雷珠单抗对增生性糖尿病视网膜病变眼部VEGF-A、VEGF-B、PIGF及玻璃体切除术的影响

doi:10. 13281/j. cnki. issn.1004-4469. 2018. 04. 004

眼科

雷珠单抗对增生性糖尿病视网膜病变眼部VEGF-A、VEGF-B、PIGF及玻璃体切除术的影响

刘朝辉高晓虹栗改云李海燕张喜梅马涛

030002太原，山西省眼科医院

收稿日期:2017-12-13 出版日期:2018-07-25 发布日期:2018-07-27
通讯作者: 高晓虹，Email：violetdaisynn@126.com
基金资助:
山西省科技厅科研课题（201301003）

Effects of intravitreal ranibizumab injection on VEGF-A, VEGF-B, PIGF and vitrectomy in eye of proliferative diabetic retinopathy

LIU Zhao-hui, GAO Xiao-hong, LI Gai-yun, LI Hai-yan, ZHANG Xi-mei, MA Tao.

Shanxi Eye Hospital, Taiyuan 030002, China

Received:2017-12-13 Online:2018-07-25 Published:2018-07-27
Contact: GAO Xiao-hong, Email: violetdaisynn@126.com

摘要/Abstract

摘要：

目的观察玻璃体腔注射雷珠单抗（intravitreal ranibizumab，IVR）对增生性糖尿病视网膜病变（proliferative diabetic retinopathy，PDR）患者房水、玻璃体及增殖膜中血管内皮生长因子（vascular endothelial growth factor，VEGF）-A、VEGF-B和胎盘生长因子（placental growth factor，PIGF）表达及玻璃体切除术安全性的影响。设计前瞻性研究。研究对象 2015年1月至2016年10月山西省眼科医院PDR患者60例60眼。方法患者随机分为单纯玻璃体切除术（pars plana vitrectomy，PPV）组和IVR联合PPV组，各30眼。PPV组患者PPV手术时抽取房水、玻璃体及增殖膜取材；IVR联合PPV组于IVR前抽取房水，IVR 7天后联合PPV时抽取房水、玻璃体及增殖膜取材。采用酶联免疫吸附测定（ELISA）法检测房水、玻璃体中VEGF-A、VEGF-B及PIGF含量；免疫组织化学染色检查增殖膜中VEGF-A、VEGF-B及PIGF水平；苏木素-伊红（HE）染色观察增殖膜中血管数目；观察两组手术时间、术中出血严重程度。主要指标房水、玻璃体、增殖膜中VEGF-A、VEGF-B及PIGF含量；手术时间、术中出血程度。结果 IVR联合PPV组房水中VEGF-A含量IVR治疗后（108.30±27.13）较治疗前（384.84±114.17）明显降低（P=0.000）； VEGF-B、PIGF含量IVR治疗前后差异无统计学意义（P均>0.05）。IVR联合PPV组IVR术后7天房水、玻璃体及增殖膜中VEGF-A含量较PPV组明显降低（P均＜0.05）；VEGF-B及PIGF差异无统计学意义（P均＞0.05）。与PPV组比较，IVR联合PPV组增殖膜中血管数目、术中出血程度、手术时间明显降低（P均＜0.05）。结论玻璃体腔注射雷珠单抗可明显降低PDR患者房水、玻璃体及增殖膜中VEGF-A含量并使增殖膜中血管数目减少，缩短PPV手术时间、减轻术中出血程度，提高PPV手术的安全性。但降低房水、玻璃体及增殖膜中VEGF-B及PIGF含量不明显。（眼科， 2018, 27： 258-263）

关键词: 糖尿病视网膜病变, 血管内皮生成抑制剂, 血管内皮生长因子家族, 玻璃体切除术

Abstract:

Objective To observe the concentration of the vascular endothelial growth factor (VEGF)-A, VEGF-B and placental growth factor(PIGF) in aqueous humor ,vitreous and neovascular membrane of proliferative diabetic retinopathy (PDR) and the safety of vitrectomy after intravitreal ranibizumab injection(IVR). Design Prospective study. Participants A total of 60 PDR patients (60 eyes) were enrolled in this study from January 2015 to October 2016 in Shanxi Eye Hospital. Methods The patients were randomly divided into pars plana vitrectomy (PPV) group and IVR combined with PPV group, 30 eyes in each group. Samples of aqueous humor, vitreous and neovascular membrane were collected in the PPV group. Samples of aqueous humor were collected before IVR and samples of vitreous and neovascular membrane on 7th day after IVR during PPV in the IVR combined with PPV group. The concentrations of VEGF-A, VEGF-B and PIGF in the aqueous humor and vitreous were measured with enzyme linked immunosorbent assay (ELISA). The expression of VEGF-A, VEGF-B and PIGF in the proliferative membrane was also studied with immunohistochemistry method. The number of blood vessels in the proliferative membrane was observed with haematoxylin and eosin (HE) stains. The surgical time, severity of intraoperative bleeding between the two groups was observed. Main Outcome Measures The contents of VEGF-A, VEGF-B and PIGF in aqueous humor, vitreous and proliferating membrane were observed. The operation time and intraoperative bleeding were observed. Results The VEGF-A concentration (108.30±27.13) after IVR was significantly lower than that before IVR (384.84±114.17) (P=0.000) in the aqueous humor. There was no significant difference between VEGF-B and PIGF before and after IVR (all P>0.05). The levels of VEGF-A in the aqueous humor, vitreous and proliferative membrane on 7th day after IVR in IVR combined with PPV group were significantly lower than those in the PPV group (all P<0.05). There was no significant difference in VEGF-B and PIGF (all P>0.05). Compared with the PPV group, the number of blood vessels, the degree of intraoperative blood and the operation time in IVR combined with PPV group were significantly lower (all P<0.05). Conclusion Ranibizumab significantly decreased VEGF-A concentration, the number of blood vessels in the proliferative membrane, the surgical time, severity of intraoperative bleeding, which improved surgical safety and reduced postoperative complications. However, the content of VEGF-B and PIGF loss in aqueous humor, vitreous and proliferative membrane was not obvious. (Ophthalmol CHN, 2018, 27: 258-263)

Key words: diabetic retinopathy, angiogenesis inhibitors, vascular endothelial growth factor family, vitrectomy surgery
　　

刘朝辉高晓虹栗改云李海燕张喜梅马涛 . 雷珠单抗对增生性糖尿病视网膜病变眼部VEGF-A、VEGF-B、PIGF及玻璃体切除术的影响[J]. 眼科, doi: 10. 13281/j. cnki. issn.1004-4469. 2018. 04. 004.

LIU Zhao-hui, GAO Xiao-hong, LI Gai-yun, LI Hai-yan, ZHANG Xi-mei, MA Tao. .

Effects of intravitreal ranibizumab injection on VEGF-A, VEGF-B, PIGF and vitrectomy in eye of proliferative diabetic retinopathy

[J]. Ophthalmology in China, doi: 10. 13281/j. cnki. issn.1004-4469. 2018. 04. 004.

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雷珠单抗对增生性糖尿病视网膜病变眼部VEGF-A、VEGF-B、PIGF及玻璃体切除术的影响

Effects of intravitreal ranibizumab injection on VEGF-A, VEGF-B, PIGF and vitrectomy in eye of proliferative diabetic retinopathy

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