玻璃体内注射抗血管内皮生长因子药物对糖尿病肾脏损害的影响

目的:观察玻璃体内抗血管内皮生长因子(VEGF)治疗对糖尿病患者肾脏损害的影响。方法:收集2016年6月至2019年9月收治的接受璃体内抗VEGF治疗糖尿病视网膜病变(DR)后肾脏损害明显加重的患者,回顾性分析其临床、病理特征及预后。结果:共9例DR分期Ⅲ~Ⅴ期患者纳入本研究。玻璃体内抗VEGF治疗后,1例基线仅有高血压无蛋白尿的患者临床病理表现符合血栓性微血管病(TMA);1例基线有蛋白尿、无高血压的患者出现血压明显升高,肾脏病理表现糖尿病肾病(DN)。另7例基线有蛋白尿和高血压的患者均表现为肾脏损害加速进展,尿蛋白定量、血清肌酐(SCr)和血压较基线明显升高(2例行肾脏病理符合DN),1例合并急性心肌梗死。9例均需增加降压药物种类或剂量以维持血压平稳,1例TMA患者同时给予小剂量糖皮质激素治疗。9例患者中位随访14.9(4.5,21.5)月,1例TMA患者蛋白尿转阴,肾功能部分恢复;1例新发高血压患者SCr保持稳定;余7例肾功能持续进展,多次用药的4例患者中3例进展为终末期肾病。结论:DR患者玻璃体内抗VEGF治疗可加重肾脏损害和高血压,故在治疗前后应密切监测尿蛋白、肾功能和血压,关注可能的不良事件。

Intravitreal injection of vascular endothelial growth factor inhibitors on renal damage in patients with diabetes

Objective:To observe the impact of intravitreal vascular endothelial growth factor inhibitors(VEGF) on renal damage among diabetic patients. Methodology:This study retrospectively analyzed the characteristic of renal injury following intravitreal VEGF inhibitors therapy in 9 patients with diabetic retinopathy(DR) stage Ⅲ-Ⅴ. Results:After intravitreal VEGF inhibitors injection,1 patient with preexisting hypertension merely presented with clinical and pathological character of thrombotic microangiopathy(TMA),1 patient with preexisting proteinuria presented with elevation of blood pressure,renal biopsy showed a pattern of diabetic nephropathy.The other 7 patients with preexisting proteinuria and hypertension presented with accelerated renal damage progression,worsening proteinuria and renal function,elevated blood pressure,and 1 of them developed myocardial infarction. Renal biopsies proved diabetic nephropathy in 2 of the 7 patients. Dosage of antihypertensive agents increased in all 9 patients. Additional corticosteroids was administered to the patient with TMA. With a median follow-up of 14.9 month,the TMA patient acquired negative proteinuria and partial recovery of renal function.The patient with preexisting proteinuria merely presented with stable renal function.Renal function sustained deteriorated in the other 7 patients,and 3 of them progressed to ESRD. Conclusion:Intravitreal VEGF inhibitors therapy in DR patient may accelerate renal damage progression or induce de novo renal injury and hypertension. More attention should be focused on the possible adverse events during intravitreal VEGF inhibitors therapy in DR patient.