發(fā)布時(shí)間：2018-04-29 17:13

  本文選題：嚴(yán)重增生性糖尿病視網(wǎng)膜病變 + 康柏西普��； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的觀察微創(chuàng)玻璃體視網(wǎng)膜手術(shù)(VRS)不同時(shí)機(jī)玻璃體腔內(nèi)注射抗血管內(nèi)皮生長(zhǎng)因子(vascular endothelial growth factor,VEGF)藥物康柏西普(intravitreal conbercept,IVC)對(duì)嚴(yán)重增生性糖尿病視網(wǎng)膜病變(proliferative diabetic retinopathy,PDR)的臨床療效。探索VRS術(shù)前及術(shù)中注射抗VEGF藥物的臨床適應(yīng)癥。方法1、前瞻性非隨機(jī)臨床對(duì)照研究方法。選取2014年12月至2016年3月天津市眼科醫(yī)院收治的嚴(yán)重PDR共112例(120只眼)納入研究。根據(jù)患者眼部及全身情況分為擬術(shù)前注藥組和擬術(shù)中注藥組。告知所有患者IVC的治療目的及風(fēng)險(xiǎn),由患者決定是否注藥。按照兩組IVC與否和時(shí)間分為術(shù)前注藥組及相應(yīng)對(duì)照組1,術(shù)中注藥組及相應(yīng)對(duì)照組2。術(shù)前注藥組于VRS術(shù)前3-7天行IVC,然后行23G微創(chuàng)VRS;術(shù)中注藥組于23G微創(chuàng)VRS術(shù)畢行IVC,兩組conbercept用量均為0.05ml;兩對(duì)照組均僅行23G VRS。2、對(duì)比分析兩注藥組與對(duì)照組術(shù)后一過(guò)性高眼壓、早晚期玻璃體積血(vitreous hemorrhage,VH)、視網(wǎng)膜前增殖膜及牽拉性視網(wǎng)膜脫離(tractional retinal detachment,TRD)、新生血管性青光眼(neovascular glaucoma,NVG)等并發(fā)癥,術(shù)后黃斑中心凹視網(wǎng)膜厚度(central retinal thickness,CRT)、最小分辨角對(duì)數(shù)(logMAR)最佳矯正視力(best corrected visual acuity,BCVA)情況。3、應(yīng)用SPSS21.0軟件對(duì)所有數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析。經(jīng)正態(tài)性檢驗(yàn)和方差齊性檢驗(yàn),計(jì)量資料采用(均數(shù)±標(biāo)準(zhǔn)差)表示,使用獨(dú)立樣本t檢驗(yàn);計(jì)數(shù)資料使用Personχ2檢驗(yàn)、連續(xù)性校正χ2檢驗(yàn)或Fisher精確檢驗(yàn)。術(shù)后log MAR BCVA采用重復(fù)測(cè)量?jī)梢蛩胤讲罘治�。以�?0.05為檢驗(yàn)水準(zhǔn),P0.05為有統(tǒng)計(jì)學(xué)差異。結(jié)果1、術(shù)前基本情況術(shù)前注藥組及其對(duì)照組1、術(shù)中注藥組及其對(duì)照組2性別、年齡、糖尿病病程、高血壓史、PDR分期、視網(wǎng)膜激光光凝史、logMAR BCVA、眼壓比較,均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。術(shù)前注藥組與術(shù)中注藥組平均年齡分別為(49.27±8.45)、(57.32±6.25)歲,差異有統(tǒng)計(jì)學(xué)意義(t=-4.00,P0.05)。兩注藥組平均糖尿病病程分別為(6.58±3.10)、(9.96±3.35)年,有統(tǒng)計(jì)學(xué)差異(t=-3.85,P0.05)。兩組PDRⅤ期和Ⅵ期分別有25/5,18/12只眼,有統(tǒng)計(jì)學(xué)差異(χ2=4.02,P0.05)。2、術(shù)后并發(fā)癥統(tǒng)計(jì)結(jié)果兩注藥組與其相應(yīng)對(duì)照組術(shù)后早期VH發(fā)生率相比,注藥組早期VH發(fā)生率低于其相應(yīng)對(duì)照組,有統(tǒng)計(jì)學(xué)差異(χ2=4.71,4.63,P0.05)。兩注藥組晚期VH與相應(yīng)對(duì)照組相比均無(wú)顯著統(tǒng)計(jì)學(xué)差異(χ2=0.27,0.00,P0.05)。兩注藥組與相應(yīng)對(duì)照組術(shù)后一過(guò)性高眼壓、視網(wǎng)膜前增殖膜、NVG等并發(fā)癥情況,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)前注藥組和術(shù)中注藥組術(shù)后一過(guò)性高眼壓,早、晚期VH發(fā)生率,視網(wǎng)膜前增殖膜,NVG等并發(fā)癥相比,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。3、logMAR BCVA、CRT變化情況兩注藥組與其相應(yīng)對(duì)照組兩次CRT測(cè)量平均下降幅度相比,注藥組均明顯低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(t=-3.04,-4.14,P0.05)。不同時(shí)間點(diǎn)logMAR BCVA呈現(xiàn)顯著的隨時(shí)間變化趨勢(shì)(F時(shí)間=177.71,133.20,P0.05)。組間比較,注藥組術(shù)后6個(gè)月logMAR BCVA均比其相應(yīng)對(duì)照組同期顯著改善,差異有統(tǒng)計(jì)學(xué)意義(F=4.86,4.26,P0.05)。兩注藥組術(shù)后1周、術(shù)后1個(gè)月CRT及兩者下降幅度相比,差異均無(wú)統(tǒng)計(jì)學(xué)意義(t=-0.38,0.50,1.42,P0.05)。不同時(shí)間點(diǎn)logMAR BCVA呈現(xiàn)顯著的隨時(shí)間變化趨勢(shì)(F時(shí)間=195.25,P0.05),組間無(wú)明顯統(tǒng)計(jì)學(xué)差異(F=0.47,P0.05)。結(jié)論1、康柏西普輔助23G微創(chuàng)VRS治療嚴(yán)重PDR安全有效,可減少術(shù)后早期出血,減輕黃斑水腫,提高術(shù)后視力。2、對(duì)于新生血管活躍或范圍較大的PDR患者,可選擇VRS術(shù)前注射抗VEGF藥物;而對(duì)于新生血管部分消退尤其是伴有陳舊性TRD的患眼,可選擇術(shù)中注射抗VEGF藥物。3、康柏西普可抑制術(shù)后新生血管的生成,減輕黃斑水腫,在病人知情同意的情況下,可作為輔助VRS的有效選擇。4、VRS不同時(shí)機(jī)注射抗VEGF藥物的適應(yīng)癥目前尚無(wú)定論,術(shù)前和術(shù)中注藥各有利弊,應(yīng)綜合考慮患者眼部及全身情況采取相應(yīng)手術(shù)方式。
[Abstract]:Objective To observe the clinical efficacy of intravitreous injection of anti - vascular endothelial growth factor ( IVC ) in patients with severe proliferative diabetic retinopathy ( PDR ) . There was no statistical difference between the two groups ( 49.27 鹵 8.45 ) , ( 57.32 鹵 6.25 ) years old and the difference was statistically significant ( t = - 4.00 , P0.05 ) . The mean diabetic duration of the two groups was ( 6.58 鹵 3.10 ) and ( 9.96 鹵 3.35 ) years , respectively ( t = - 3.85 , P0.05 ) . Compared with the control group , there was no significant difference between the two groups ( 蠂2 = 4.71 , 4.63 , P0.05 ) . There was no significant difference between the two groups ( 蠂2 = 4.71 , 4.63 , P0.05 ) . There was no significant difference in logMAR BCVA between the two groups ( F = - 0.38 , 0.50 , 1.42 , P0.05 ) . There was no significant difference in logMAR BCVA between the two groups ( F = - 0.38 , 0.50 , 1.42 , P0.05 ) . There was no significant difference between the two groups ( F = 0.47 , P0.05 ) . Conclusion : 1 . The treatment of acute PDR is safe and effective , which can reduce early postoperative hemorrhage , reduce macular edema and improve vision after operation .

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R779.6

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相關(guān)期刊論文 前8條

1 王默;廖欣;謝春蕾;汪浩;王方;;不同時(shí)間玻璃體腔注射雷珠單抗輔助玻璃體切割手術(shù)治療增生型糖尿病視網(wǎng)膜病變的療效觀察[J];中華眼底病雜志;2016年03期

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本文編號(hào)：1820838