补体因子H（CFH）基因多态性对玻璃体内注射雷珠单抗治疗年龄相关性黄斑变性（AMD）疗效的影响。
The effect of CFH polymorphisms on the response to the treatment of age-related macular degeneration (AMD) with intravitreal ranibizumab.
作者信息
Dikmetas Ozlem, Kadayıfcılar Sibel, Eldem Bora
机构信息
Hacettepe University School of Medicine, Department of Ophthalmology.
出版信息
Mol Vis. 2013 Dec 20;19:2571-8. eCollection 2013.
PURPOSE
The purpose of this study is to evaluate the effect of complement factor H (CFH) Y402H CC and TT polymorphisms on treatment response to intravitreal ranibizumab injection in patients with wet age-related macular degeneration (AMD).
METHODS
One hundred ninety-three patients with choroidal neovascularization (CNV) secondary to AMD who were monitored for at least 6 months of follow-up, and with at least three ranibizumab injections, were included in the study. At the final examination, an increase in visual acuity (VA) of five letters or more compared to the initial VA was regarded as a good response, and a decrease in VA of five letters or more compared to the initial VA was evaluated as a poor response. A genetic examination was performed with a PCR melting curve analysis. In the statistical evaluation, SPSS version 18 software was used.
RESULTS
The mean age of the patients was 71.01 (55-86) years, the mean follow-up was 13.34 (6-36) months, and the mean number of injections was 4.02 (3-15). There were 96 patients in the good response group (Group 1) and 97 patients in the poor response group (Group 2). The initial VA in Group 1 was 41.34 (10-64) letters, the initial central macular thickness (CMT) was 213.40 (126-494) µm, and the initial lesion width was 3760 (1430-6430) µm. The initial VA in Group 2 was 52.89 (26-82) letters, the initial CMT was 257.60 (115-882) µm, and the initial lesion width was 4460 (1000-7650) µm. There was no statistically significant difference between the two groups in terms of the initial VA and CMT (p=0.094, p=0.083). However, there was a statistically significant difference between the groups in the width of the initial lesion (p=0.003). In Group 1, 15 CC, 30 TT, and 51 TC alleles were found, and in Group 2, 49 CC, two TT, and 46 TC alleles were found, and the distribution was significantly different between the two groups (p=0.012). The change in the distribution of genotypes was not associated with either the lesion size or VA (p=0.841). Fibrosis developed in 12 patients who were all poor responders.
CONCLUSIONS
CFH Y402H CC accompanied a poor response, and TT accompanied a good response in this series of patients with AMD undergoing ranibizumab therapy.
目的
本研究旨在评估补体因子H（CFH）Y402H位点CC和TT基因多态性对湿性年龄相关性黄斑变性（AMD）患者玻璃体内注射雷珠单抗治疗反应的影响。
方法
本研究纳入了193例继发于AMD的脉络膜新生血管（CNV）患者，这些患者至少接受了6个月的随访且至少注射了3次雷珠单抗。在最后一次检查时，与初始视力相比，视力提高5个字母或更多被视为良好反应，与初始视力相比，视力下降5个字母或更多被评估为不良反应。采用聚合酶链反应熔解曲线分析进行基因检测。在统计评估中，使用SPSS 18版软件。
结果
患者的平均年龄为71.01（55 - 86）岁，平均随访时间为13.34（6 - 36）个月，平均注射次数为4.02（3 - 15）次。良好反应组（第1组）有96例患者，不良反应组（第2组）有97例患者。第1组的初始视力为41.34（10 - 64）个字母，初始中心黄斑厚度（CMT）为213.40（126 - 494）μm，初始病变宽度为3760（1430 - 6430）μm。第2组的初始视力为52.89（26 - 82）个字母，初始CMT为257.60（115 - 882）μm，初始病变宽度为4460（1000 - 7650）μm。两组在初始视力和CMT方面无统计学显著差异（p = 0.094，p = 0.083）。然而，两组在初始病变宽度方面存在统计学显著差异（p = 0.003）。在第1组中，发现15个CC等位基因、30个TT等位基因和51个TC等位基因，在第2组中，发现49个CC等位基因、2个TT等位基因和46个TC等位基因，两组间分布有显著差异（p = 0.012）。基因型分布的变化与病变大小或视力均无关联（p = 0.841）。12例患者发生纤维化，这些患者均为不良反应者。
结论
在这一系列接受雷珠单抗治疗的AMD患者中，CFH Y402H位点CC基因型与不良反应相关，TT基因型与良好反应相关。
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