与接受康柏西普的 NVG 合并 PDR 患者术中出血减少相关的房水中血管生成因子下调：一项随机对照试验。
Downregulation of angiogenic factors in aqueous humor associated with less intraoperative bleeding in PDR patients with NVG receiving conbercept: a randomized controlled trial.
机构信息
Department of Ophthalmology, Xuzhou Eye Disease Prevention and Treatment Institute, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, 221116, Jiangsu Province, China.
出版信息
BMC Ophthalmol. 2022 May 18;22(1):224. doi: 10.1186/s12886-022-02451-6.
BACKGROUND
To analyze the level changes of 28 cytokines in aqueous humor of patients with proliferative diabetic retinopathy (PDR) coexisting neovascular glaucoma (NVG) after intravitreal injection of conbercept (IVC), and to investigate whether these cytokines are associated with intraoperative bleeding (IOB).
METHODS
Totally 34 eyes with NVG secondary to PDR were enrolled. Patients were randomized into two groups, and all of them underwent 25-gauge pars plana vitrectomy (PPV) combined with trabeculectomy. Group I, 18 eyes received IVC 3 days before PPV, and 100 µL aqueous humor was collected at the time of IVC pretreatment and 3 days later at the beginning of PPV respectively. Group II, 16 eyes received IVC after PPV, and 100 µL aqueous humor was collected only at the beginning of PPV. Aqueous humor from 19 eyes with age-matched cataract patients served as controls. Luminex bead-based multiplex array was used to measure the levels of 28 cytokines in aqueous humor. The baseline cytokine levels were compared among the three groups. All NVG patients were divided into IOB and non-bleeding (INB) groups. The cytokine levels of aqueous humor at the beginning of PPV were compared between group I and II, also between IOB and INB groups. IOB in NVG patients was graded according to vitreous bleeding amount. The correlation between cytokine levels and the grades of IOB were analyzed.
RESULTS
Compared with controls, the baseline levels of 18 cytokines associated with inflammation and angiogenesis showed significantly increased in group I and group II (all, P < 0.0167). The IOB rate as well as the levels of IL-4, IL-22, Ang-2, PLGF and VEGF-A in group I were significantly lower than in group II (all, P < 0.05). The levels of IL-4, IL-22, Ang-2, PLGF and VEGF-A were significantly lower in INB group than in IOB group (all, P < 0.05). The levels of IL-4, Ang-2, PLGF and VEGF-A were positively correlated with the grades of IOB in NVG patients (all, r > 0.4, P < 0.05).
CONCLUSIONS
IVC 3 days before PPV combined with trabeculectomy reduces IOB in NVG patients, in which the downregulation of IL-4, Ang-2, PLGF and VEGF-A after IVC may be an underlying mechanism.
TRIAL REGISTRATION
ChiCTR2100048118 , retrospectively registered on 2 July 2021.
背景
分析增生性糖尿病视网膜病变（PDR）合并新生血管性青光眼（NVG）患者玻璃体内注射康柏西普（IVC）后房水中 28 种细胞因子水平的变化，并探讨这些细胞因子是否与术中出血（IOB）相关。
方法
共纳入 34 例 NVG 继发于 PDR 的患者。患者随机分为两组，均接受 25G 经睫状体平坦部玻璃体切除术（PPV）联合小梁切除术。组 I，18 只眼在 PPV 前 3 天接受 IVC，分别在 IVC 预处理前和 PPV 开始时采集 100µL 房水。组 II，16 只眼在 PPV 后接受 IVC，仅在 PPV 开始时采集 100µL 房水。19 只年龄匹配的白内障患者的房水作为对照。采用 Luminex 珠基多重阵列法检测房水中 28 种细胞因子的水平。比较三组的基础细胞因子水平。所有 NVG 患者均分为 IOB 和非出血（INB）组。比较组 I 和组 II、IOB 组和 INB 组 PPV 开始时房水中细胞因子的水平。根据玻璃体出血量对 NVG 患者的 IOB 进行分级。分析细胞因子水平与 IOB 分级的相关性。
结果
与对照组相比，组 I 和组 II 中与炎症和血管生成相关的 18 种细胞因子的基础水平均显著升高（均 P<0.0167）。组 I 的 IOB 率以及 IL-4、IL-22、Ang-2、PLGF 和 VEGF-A 水平均显著低于组 II（均 P<0.05）。INB 组的 IL-4、IL-22、Ang-2、PLGF 和 VEGF-A 水平均显著低于 IOB 组（均 P<0.05）。NVG 患者中，IL-4、Ang-2、PLGF 和 VEGF-A 水平与 IOB 分级呈正相关（均 r>0.4，P<0.05）。
结论
PPV 联合小梁切除术前 3 天接受 IVC 可减少 NVG 患者的 IOB，IVC 后 IL-4、Ang-2、PLGF 和 VEGF-A 的下调可能是其潜在机制。
试验注册
ChiCTR2100048118，于 2021 年 7 月 2 日进行了回顾性注册。
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