Different drugs combined with macular laser photocoagulation for macular edema after diabetic retinopathy in elderly patients

doi:10.3760/cma.j.issn.1007-1245.2024.21.010

Abstract

Abstract:

Objective　To explore the clinical efficacy of triamcinolone acetonide or conbercept combined with laser photocoagulation in the treatment of macular edema after diabetic retinopathy (DR) in elderly patients. Methods　Seventy elderly patients with macular edema after DR (82 eyes) treated at Department of Ophthalmology, Lianyungang First People's Hospital from June 2020 to June 2023 were selected for the prospective study, and were divided into an observation group (35 cases and 42 eyes) and a control group (35 cases and 40 eyes) by the random number table method. There were 19 males and 16 females in the observation group; they were (73.26±4.89) years old. There were 17 males and 18 females in the control group; they were (72.87±5.11) years old. The observation group took conbercept and macular laser photocoagulation. The control group took macular laser photocoagulation. The improvement and regression times of symptoms, visual function-related indicators [subfoveal choroidal thickness (SFCT), best corrected visual acuity (BCVA), and central macular thickness (CMT)], disease-related biochemical indicators [vascular endothelial growth factor (VEGF) and stromal cell-derived factor-1 (SDF-1)], macular blood flow densities [superficial capillary plexus (SCP) and deep capillary plexus (DCP)], and disease-related indicators [choroidal vascular index (CVI) and serum complement 1q/tumor necrosis factor-associated protein 9 (CTRP9)] before the treatment and after 3 months' treatment, and incidences of adverse reactions were compared between groups by t and χ² tests. Results　The macular edema improvement time, fundus bleeding absorption time, and effusion absorption time in the observation group were shorter than those in the control group [(4.36±0.21) weeks vs. (5.42±0.38) weeks, (2.39±0.23) weeks vs. (3.42±0.33) weeks, and (10.36±0.81) weeks vs. (12.25±1.15) weeks], with statistical differences (t=15.733, 16.463, and 8.637; all P<0.05). After 3 months' treatment, the CMT, VEGF, SDF-1, and CVI in the observation group were lower than those in the control group [(339.56±31.24) μm vs. (398.69±27.29) μm, (138.72±16.73) ng/L vs. (276.19±15.92) ng/L, (415.23±24.80) mg/L vs. (526.16±22.93) mg/L, and (63.86±0.94)% vs. (64.97±0.61)%]; the levels of BCVA, SCP, DCP, and CTRP9 in the observation group were higher than those in the control group [(0.49±0.08) vs. (0.34±0.07), (39.92±2.84)% vs. (38.16±2.79)%, (45.96±2.71)% vs. (43.39±2.39)%, and (113.36±14.65) μg/L vs. (102.45±13.29) μg/L]; there were statistical differences (t=10.180, 30.080, 21.034, 6.420, 9.018, 2.830, 4.546, 3.575; all P<0.05). There was no statistical difference in SFCT between the two groups (t=0.302; P=0.763). During the treatment, 1 case of dry eyes (single eye) occurred in observation group, and 1 case of conjunctival congestion (single eye) occurred in control group; the rest had no obvious adverse reactions (χ²=0.001; P=0.972). Conclusions　Compared with macular laser photocoagulation combined with triamcinolone acetonide, macular laser photocoagulation combined with conbercept has better clinical efficacy for elderly patients with macular edema after DR, and the latter one can better promote the recovery of visual function. In addition, it has a positive effect on the visual acuity, and can alleviate the clinical symptoms.

Key words:

Diabetic retinopathy, Macular edema, Laser, Conbercept, Triamcinolone acetonide

摘要：

目的　探究不同药物（曲安奈德、康柏西普）联合黄斑区激光光凝对老年糖尿病视网膜病变（DR）后黄斑水肿的影响。方法　前瞻性研究，选取2020年6月至2023年6月于连云港市第一人民医院眼科就诊的70例（82眼）老年DR后黄斑水肿患者作为研究对象，采用随机数字法分为观察组（35例，42眼）和对照组（35例，40眼）。观察组男19例、女16例，年龄（73.26±4.89）岁，采用康柏西普联合黄斑区激光光凝治疗；对照组男17例、女18例，年龄（72.87±5.11）岁，采用曲安奈德联合黄斑区激光光凝治疗。对比两组患者症状改善与消退时间、治疗前后视功能相关指标［黄斑中心凹下脉络膜厚度（SFCT）、最佳矫正视力（BCVA）、黄斑中心凹厚度（CMT）］、疾病相关生化指标［血管内皮生长因子（VEGF）、人基质细胞衍生因子1（SDF-1）］、黄斑区血流密度［浅层毛细血管丛（SCP）、深层毛细血管丛（DCP）］、疾病相关指标［脉络膜血管指数（CVI）、血清补体1q/肿瘤坏死因子相关蛋白9（CTRP9）］及不良反应发生情况。统计学方法采用t检验、χ²检验。结果　观察组黄斑水肿改善时间、眼底出血吸收时间、渗出吸收时间均短于对照组［（4.36±0.21）周比（5.42±0.38）周、（2.39±0.23）周比（3.42±0.33）周、（10.36±0.81）周比（12.25±1.15）周］，差异均有统计学意义（t=15.733、16.463、8.637，均P<0.05）。治疗3个月后，观察组CMT、VEGF、SDF-1、CVI均低于对照组［（339.56±31.24）μm比（398.69±27.29）μm、（138.72±16.73）ng/L比（276.19±15.92）ng/L、（415.23±24.80）mg/L比（526.16±22.93）mg/L、（63.86±0.94）%比（64.97±0.61）%］，BCVA、SCP、DCP、CTRP9水平均高于对照组［（0.49±0.08）比（0.34±0.07）、（39.92±2.84）%比（38.16±2.79）%、（45.96±2.71）%比（43.39±2.39）%、（113.36±14.65）μg/L比（102.45±13.29）μg/L，差异均有统计学意义（t=10.180、30.080、21.034、6.420、9.018、2.830、4.546、3.575，均P<0.05）。两组患者SFCT比较，差异无统计学意义（t=0.302，P=0.763）。治疗期间，观察组出现1例眼部干涩（单眼），对照组出现1例结膜充血（单眼），其余无明显不良反应（χ²=0.001，P=0.972）。结论　与曲安奈德联合黄斑区激光光凝相比，康柏西普联合黄斑区激光光凝可有效改善老年DR后黄斑水肿患者视功能，缓解其临床症状，促进视力恢复，具有良好临床疗效。

关键词:

糖尿病视网膜病变, 黄斑水肿, 激光, 康柏西普, 曲安奈德

Yu Meixia, Zhang Chengxia, Dong Youhui, Xu Kai.

Different drugs combined with macular laser photocoagulation for macular edema after diabetic retinopathy in elderly patients [J]. International Medicine and Health Guidance News, 2024, 30(21): 3569-3574.

郁美霞张成霞董有慧徐凯.

不同药物联合黄斑区激光光凝对老年糖尿病视网膜病变后黄斑水肿的影响 [J]. 国际医药卫生导报, 2024, 30(21): 3569-3574.

References

[1] 李剑,高法,曹方,等. 从"脾损络伤"探讨2型糖尿病的中医病机[J]. 中国中医基础医学杂志,2023,29(6):912-915.DOI:10.19945/j.cnki.issn.1006-3250.2023.06.001.
[2] 袁丽莎,张宁,任秋月,等. 芪黄益肾方对糖尿病视网膜病变大鼠视网膜组织病理形态和血-视网膜屏障功能的影响[J]. 中国中医药信息杂志,2023,30(6):81-86.DOI:10.19879/j.cnki.1005-5304.202208088.
[3] 付梅,陈长征,蒋婧文,等.糖尿病视网膜病变分级与视网膜缺血的相关性分析[J].中华眼底病杂志,2021,37(10):784-789.
[4] 何娜,廖丁莹,郑玉萍,等. 糖尿病性黄斑水肿与玻璃体视乳头牵引的相关性分析[J]. 西部医学,2016,28(10):1393-1396.DOI:10.3969/j.issn.1672-3511.2016.10.014.
[5] 马列,孟颖,刘广峰,等.玻璃体腔内注射康柏西普联合黄斑激光治疗BRVO继发ME对患者视功能、黄斑水肿的影响[J].武警后勤学院学报(医学版),2021,30(10):191-192,194.DOI:10.16548/j.2095-3720.2021.10.048.
[6] 张少华,张超,张鹏. 阿柏西普治疗不同类型糖尿病黄斑水肿临床效果及影响因素[J]. 陕西医学杂志,2022,51(7):874-877,881.DOI:10.3969/j.issn.1000-7377.2022.07.026.
[7] 桂衍超,段梅,管一鸣,等. 雷珠单抗治疗视网膜分支静脉阻塞继发黄斑水肿的预后影响因素及临床疗效[J]. 临床眼科杂志,2023,31(5):385-390.DOI:10.3969/j.issn.1006-8422. 2023.05.001.
[8] 李爽,张海召,姜晓丹,等. 玻璃体腔注射阿柏西普联合全视网膜光凝治疗糖尿病视网膜病变增殖期黄斑水肿的疗效分析[J]. 河北医科大学学报,2022,43(2):183-186,197.DOI:10.3969/j.issn.1007-3205.2022.02.012.
[9] 蒋莉,罗小玲,秦波,等. 康柏西普玻璃体内注射与其联合黄斑区激光光凝对糖尿病黄斑水肿的疗效比较[J]. 中华实验眼科杂志,2022,40(1):41-46.DOI:10.3760/cma.j.cn115989-20201104-00746.
[10] 朱琴,戴虹. 房水中细胞因子与玻璃体腔注射康柏西普治疗视网膜中央静脉阻塞继发黄斑水肿预后的相关性分析[J]. 临床眼科杂志,2023,31(5):409-413.DOI:10.3969/j.issn.1006-8422.2023.05.005.
[11] 谢红,骆艺,张景,等. 复方血栓通胶囊联合康柏西普治疗糖尿病视网膜病变的临床研究[J]. 现代药物与临床,2022,37(7):1560-1564.DOI:10.7501/j.issn.1674-5515.2 022.07.023.
[12] 董玮,陈志敏,许衍辉,等. 利湿颗粒联合曲安奈德注射液治疗白内障手术后黄斑囊样水肿的临床疗效观察[J]. 中华中医药学刊,2023,41(6):225-228,后插17.DOI:10.13193/j.issn.1673-7717.2023.06.049.
[13] 徐姗姗,宋智慧,李光耀,等. 局部注射曲安奈德用于治疗黄斑水肿有效性和安全性的系统评价[J]. 临床药物治疗杂志,2022,20(10):23-29.DOI:10.3969/j.issn.1672-3384. 2022.10.005.
[14] Cheung GC, Yoon YH, Chen LJ, et al. Diabetic macular oedema: evidence-based treatment recommendations for Asian countries[J].Clin Exp Ophthalmol,2018,46(1):75-86.DOI:10.1111/ceo.12999.
[15] 张伟亮,李双农.EDISD-OCT的眼科应用[J].中国中医眼科杂志,2015,25(3):223-227.DOI:10.13444/j.cnki.zgzyykzz.2015.03.026.
[16] 李娟,方敬爱. 益肾胶囊对糖尿病肾病大鼠肾组织SOCS3、TGF-β1、MCP-1表达的影响[J]. 中国中西医结合肾病杂志,2011,12(4):291-294.DOI:10.3969/j.issn. 1009-587X. 2011.04.004.
[17] 林璐,王安平,窦京涛,等. 血红蛋白糖化指数对糖尿病诊断影响的研究[J]. 中华糖尿病杂志,2022,14(11):1251-1257.DOI:10.3760/cma.j.cn115791-20220607-00260.
[18] 王芳,王誉程,ODURO Patrick Kwabena,等.基于网络药理学和分子对接技术探讨糖网明目颗粒治疗糖尿病视网膜病变的作用机制[J].天津中医药,2023,40(1):95-103.DOI:10.11656/j.issn.1672-1519.2023.01.18.
[19] 张祖嫣,王峰,苏颖. 眼底激光联合雷珠单抗治疗对糖尿病视网膜病变及静脉阻塞引起黄斑水肿患者视力的影响[J]. 临床和实验医学杂志,2023,22(6):609-613.DOI:10.3969/j.issn.1671-4695.2023.06.013.
[20] Zhang C, Wang H, Nie J, et al. Protective factors in diabetic retinopathy: focus on blood-retinal barrier[J].Discov Med,2014,18(98):105-112.
[21] 曾秀伟,赵艳荣,尚士博,等. 葛根素注射液联合康柏西普治疗非增殖期糖尿病视网膜病变的临床研究[J]. 现代药物与临床,2023,38(2):409-413.DOI:10.7501/j.issn.1674-5515. 2023.02.028.
[22] 王前,倪家骧,史京哲. 曲安奈德联合玻璃酸钠注射液治疗骨性膝关节炎的疗效观察[J]. 首都医科大学学报,2006,27(6):830-832.DOI:10.3969/j.issn.1006-7795. 2006.06.036.
[23] 陈雪梅,张少玉,周志霞,等. 血清VEGF、IGF-1水平与早产儿视网膜病变严重程度及预后的关系[J]. 临床和实验医学杂志,2023,22(1):73-77.DOI:10.3969/j.issn.1671-4695. 2023.01.020.
[24] 巨朝娟,张骞颖,邢朋欣,等. 抗血管内皮细胞生长因子治疗糖尿病性黄斑水肿的疗效及光学相干断层扫描血管造影结果分析[J]. 中国现代医学杂志,2022,32(10):36-41.DOI:10.3969/j.issn.1005-8982.2022.10.007.
[25] 刘彦,陈建华,赵慧英,等. 康柏西普玻璃体腔注射联合激光光凝对糖尿病黄斑水肿患者脉络膜厚度的影响[J]. 陕西医学杂志,2019,48(8):1063-1065,1073.DOI:10.3969/j.issn. 1000-7377.2019.08.029.
[26] 强甜甜,赵思婕,范宇晨,等. 康柏西普联合阈值下激光治疗糖尿病性黄斑水肿后黄斑区血流密度及形态结构的变化[J]. 蚌埠医学院学报,2023,48(11):1529-1533.DOI:10.13898/j.cnki.issn.1000-2200.2023.11.010.
[27] 翟军印,陆亚玲,张艺. 交泰归芍方联合玻璃体切割术治疗增殖性糖尿病视网膜病变合并黄斑水肿临床研究[J]. 山东中医杂志,2023,42(1):38-44.DOI:10.16295/j.cnki. 0257-358x.2023.01.008.
[28] 张瀚文,石岩. 糖尿病视网膜病变与血-视网膜屏障损伤机制研究进展[J]. 中华中医药学刊,2021,39(3):105-109.DOI:10.13193/j.issn.1673-7717.2021.03.027.
[29] Li W, Ma N, Liu MX, et al. C1q/TNF-related protein-9 attenuates retinal inflammation and protects blood-retinal barrier in db/db mice[J].Eur J Pharmacol,2019,853:289-298.DOI:10.1016/j.ejphar.2019.04.012.
[30] Cheng Y, Qi Y, Liu S, et al. C1q/TNF-related protein 9 inhibits high glucose-induced oxidative stress and apoptosis in retinal pigment epithelial cells through the activation of AMPK/Nrf2 signaling pathway[J].Cell Transplant,2020,29:963689720962052.DOI:10.1177/0963689720962052.