康柏西普和雷珠单抗治疗湿性年龄相关性黄斑变性的效果对比
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摘要
目的对比玻璃体腔注射康柏西普与雷珠单抗治疗湿性年龄相关性黄斑变性(AMD)的临床效果。方法选取2016年11月～2017年11月沈阳市第四人民医院收治的100例湿性AMD患者(100只眼)。通过ETDRS视力表、光学相干断层扫描(OCT)、眼底荧光血管造影(FFA)等辅助检查来确诊,采用随机数字表法将患者分为康柏西普组和雷珠单抗组,每组各50例(50只眼)。康柏西普组给予玻璃体腔注射10 g/L的康柏西普0.05 ml(含康柏西普0.5 mg),雷珠单抗治疗组给予玻璃体腔注射10 g/L的雷珠单抗0.05 ml(含雷珠单抗0.5 mg),随访12个月,对比两组患者治疗前后的ETDRS视力、黄斑中心凹视网膜厚度及脉络膜新生血管(CNV)渗漏情况。结果两组患者治疗前的ETDRS视力与黄斑中心凹视网膜厚度比较,差异无统计学意义(P>0.05);治疗后两组的ETDRS视力均高于治疗前,黄斑中心凹视网膜厚度小于治疗前,差异有统计学意义(P<0.05);治疗后两组的ETDRS视力与黄斑中心凹视网膜厚度比较,差异无统计学意义(P>0.05);两组的CNV病灶渗漏情况比较,差异无统计学意义(P>0.05);康柏西普组的注射次数少于雷珠单抗组,差异有统计学意义(P<0.05);两组随访期间均未见与注射及药物有关的眼部及全身不良反应产生。结论玻璃体腔内注射康柏西普与雷珠单抗治疗湿性AMD均有较好的效果,可明显提高患者视力,减轻黄斑水肿的程度,有效抑制新生血管的渗漏,但是随访期间,康柏西普治疗组的药物注射次数明显少于雷珠单抗治疗组,从经济学角度考虑,能一定程度节省患者支付的医疗费用。
Objective To compare the clinical effect of intravitreal injection of Conbercept and Ranibizumab in the treatment of wet age-related macular degeneration(AMD). Methods A total of 100 cases of wet AMD patients(100 eyes) treated in the Fourth People′s Hospital of Shenyang City from November 2016 to November 2017 were selected.The patients were diagnosed by examining the early treatment diabetic retinopathy study(ETDRS) visual acuity chart,optical coherence tomography(OCT), fundus fluorescein angiography(FFA), etc. The patients were divided into the Conbercept and the Ranibizumab groups by random number table methods, with 50 cases in each group(50 eyes). In the Conbercept treatment group, intravitreal injection of 0.05 ml Conbercept(10 g/L with 0.5 mg Conbercept). In the Ranibizumab treatment group, intravitreal injection of 0.05 ml Ranibizumab(10 g/L with 0.5 mg Ranibizumab). After12-month follow-up, the ETDRS visual acuity, foveal retinal thickness and choroidal neovascularization(CNV) leakage before and after treatment were compared in the two groups. Results There was no significant difference in the ETDRS visual acuity or foveal retinal thickness between the two groups before treatment(P>0.05). After treatment, the visual acuity of ETDRS was higher than that before treatment, and the thickness of foveal retina was less than that before treatment, the differences were statistically significant(P<0.05). There was no significant difference in the visual acuity of ETDRS or the thickness of foveal retina in the two groups after treatment(P >0.05). On comparison of the CNV leakage, there was no significant difference(P >0.05). The number of injections in the conbercept group was less than that in the ranibizu mab group(P <0.05).There were no ocular and systemic adverse reactions related to injection or drug during the follow-up period. Conclusion Intravitreal injection of Conbercept and Ranibizumab in the treatment of wet AMD has a good effect, can markedly improve the patients′ vision, reduce macular edema, and effectively inhibit the leakage of new blood vessels, but during the follow-up, the number of drug injections in the Conbercept treatment group was greatly less than that in the Ranibizumab treatment group. From an economic point of view, the medical expenses paid by the patients can be saved to some extent in the former.
Objective To compare the clinical effect of intravitreal injection of Conbercept and Ranibizumab in the treatment of wet age-related macular degeneration(AMD). Methods A total of 100 cases of wet AMD patients(100 eyes) treated in the Fourth People′s Hospital of Shenyang City from November 2016 to November 2017 were selected.The patients were diagnosed by examining the early treatment diabetic retinopathy study(ETDRS) visual acuity chart,optical coherence tomography(OCT), fundus fluorescein angiography(FFA), etc. The patients were divided into the Conbercept and the Ranibizumab groups by random number table methods, with 50 cases in each group(50 eyes). In the Conbercept treatment group, intravitreal injection of 0.05 ml Conbercept(10 g/L with 0.5 mg Conbercept). In the Ranibizumab treatment group, intravitreal injection of 0.05 ml Ranibizumab(10 g/L with 0.5 mg Ranibizumab). After12-month follow-up, the ETDRS visual acuity, foveal retinal thickness and choroidal neovascularization(CNV) leakage before and after treatment were compared in the two groups. Results There was no significant difference in the ETDRS visual acuity or foveal retinal thickness between the two groups before treatment(P>0.05). After treatment, the visual acuity of ETDRS was higher than that before treatment, and the thickness of foveal retina was less than that before treatment, the differences were statistically significant(P<0.05). There was no significant difference in the visual acuity of ETDRS or the thickness of foveal retina in the two groups after treatment(P >0.05). On comparison of the CNV leakage, there was no significant difference(P >0.05). The number of injections in the conbercept group was less than that in the ranibizu mab group(P <0.05).There were no ocular and systemic adverse reactions related to injection or drug during the follow-up period. Conclusion Intravitreal injection of Conbercept and Ranibizumab in the treatment of wet AMD has a good effect, can markedly improve the patients′ vision, reduce macular edema, and effectively inhibit the leakage of new blood vessels, but during the follow-up, the number of drug injections in the Conbercept treatment group was greatly less than that in the Ranibizumab treatment group. From an economic point of view, the medical expenses paid by the patients can be saved to some extent in the former.
引文
[1]何苗,曹奎.雷珠单抗联合光动力疗法对湿性年龄相关性黄斑变性患者视觉功能、敏感度及血清VEGF含量的影响[J].海南医学院学报,2016,22(17):2066-2068,2072.
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[11]徐蕾,王大江.玻璃体内注射雷珠单抗联合小梁切除术治疗新生血管性青光眼[J].中华眼外伤职业眼病杂志,2015,37(2):125-128.
[12]谢九冰,寇义华,刘若屏,等.Ex-Press植入联合雷珠单抗玻璃体内注射治疗新生血管性青光眼[J].眼科新进展,2016,36(1):61-64.
[13]蒋磊,宫媛媛.抗VEGF药物在视网膜血管性疾病手术期的应用[J].中华实验眼科杂志,2014,32(3):274-277.
[14]马乐,闫少芳,黄旸木,等.早期老年黄斑变性视功能改变与黄斑色素密度的关系[J].北京大学学报(医学版)2012,44(6):973-976.
[15]Cho HJ,Kim HS,Yoo SG,et al.Retinal pigment epithelial tear after intravitreal Ranibizumab treatment for retinal allgiomatous proliferation[J].Am J Ophthalmol,2015,160(5):1000,1005.
[2]李娟娟,黎铧.玻璃体腔注射雷珠单抗对中心凹下瘢痕化的湿性年龄相关性黄斑变性的疗效及意义[J].中华实验眼科杂志,2017,35(1):153-154.
[3]赵露,谢国丽,王艳玲.玻璃体腔注射雷珠单抗对湿性年龄相关性黄斑变性患者眼血流动力学的影响[J].山东大学耳鼻喉眼学报,2016,30(4):101-104.
[4]张秀霞,郭丽英.网络宣教对糖尿病性视网膜病变患者的护理干预效果[J].解放军医药杂志,2016,28(6):93-94.
[5]张燕,郑瑞莲,王瑞夫.玻璃体腔注射抗血管内皮生长因子治疗湿性年龄相关性黄斑变性的临床效果[J].中国医药导报,2016,13(9):140-143.
[6]Shan N,Maguire MG,Martin DF,et al.Angiographic cystoid macular edema and outcomes in the comparison of age-related macular degeneration treatments trials[J].Ophthalmology,2016,l23(4):858-864.
[7]Lalwani GA,Rosenfeld PJ,Fung AE,et al.A variable-dosing regimen with in travitreal Ranibizumab for neovaseular age-related macular degeneration:year 2 of the PRONTO Study[J].Am J Ophthalmol,2009,148(1):43-58.
[8]Ford KM,D′amour PA.Molecular regulation of vascular endothelial growth factor expression in the retinal pigment epithelium[J].Mol Vis,2012,18:519-527.
[9]Huang C,Xu Y,Li X,et al.Vascular endothefial growth factor A polymorphisms and age-related macular degeneration:a systematic review and meta-analysis[J].Mol Vis,2013,19:1211-1221.
[10]Peden MC,Suner IJ,Hammer ME,et al.Long-term outcomes in eyes receiving fixed-interval dosing of anti-vascular endothelial growth factor agents for wet age-related macular degeneration[J].Ophthalmology,2015,122(4):803-808.
[11]徐蕾,王大江.玻璃体内注射雷珠单抗联合小梁切除术治疗新生血管性青光眼[J].中华眼外伤职业眼病杂志,2015,37(2):125-128.
[12]谢九冰,寇义华,刘若屏,等.Ex-Press植入联合雷珠单抗玻璃体内注射治疗新生血管性青光眼[J].眼科新进展,2016,36(1):61-64.
[13]蒋磊,宫媛媛.抗VEGF药物在视网膜血管性疾病手术期的应用[J].中华实验眼科杂志,2014,32(3):274-277.
[14]马乐,闫少芳,黄旸木,等.早期老年黄斑变性视功能改变与黄斑色素密度的关系[J].北京大学学报(医学版)2012,44(6):973-976.
[15]Cho HJ,Kim HS,Yoo SG,et al.Retinal pigment epithelial tear after intravitreal Ranibizumab treatment for retinal allgiomatous proliferation[J].Am J Ophthalmol,2015,160(5):1000,1005.
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