發(fā)布時(shí)間：2018-04-15 09:36

  本文選題：濕性老年性黃斑變性 + 固視方　； 參考：《湖北中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:觀察固視方聯(lián)合抗VEGF治療濕性老年性黃斑變性(AMD)的臨床療效。方法:采用回顧性對(duì)照研究的方法,將2014年10月至2016年12月在湖北省中醫(yī)院眼科確診為濕性AMD的患者45例(50只眼),分為治療組23例(26只眼),對(duì)照組22例(24只眼)。治療組給予固視方聯(lián)合局部抗VEGF藥物(本研究選用Lucentis)玻璃體腔注射治療,對(duì)照組僅給予Lucentis玻璃體腔注射,每月隨訪復(fù)查,根據(jù)視力、OCT、FFA結(jié)果決定是否追加治療,兩組均隨訪6個(gè)月,對(duì)兩組患者的最佳矯正視力(BCVA)、黃斑中心視網(wǎng)膜厚度(CMT)、FFA熒光滲漏、注藥次數(shù)方面進(jìn)行評(píng)價(jià)。結(jié)果:治療組的平均BCVA(logMAR)從基線測(cè)量時(shí)的0.83±0.21提高到0.15±0.17,對(duì)照組從基線0.86±0.27提高到0.46±0.17,采用配對(duì)樣本t檢驗(yàn)可得出兩組組內(nèi)比較p0.05,差異具有統(tǒng)計(jì)學(xué)意義,說(shuō)明兩組治療后的BCVA均較治療前有明顯提高。采用獨(dú)立樣本t檢驗(yàn)得出治療1月、2月兩組組間比較p0.05,表明兩組的平均BCVA變化值差異無(wú)統(tǒng)計(jì)學(xué)意義;治療3月、4月、5月、6月兩組組間比較p0.05,說(shuō)明兩組平均BCVA的變化值差異具有統(tǒng)計(jì)學(xué)意義。OCT的觀察結(jié)果顯示,治療組的CMT從基線的358.4±60.1下降到196.0±18.2,對(duì)照組從362.0±44.2下降到208.0±11.0,配對(duì)樣本t檢驗(yàn)可得到兩組組內(nèi)的p0.05,差異具有統(tǒng)計(jì)學(xué)意義,表明兩組治療后的CMT較治療前明顯減少。采用兩獨(dú)立樣本t檢驗(yàn)得出組間的p0.05,差異無(wú)統(tǒng)計(jì)學(xué)意義,表明兩組在治療后CMT的變化幅度相差不大,但治療組平均注射Lucentis的次數(shù)較對(duì)照組少,說(shuō)明固視方在一定程度上可減輕黃斑區(qū)的水腫。FFA檢查顯示,治療1、2月采用卡方檢驗(yàn)得出兩組的CNV閉合情況p0.05,差異具有統(tǒng)計(jì)學(xué)意義,表明治療組的CNV閉合情況優(yōu)于對(duì)照組;治療3、4、5、6月,經(jīng)卡方檢驗(yàn)得出兩組的p0.05,差異無(wú)統(tǒng)計(jì)學(xué)意義,說(shuō)明兩組的CNV閉合情況是相近的。從Lucentis的注射次數(shù)來(lái)看,治療組的平均注射次數(shù)為2.27±0.78,對(duì)照組平均注射次數(shù)為3.04±0.95,采用獨(dú)立樣本t檢驗(yàn)得出p0.05,差異具有統(tǒng)計(jì)學(xué)意義,表明治療組的注射次數(shù)少于對(duì)照組。結(jié)論:1.固視方聯(lián)合抗VEGF治療和單純抗VEGF治療均能顯著提高濕性AMD患者的視力。2.固視方能有效改善或穩(wěn)定抗VEGF治療后患者的視力。3.固視方在一定程度上減輕黃斑區(qū)的水腫,穩(wěn)定中央黃斑區(qū)的厚度。4.固視方聯(lián)合抗VEGF治療有延長(zhǎng)單純抗VEGF治療玻璃體腔注藥的間隔時(shí)間的趨勢(shì),能明顯減少抗VEGF治療的頻次。
[Abstract]:Objective: to observe the clinical effect of Gushi prescription combined with anti-VEGF in the treatment of wet age-related macular degeneration (AMDD).Methods: from October 2014 to December 2016, 45 patients with wet AMD were divided into treatment group (23 cases) and control group (22 cases, 24 eyes).The treatment group was treated with Lucentis intravitreal injection combined with local antitumor drugs (Lucentis), and the control group was given Lucentis intravitreal injection only, followed up every month, according to the results of visual acuity and OCTFFA, the patients in the treatment group were given additional treatment, and the patients in the control group were given Lucentis intravitreal injection only.The two groups were followed up for 6 months to evaluate the best corrected visual acuity (BCVA), central macular retinal thickness (CMT) and FFA fluorescence leakage, and the times of injection.Results: the average BCVAg log Mar in the treatment group was increased from 0.83 鹵0.21 to 0.15 鹵0.17 at baseline and from 0.86 鹵0.27 to 0.46 鹵0.17 in the control group.The results showed that the BCVA of the two groups after treatment was significantly higher than that before treatment.The independent sample t-test was used to get the comparison between the two groups in 1 month and 2 months, which indicated that there was no significant difference in average BCVA between the two groups.The comparison between the two groups in three months, four months, five months and six months showed that the difference of average BCVA between the two groups was statistically significant.The CMT of the treatment group decreased from 358.4 鹵60.1 to 196.0 鹵18.2in the baseline, and that of the control group decreased from 362.0 鹵44.2 to 208.0 鹵11.0.The matched sample t test showed that there was a significant difference between the two groups (p0.05), indicating that the CMT of the two groups after treatment was significantly lower than that before treatment.Using two independent samples t test, the difference between the two groups was not statistically significant, indicating that the change of CMT in the two groups after treatment was not different, but the average number of Lucentis injection in the treatment group was less than that in the control group.The results showed that Gushi Fang could alleviate edema in macular area to some extent. FFA examination showed that after 1 month treatment, the closure of CNV in two groups was obtained by chi-square test (p0.05). The difference was statistically significant, indicating that the closure of CNV in the treatment group was better than that in the control group.In 6 months after treatment, p0.05 of the two groups was obtained by chi-square test. The difference was not statistically significant, indicating that the closure of CNV in the two groups was similar.The average injection times of Lucentis were 2.27 鹵0.78 in the treatment group and 3.04 鹵0.95 in the control group. The difference was statistically significant by using independent sample t test, indicating that the injection times in the treatment group were less than those in the control group.Conclusion 1.Both the combination of Gushi prescription and anti VEGF therapy and anti VEGF therapy could significantly improve the visual acuity of patients with wet AMD.Gushi prescription can effectively improve or stabilize the visual acuity of patients after VEGF treatment.Gu Shi Fang alleviated the edema of macular area to a certain extent and stabilized the thickness of central macular area. 4.The combination of Gu Shi Fang and anti VEGF has the tendency of prolonging the interval time of intravitreal injection of anti VEGF alone, and can significantly reduce the frequency of anti VEGF therapy.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R774.5

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 汝亞琴;金智生;;中醫(yī)藥治療年齡相關(guān)性黃斑變性研究進(jìn)展[J];西部中醫(yī)藥;2013年09期

2 張軼;張軍軍;范瑋;;補(bǔ)體在滲出型老年性黃斑變性中的作用研究進(jìn)展[J];中華眼底病雜志;2012年05期

3 劉志恒;鄭曰忠;;炎癥與年齡相關(guān)性黃斑變性[J];臨床眼科雜志;2012年03期

4 銀娟萍;彭惠;;年齡相關(guān)性黃斑變性的預(yù)防[J];國(guó)際眼科雜志;2012年02期

5 仲路;姚靜;高峰;周欣;趙s，

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