雷珠单抗联合曲安奈德治疗湿性年龄相关性黄斑变性的疗效及对白介素的影响

目的：观察雷珠单抗联合曲安奈德治疗湿性年龄相关性黄斑变性（AMD）的临床疗效，并探讨该疗 法对白介素（IL）-1β、IL-2、IL-6、IL-8水平的影响。方法：前瞻性研究。选取2017年11月至2018 年10月内蒙古包钢医院收治的86例（102眼）湿性AMD患者，采用随机数表法分为雷珠单抗组（43 例，50眼）和联合组（43例，52眼），雷珠单抗组患者实施玻璃体腔注射雷珠单抗治疗，联合组在雷 珠单抗组基础上加用曲安奈德治疗。比较2组治疗前，治疗后2周、1个月及3个月眼压值；比较2组 治疗前，治疗后1、3、6个月黄斑中心凹厚度（CMT）及视力变化；比较2组治疗前、治疗后1个月血 清IL-1β、IL-2、IL-6、IL-8水平；对治疗期间2组并发症发生情况。采用t检验、重复测量方差分析 及χ2 检验对数据进行分析。结果：2组患者眼压值比较，差异无统计学意义（F组间=1.275，P=0.496； F时间=1.810，P=0.211；F交互=1.772，P=0.335）；治疗前2 组CMT、视力比较，差异无统计学意义 （t=0.042，P=0.967；t=0.720，P=0.473）；治疗后1、3、6个月，联合组CMT均低于雷珠单抗组（t=2.086， P=0.039；t=3.398，P=0.001；t=2.987，P=0.004），视力均高于雷珠单抗组（t=3.265，P=0.001；t=2.217， P=0.029；t=2.519，P=0.013）；随着治疗时间的延长，2组CMT均呈降低趋势（t治疗前vs.治疗后1个月=6.210、 4.218，P<0.001；t治疗后1个月vs.治疗后3个月=16.772、15.865，P<0.001；t治疗后3个月vs.治疗后6个月=4.472、4.848， P<0.001），视力呈升高趋势（t治疗前vs.治疗后1个月=4.527、8.395，P<0.001；t治疗后1个月vs.治疗后3个月=5.369、5.349， P<0.001；t治疗后3个月vs.治疗后6个月=3.335、3.730，P<0.001）；与治疗前相比，治疗后1个月2组血清IL-1β、 IL-6、IL-8水平均降低（t联合组=10.544、32.169、33.156，均P<0.001；t雷珠单抗组=8.996、25.687、30.754， 均P<0.001），且联合组低于雷珠单抗组（t=2.894，P=0.005；t=5.997，P<0.001；t=3.934，P<0.001）；与 治疗前相比治疗后3个月2组血清IL-2水平均升高（t=20.067、9.091，均P<0.001），且联合组高于雷 珠单抗组（t=7.705，P<0.001）；2组出血、眼内异物感、一过性眼压升高发生率及并发症总发生率比 较，差异均无统计学意义（校正χ2 =0.001，P=0.972；校正χ2 =0.221，P=0.638；Fisher精确检验P=0.116； 校正χ2 =0.004，P=0.951）。结论：玻璃体腔注射雷珠单抗联合曲安奈德可有效改善湿性AMD视觉功能， 降低CMT及血清IL-1β、IL-6、IL-8水平，增加血清IL-2水平，缓解炎症反应程度。

Therapeutic Effect of Ranibizumab Combined with Triamcinolone Acetonide on Wet Age-Related Macular Degeneration and Its Effect on Interleukin

Objective: To observe the clinical efficacy of Ranibizumab combined with Triamcinolone acetonide in the treatment of wet age-related macular degeneration (AMD), and to explore its effects on interleukin (IL)-1β, IL-2, IL-6. The impact of IL-8 levels. Methods: This is a retrospective study. A total of 86 cases (102 eyes) of wet AMD patients admitted to Inner Mongolia Baogang Hospital from November 2017 to October 2018 were randomly divided into Ranibizumab group (43 cases, 50 eyes) and combination group (43 cases, 52 eyes). The patients in the Ranibizumab group were treated with intravitreal injection of Ranibizumab, and the combined group was treated with Triamcinolone acetonide with the same method on the basis of intravitreal injection of Ranibizumab. The intraocular pressure values of the two groups before treatment, 2 weeks, 1 month and 3 months after treatment were compared. The central retinal thickness (CMT) and visual acuity of the two groups before treatment, 1 month, 3 months and 6 months after treatment were compared. The serum levels of IL-1β, IL-2, IL-6 and IL-8 were compared between the two groups before treatment and 1 month after treatment. The complications during treatment were counted and compared. Two-sample measurement data using t test. Repeated measurement variance analysis using repeated measurement data, further comparison using LSD-t test. χ 2 test was used for two count sample data. Results: There were no significant differences between the two groups (Fgroups=1.275, P=0.496; Ftime=1.810, P=0.211; Finteraction=1.772, P=0.335). There was no significant difference in CMT and visual acuity between the two groups before treatment (t=0.042, P=0.967; t=0.720, P=0.473). At one month, three months and six months after treatment, CMT of combined group was lower than that of Ranibizumab group (t=2.086, P=0.039; t=3.398, P=0.001; t=2.987, P=0.004), and visual acuity of combined group was higher than that of Ranibizumab group at different time (t=3.265, P=0.001; t=2.217, P=0.029; t=2.519, P=0.013). The CMT decreased (tbefore treatment vs. 1 month after treatment=6.210, 4.218, P<0.001; t1 month after treatment vs. 3 months after treatment=16.772, 15.865, P<0.001; t3 months after treatment vs. 6 months after treatment=4.472, 4.848, P<0.001) and visual acuity increased (tbefore treatment vs. 1 month after treatment=4.527, 8.395, P<0.001; t1 month after treatment vs. 3 months after treatment=5.369, 5.349, P<0.001; t3 months after treatment vs. 6 months after treatment=3.335, 3.730, P<0.001) with time in both groups. Compared with before treatment, the serum levels of IL-1β, IL-6 and IL-8 in 1 month after treatment were lower in the 2 groups (tcombined group=10.544, 32.169, 33.156, all P<0.001; tRanibizumab group=8.996, 25.687, 30.754, all P<0.001), and the combined group were lower than those in the Ranibizumab group (t=2.894, P=0.005; t=5.997, P<0.001; t=3.934, P<0.001). Compared with before treatment, the serum IL-2 level in the 2 groups were higher that 3 months after treatment (t=20.067, 9.091, all P<0.001), and the combined group was higher than that in the Ranibizumab group (t=7.705, P<0.001). There were no significant difference in the rates of bleeding, intraocular foreign body sensation, transient intraocular hypertension and total complications between the two groups (correction χ2 =0.001, P=0.972; correction χ2 =0.221, P=0.638; Fisher's exact test P=0.116; correction χ2 =0.004, P=0.951). Conclusions: Intravitreal injection of Ranibizumab combined with triamcinolone acetonide can effectively improve the visual function of wet AMD, reduce CMT, relieve inflammation, and it is safe and reliable.