组(95.16%,59/62)(χ2=9.36,P=0.002);观察组不良反应发生率(6.45%,4/62)低于对照组(19.35%,12/62)(χ2=4.59,P=0.032).结论 甲钴胺联合PRP治疗重度非增生型DR可有效改善视力,降低CMT和炎症因子水平,且并发症少.

Abstract

Objective To observe the efficacy of mecobalamine combined with panretinal laser photocoagulation(PRP)in the treatment of severe non-proliferative diabetic retinopathy(DR).Methods This was a prospective randomized controlled study.A total of 124 patients(124 eyes)with severe non-proliferative DR treated in Zhengzhou Second People's Hospital from Jan.2022 to Oct.2023 were divided into two groups using randomized number table methods,with 62 patients(62 eyes)in each group.The control group received PRP treatment for 4 times(once/2 weeks),consisting of mydilation,adjustment of laser energy after anesthesia,and disseminated photocoagulation from the vascular arch to the four guadrants.Apart from PRP treatment,the observation group received additional oral-taken mecobalamin with,0.5 mg/time,3 times/day,for a total of 2 months.Best corrected visual acuity(BCVA,logMAR),central macular thickness(CMT),inflammatory factor levels,clinical efficacy rate and adverse reactions were compared between the two groups.Results BCVA of both groups improved after treatment(observation group:0.52±0.23 before treatment,0.30±0.17 after treatment,t=10.24,P<0.001;control group:0.53±0.22 before treatment,0.38±0.17 after treatment,t=17.08,P<0.001),and the improvement was more significant in the observation group(t=2.94,P=0.004);CMT decreased[observation group:(324.48±24.36)μm before treatment,(248.37±19.84)μm after treatment,t=22.43,P<0.001;control group:(329.24±22.51)μm before treatment,(286.75±20.72)μm after treatment,t=10.63,P<0.001],and after treatment,the indexes of the observation group changed more significantly(t=10.54,P<0.001);Tumor necrosis factor-α reduced[observation group:(57.64±6.28)ng/L before treatment,(30.18±1.32)ng/L after treatment,t=33.40,P<0.001;control group:(57.45±6.51)ng/L before treatment,(39.16±2.77)ng/L after treatment,t=18.76,P<0.001],and the observation group showed a more significant decrease after treatment(t=22.97,P<0.001);Interleukin-1β reduced[observation group:(27.43±1.35)pg/ml before treatment,(11.87±0.30)pg/ml after treatment,t=84.81,P<0.001;control group:(27.22±1.46)pg/ml before treatment and(16.42±0.68)pg/ml after treatment,t=53.52,P<0.001],and the observation group showed significantly lower levels after treatment(t=48.39,P<0.001).The total effective rate of the control group(75.81%,47/62)was lower than that of the observation group(95.16%,59/62)(χ2=9.36,P=0.002).The adverse reactions in the observation group(6.45%,4/62)were lower than those in the control group(19.35%,12/62)(χ2=4.59,P=0.032).Conclusion Compared with retinal laser photocoagulation alone,mecobalamine combined with retinal laser photocoagulation promotes the improvement of symptoms in DR patients,improves visual acuity,reduces retinal thickness and inflammatory factor levels in macular area,and achieves better clinical efficacy with less complications.

关键词

甲钴胺/光凝,激光,眼底/视网膜病变,糖尿病/疗效,临床/因子,炎症

Key words

Mecobalamine/Photocoagulation,retinal,laser/Retinopathy,diabetic/Efficacy,clinical/Factors,inflammatory

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出版年

2024
中华眼外伤职业眼病杂志
中华医学会

中华眼外伤职业眼病杂志

影响因子：0.622
ISSN：2095-1477
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