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

Efficacy of anti-vascular endothelial cell growth factor treatment for diabetic macular edema and the value of optical coherence tomography angiography in the outcome measurement

摘要:

目的 分析抗血管内皮细胞生长因子（VEGF）治疗糖尿病性黄斑水肿（DME）的疗效及光学相干断层扫描血管造影（OCTA）结果。方法 选取2018年4月—2021年4月在河北医科大学第一医院接受治疗的DME患者80例（130眼）。将患者分为A组和B组，每组40例（分别为70眼、80眼）。A组给予曲安奈德治疗，B组给予康柏西普治疗。记录两组治疗前、治疗后1个月及治疗后3个月的最佳矫正视力（BCVA）和眼内液白细胞介素6（IL-6）、一氧化氮合酶（NOS）水平，并采用OCTA检查治疗前、治疗后1个月及治疗后3个月黄斑中心凹旁厚度（PMT）、黄斑中心厚度（FMT）、中心视网膜厚度（CRT）及中心凹无血管区面积（FAZ）。结果 两组治疗前、治疗后1个月、治疗后3个月的BCVA比较，经重复测量设计的方差分析，结果显示：①不同时间点的BCVA有差异（P <0.05）；②两组BCVA有差异（P <0.05），B组治疗后3个月BCVA值较A组低；③两组BCVA变化趋势有差异（P <0.05）。两组治疗前、治疗后1个月、治疗后3个月的PMT、FMT比较，经重复测量设计的方差分析，结果显示：①不同时间点的PMT、FMT有差异（P <0.05）；②两组PMT、FMT有差异（P <0.05），A组治疗后较B组厚；③两组PMT、FMT变化趋势有差异（P <0.05）。两组治疗前、治疗后1个月、治疗后3个月的CRT、FAZ比较，经重复测量设计的方差分析，结果显示：①不同时间点的CRT、FAZ有差异（P <0.05）；②两组CRT、FAZ有差异（P <0.05），A组治疗后较B组厚；③两组CRT、FAZ变化趋势有差异（P <0.05）。两组治疗前、治疗后1个月、治疗后3个月的眼内液IL-6、NOS比较，经重复测量设计的方差分析，结果显示：①不同时间点的眼内液IL-6、NOS有差异（P <0.05）；②两组眼内液IL-6、NOS有差异（P <0.05）；③两组眼内液IL-6、NOS变化趋势有差异（P <0.05）。结论 抗VEGF治疗DME可有效改善视网膜渗漏及黄斑水肿，降低炎症水平，OCTA定量分析可提供可靠的检测结果。

Abstract:

Objective To analyze the efficacy of anti-vascular endothelial cell growth factor (VEGF) treatment for diabetic macular edema (DME) and the value of optical coherence tomography angiography (OCTA) in the outcome measurement.Methods Eighty DME patients (130 eyes) treated in the First Hospital of Hebei Medical University from April 2018 to April 2021 were divided into two groups, in which group A (40 patients, 70 eyes) was treated with verteporfin and group B (40 patients, 80 eyes) with conbercept. The best corrected visual acuity (BCVA) and the levels of interleukin-6 (IL-6) and nitric oxide synthase (NOS) in the intraocular fluid before the treatment, 1 month after the treatment and 3 months after the treatment were recorded. Besides, the parafoveal thickness (PFT), central macular thickness (CMT), central retinal thickness (CRT) and foveal avascular zone (FAZ) were measured via OCTA.Results There was no significant difference in BCVA between two groups before treatment and 1 month after treatment (P > 0.05), while BCVA after 3 months of treatment was lower in the group B relative to that in the group A (P < 0.05). As shown in the repeated measures analysis of variance, BCVA before the treatment, 1 month after the treatment and 3 months after the treatment were different (P < 0.05), and BCVA was different between the two groups (P < 0.05). Besides, the change trend of BCVA was also different between the two groups (P < 0.05). The PFT and CMT were different among the time points and between the groups, and they were higher in the group A than those in group B after treatment (P < 0.05). The change trends of PFT and CMT were different between the two groups (P < 0.05). The CRT and FAZ were also different among the time points (P < 0.05) and between the two groups (P < 0.05), and those in the group A were higher compared with the group B after treatment (P < 0.05). The change trends of CRT and FAZ were different between the two groups (P < 0.05). As for the levels of IL-6 and NOS in the intraocular fluid, they were different among the time points (P < 0.05) and between the groups (P < 0.05), and their change trends differed between the two groups as well (P < 0.05).Conclusions Anti-VEGF treatment effectively mitigates retinal blood leakage and macular edema as well as the inflammation in DME. In addition, quantitative OCTA analysis provides reliable results for assessing the therapeutic efficacy of anti-VEGF treatment.