抗延胡索酸酶抗体作为抗血管内皮生长因子治疗糖尿病黄斑水肿功能疗效的预测因子。

Anti-Fumarase Antibody as a Predictor of Functional Efficacy of Anti-VEGF Therapy for Diabetic Macular Edema.

机构信息

Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.

出版信息

Invest Ophthalmol Vis Sci. 2019 Feb 1;60(2):787-794. doi: 10.1167/iovs.18-26209.

DOI:10.1167/iovs.18-26209

PMID:30807637

Abstract

PURPOSE

To evaluate whether baseline titers of anti-fumarase antibody are associated with visual prognosis after anti-VEGF treatment for diabetic macular edema (DME).

METHODS

In this retrospective study, we investigated 52 eyes of 52 DME patients who received intravitreal injections of anti-VEGF drugs (ranibizumab or aflibercept) after blood sampling at baseline. Optical coherence tomography (OCT) images were obtained at every monthly visit. The serum titer of anti-fumarase antibody at baseline was measured using ELISA. We evaluated the relationship between the titer of anti-fumarase antibody at baseline and visual acuity (VA) improvement at 12 months.

RESULTS

The serum titer of anti-fumarase IgG was related to the logMAR visual acuity (VA; R = 0.329, P = 0.017) and the disrupted ellipsoid zone (EZ; R = 0.364, P = 0.008) at baseline. The titer of this autoantibody was not associated with logMAR VA (R = -0.007, P = 0.980) but was associated with VA improvement (R = 0.465, P < 0.001) at 12 months upon anti-VEGF treatment. The transverse length of the disrupted EZ line was shortened at 12 months (P < 0.001), and restoration of the EZ line was correlated to the autoantibody titer (R = 0.396, P = 0.004) compared with the decrease in central subfield (CSF) thickness. Multivariate analysis showed that pretreatment logMAR VA (β = 0.296, P = 0.045) and the autoantibody titer (β = 0.328, P = 0.017) were associated with VA improvement after anti-VEGF treatment. In contrast, the titer was not associated with logMAR VA at 12 months.

CONCLUSIONS

Anti-fumarase antibody is a novel serum biomarker predicting better functional efficacy of anti-VEGF treatment for DME.

摘要

目的

评估抗延胡索酸酶抗体的基线滴度是否与糖尿病性黄斑水肿（DME）患者接受抗血管内皮生长因子（VEGF）治疗后的视力预后相关。

方法

本回顾性研究纳入了 52 例 DME 患者的 52 只眼，这些患者在基线时进行了血样采集，随后接受了玻璃体内抗 VEGF 药物（雷珠单抗或阿柏西普）注射。在每次每月的就诊时都进行光学相干断层扫描（OCT）图像采集。使用 ELISA 法检测基线时抗延胡索酸酶抗体的滴度。我们评估了基线时抗延胡索酸酶抗体滴度与 12 个月时视力（VA）改善之间的关系。

结果

血清抗延胡索酸酶 IgG 滴度与基线时的 logMAR VA（R = 0.329，P = 0.017）和破坏的椭圆体带（EZ；R = 0.364，P = 0.008）相关。该自身抗体的滴度与 logMAR VA 不相关（R = -0.007，P = 0.980），但与抗 VEGF 治疗后 12 个月时的 VA 改善相关（R = 0.465，P < 0.001）。12 个月时破坏的 EZ 线的横向长度缩短（P < 0.001），EZ 线的恢复与自身抗体滴度相关（R = 0.396，P = 0.004），而与中央视网膜神经纤维层厚度的降低相比。多变量分析显示，预处理 logMAR VA（β = 0.296，P = 0.045）和自身抗体滴度（β = 0.328，P = 0.017）与抗 VEGF 治疗后 VA 改善相关。相比之下，该滴度与 12 个月时的 logMAR VA 不相关。