抗VEGF药物玻璃体腔内注射联合23 G玻璃体切除术对增殖性糖尿病视网膜病变患者的疗效分析

目的分析抗血管内皮生长因子(VEGF)药物玻璃体腔内注射联合23 G玻璃体切除术对增殖性糖尿病视网膜病变(PDR)患者的疗效。方法选取2017年1月~2019年1月河南省人民医院88例PDR患者(88只眼),根据治疗方案分组,各44例(44只眼)。对照组给予23 G玻璃体切除术,实验组给予抗VEGF药物玻璃体腔内注射+23 G玻璃体切除术。观察2组手术时间、电凝止血使用率,对比术前术后最佳矫正视力。结果实验组电凝止血使用频率较对照组低,手术时间较对照组短(P<0.05);与对照组比较,术后实验组最佳矫正视力较高(P<0.05);实验组并发症发生率为4.54%,低于对照组18.18%(P<0.05)。结论PDR患者采取抗VEGF药物玻璃体腔内注射和23 G玻璃体切除术联合治疗,可减少并发症,缩短手术时间,提高视力。     

2型糖尿病视网膜病变血清C肽测定及临床意义

目的 探讨血清C肽与2型糖尿病视网膜病变(DR)之间的关系及其临床意义.方法 将2型糖尿病住院病人167例分为3组,其中无糖尿病视网膜病变组(NDR组)60例,非增殖性糖尿病视网膜病变组(NPDR组)76例,增殖性糖尿病视网膜病变组(PDR组)31例.采用化学发光免疫分析法分别测定其空腹血清C肽含量并记录其他可能影响糖尿病视网膜病变发生、发展的因素.根据所测血清C肽值重新将病人分为C肽低值组(LCP组)37例,C肽正常值组(NCP组)78例,C肽高值组(HCP组)52例.结果 NDR组、NPDR组、PDR组空腹血清C肽平均水平呈降低趋势,三组之间空腹血清C肽平均水平比较差异有统计学意义(P＜0.01).LCP组、NCP组、HCP组之间DR发生率比较差异有统计学意义(x2=46.702,P＜0.01).Logistic回归分析显示空腹血清C肽水平与DR有明显相关性(B=-1.415,P=0.000),病程与DR有明显相关性(B=0.404,P=0.000).C肽水平和糖尿病病程呈负相关(r=-0.479,P=0.000),C肽水平与DR的程度呈负相关(r=-0.654,P=0.000).结论 血清C肽在2型DR的发生、发展过程中可能有重要的病理意义,其水平降低可能是2型糖尿病患者DR进展的临床标志.

Abstract：

Objective To explore the relationship of serum C-peptide with diabetic retinopathy (DR)and its clinical significance. Methods A total of 167 inpatients with type 2 diabetes were separated into three groups, NDR group (n=60 examination of ocular fundus showed normal), NPDR group (n=76 examination of ocular fundus showed nonproliferative diabetic retinopathy), PDR group (n=31 examination of ocular fundus showed proliferative diabetic retinopathy). Their fasting serum C-peptide (FCP) was tested with chemiluminescent immunoassay. At the same time, other factors that might affect the onset and progression of DR were recorded. Then all the patients were divided according to their C-peptide fasting levels in quartiles again, low C-peptide group (LCP) [n=37], normal C-peptide group (NCP) [n=78], high C-peptide group (HCP) [n=52].Results In three groups, the mean value of FCP in PDR group was the lowest, the NPDR group had the lower concentration than NDR group, [(0.61±0.33) ng/ml vs (1.34± 0.68) ng/ml vs (2.11 ± 0.80) ng/ml, P ＜0.01]. The incidence of DR among LCP group, NCP group and HCP group showed a significant difference (x2=46.702, P ＜0.01). Logistic regression analysis showed that only C-peptide (B=-1.415, P=0.000), duration of diabetes (B=0.404, P =0.000) were independently associated with DR. A negative correlation was evident between C-peptide levels and duration of diabetes (r=-0.479, P =0.000), a negative correlation was also found between C-peptide levels and DR (r=-0.654, P =0.000). Conclusions Serum C-peptide may have important significance in pathological form of Type 2 DR. The decrease of C-peptide levels may be a maker of the development of DR in type 2 diabetes.