伴浆液性视网膜脱离的糖尿病囊样黄斑水肿的危险因素及康柏西普治疗效果研究

目的探讨伴浆液性视网膜脱离(serous retinal detachment,SRD)的糖尿病囊样黄斑水肿(cystoid macular edema,CME)和不伴SRD的糖尿病CME形成的影响因素及康柏西普治疗疗效的差异。方法选取就诊于空军特色医学中心并行康柏西普治疗的50例(70眼)糖尿病CME患者纳入研究,其中28例42眼为不伴SRD的CME水肿类型,为单纯CME组;22例28眼为伴SRD的CME水肿类型,为伴SRD组。比较可能影响两种CME形成的全身指标(血压、血糖、血脂等)和眼部情况,包括糖尿病视网膜病变分期,基线黄斑中心凹厚度(central macular thickness,CMT)等;并比较两组DME患者接受单纯康柏西普治疗后的疗效差异。结果单因素分析显示,单纯CME组水肿类型的发生与高脂蛋白a水平、增生型糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)、既往全视网膜光凝史和既往黄斑光凝史均相关(均为P<0.05)。伴SRD组水肿类型的发生与高尿酸水平、高胆固醇水平和高基线CMT均相关(均为P<0.05);多因素Logistic回归分析显示,较高基线CMT为伴SRD组水肿类型发生的独立危险因素OR(95%CI)=1.006(1.002～1.010)]。两种类型的CME患者接受康柏西普治疗后明显有效(均为P<0.000 1),伴SRD的CME水肿消退较不伴SRD的CME效果更好(P<0.05),但术后视力比较,差异无统计学意义(P>0.05)。结论较高尿酸和总胆固醇水平与SRD的发生有关,基线CMT较高是伴SRD的CME发生的独立危险因素;高脂蛋白a水平、PDR、既往全视网膜光凝史和既往黄斑光凝史与不伴SRD的CME发生有关。伴SRD的CME接受康柏西普治疗的效果较不伴SRD的CME效果更好,SRD可能是DME抗血管内皮生长因子治疗预后良好的指标。

Conbercept treats diabetic cystoids macular edema with serous retinal detachment and its risk factors

Objective　To investigate the factors in diabetic cystoid macular edema （CME） with and without serous retinal detachment （SRD），and to compare the patients’ outcome after Conbercept therapy.Methods　A retrospective consecutive case series study of 50 diabetic CME patients （70 eyes） treated with Conbercept therapy in Air Force Medical Center was conducted，including 28 diabetic CME patients （42 eyes） as CME without SRD type （simple CME group），while the other 22 diabetic CME patients （28 eyes） as CME with SRD type （CME with SRD group）.The biochemical markers（blood pressure，blood glucose，serum lipids）and eye conditions，such as diabetic retinopathy stages and baseline central macular thickness （CMT） were compared，and their outcome after Conbercept treatment was recorded and compared.Results　The univariate analysis showed that high lipoprotein a （pro-a） levels，proliferative diabetic retinopathy （PDR），panretinal photocoagulation （PRP） and macular photocoagulation were associated with simple CME （all P<0.05），while high uric acid （UA），high total cholesterol （TC） levels，and high baseline CMT were associated with CME with SRD （all P<0.05）.From multiple regression analysis，high baseline CMT was positively associated with CME with SRD group［OR（95%CI）=1.006（1.002-1.010）］.Both types of diabetic CME outcome after Conbercept were significantly effective （both P<0.000 1），There was no difference in visual outcome between the two groups （P＞0.05），but the CME with SRD type has a better anatomy outcome （P<0.05）.Conclusion　High UA and high TC levels are associated with the occurrence of diabetic CME with SRD type.High baseline CMT is an independent risk factor for CME with SRD type；pro-a，PDR，previous PRP and previous macular photocoagulation are associated with simple CME type.The outcome of anti-VEGF treatment in CME with SRD type is better than that of CME without SRD type，SRD maybe an indicator of good prognosis of anti-VEGF therapy.