目的 研究抗血管内皮生长因子(VEGF)在糖尿病性黄斑水肿中的短期效果及其影响因素，并探讨相关护理干预策略。方法 按回顾性方法纳入糖尿病性黄斑水肿患者 202 例，均接受抗VEGF治疗，通过随访评价其短期效果，按短期效果将患者分成疗效达标组和疗效不佳组，对比两组最佳矫正视力(BCVA)、黄斑中心凹视网膜厚度(CMT)和临床资料，并进行糖尿病性黄斑水肿患者短期效果的多因素Logistic回归分析，分析各指标对短期效果的预测价值。结果 202 例糖尿病性黄斑水肿患者接受抗VEGF治疗后疗效不佳 23 例(11。39%)(疗效不佳组)，疗效达标 179 例(88。61%)(疗效达标组)。治疗后，疗效达标组BCVA(0。54±0。12)logMAR、CMT(287。23±30。59)µm均低于疗效不佳组的(0。62±0。15)logMAR、(305。46±33。12)µm(P<0。05)。疗效不佳组收缩压≥139 mm Hg(1 mm Hg=0。133 kPa)、舒张压≥70 mm Hg、糖化血红蛋白≥8%、高密度脂蛋白<1。2 mmol/L的占比分别为 60。87%(14/23)、73。91%(17/23)、65。22%(15/23)、69。57%(16/23)，均高于疗效达标组的 38。55%(69/179)、31。28%(56/179)、35。20%(63/179)、41。34%(74/179)，存在显著差异(P<0。05);两组性别、年龄、糖尿病类型、糖尿病病程、体质量指数、吸烟史、饮酒史、合并症、水肿分型、糖尿病性黄斑水肿病程、疾病分型、疾病分期、眼压情况对比无差异(P>0。05)。经Logistic回归分析上述存在显著差异的项目发现，收缩压、舒张压、糖化血红蛋白、高密度脂蛋白均是糖尿病性黄斑水肿患者短期效果的影响因素(P<0。05)。通过绘制受试者工作特征(ROC)曲线发现，收缩压、舒张压、糖化血红蛋白、高密度脂蛋白单一检测预测短期效果的曲线下面积(AUC)均较高，各指标联合检测的AUC最高，达到 0。747。结论 抗VEGF治疗糖尿病性黄斑水肿的短期效果较好，但仍有部分患者的疗效未达标，可能和患者收缩压、舒张压、糖化血红蛋白、高密度脂蛋白有关，因此，早期制定相关的护理措施至关重要，在提升患者短期效果上意义重大。
Analysis of factors influencing the short-term outcome of anti-VEGF therapy for diabetic macular edema
Objective To study the short-term outcome and influencing factors of anti-vascular endothelial growth factor(VEGF)in diabetic macular edema,and explore the relevant nursing intervention strategies.Methods A total of 202 patients with diabetic macular edema were retrospectively included,all of whom received anti-VEGF treatment.Their short-term outcome were evaluated through follow-up,and the patients were divided into the outcome achieved group and the poor outcome group according to the short-term outcome.The best corrected visual acuity(BCVA),central macular thickness(CMT)and clinical data of the two groups were compared,and the short-term effect of diabetic macular edema patients was analyzed by multivariate Logistic regression analysis,and the predictive value of each index on the short-term outcome was analyzed.Results 202 patients with diabetic macular edema receiving anti-VEGF treatment had poor outcome in 23 cases(11.39%)(poor outcome group),and the outcome was achieved in 179 cases(88.61%)(outcome achieved group).After treatment,BCVA and CMT were(0.54±0.12)logMAR and(287.23±30.59)µm in the outcome achieved group,which were lower than(0.62±0.15)logMAR and(305.46±33.12)µm in the poor outcome group(P<0.05).In the poor outcome group,the percentages of systolic blood pressure≥139 mm Hg(1 mm Hg=0.133 kPa),diastolic blood pressure≥70 mm Hg,glycosylated hemoglobin≥8%and high-density lipoprotein<1.2 mmol/L were 60.87%(14/23),73.91%(17/23),65.22%(15/23)and 69.57%(16/23),which were higher than 38.55%(69/179),31.28%(56/179),35.20%(63/179)and 41.34%(74/179)in the outcome achieved group,and there were significant differences(P<0.05).There was no difference in the comparison of gender,age,type of diabetes mellitus,duration of diabetes mellitus,body mass index,history of smoking,history of alcohol consumption,comorbidities,edema classification,duration of diabetic macular edema,disease classification,disease staging,and intraocular pressure status between the two groups(P>0.05).After Logistic regression analysis of the above items with significant differences,it was found that systolic blood pressure,diastolic blood pressure,glycosylated hemoglobin,and high-density lipoprotein were all factors influencing the short-term outcome of patients with diabetic macular edema(P<0.05).By plotting the receiver operating characteristic(ROC)curve,it was found that systolic blood pressure,diastolic blood pressure,glycosylated hemoglobin,and high-density lipoprotein all had high area under the curve(AUC)for predicting short-term outcome in a single test,and that the combined test of each index had the highest AUC of 0.747.Conclusion The short-term outcome of anti-VEGF treatment for diabetic macular edema is good,but there are still some patients with poor outcomes,which may be related to patients'systolic blood pressure,diastolic blood pressure,glycosylated hemoglobin,and high-density lipoprotein;therefore,it is crucial to develop relevant care measures early,which is significant in enhancing the short-term outcome of patients.
万方数据
维普
