CAJ | 학술논문

背景增生型糖尿病视网膜病变(PDR)导致患者视力下降的主要原因是纤维血管膜的收缩、牵拉引起的玻璃体积血及视网膜脱离,因此研究视网膜增生膜形成的病理机制、抑制新生血管和纤维血管膜的形成及其进展是治疗PDR的重要研究方向之一. 目的研究玻璃体腔注射avastin后PDR增生膜中血管内皮生长因子(VEGF)、结缔组织生长因子(CTGF)及色素上皮衍生因子(PEDF)表达的变化. 方法采用前瞻性随机对照研究设计.选择2008年1-6月在天津医科大学眼科医院拟行手术治疗的PDR患者24例26眼,用随机数字表法将患者随机分为单纯玻璃体切割术组和avastin注射+玻璃体切割术组,每组12例13眼,两组间性别、年龄及病程等基线资料均匹配.Avastin注射+玻璃体切割术组患者玻璃体腔注射avastin1.25 mg(0.05 ml),10d后行玻璃体切割术；单纯玻璃体切割术组患者仅行玻璃体切割术.术中收集术眼视网膜增生膜,采用免疫组织化学法检测增生膜中VEGF、CTGF和PEDF的表达. 结果 2个组患眼视网膜增生膜中VEGF、CTGF和PEDF的表达均位于细胞质.与单纯玻璃体切割术组比较,avastin注射+玻璃体切割术组患者视网膜增生膜中VEGF阳性表达率明显下降(30.77％ vs.100.00％),CTGF阳性表达率上升(92.31％ vs.62.54％),差异均有统计学意义(U=4.000,P＜0.01;U=7.500,P=0.048),而avastin注射+玻璃体切割术组与单纯玻璃体切割术组间PEDF的阳性表达率差异无统计学意义(100.00％ vs.92.31％,U=65.500,P=0.299). 结论 PDR患者玻璃体腔注射avastin后视网膜增生膜中VEGF的表达率明显降低,CTGF的表达率明显升高,而PEDF的表达率无明显变化.
배경 증생형당뇨병시망막병변(PDR)도치환자시력하강적주요원인시섬유혈관막적수축、견랍인기적파리체적혈급시망막탈리,인차연구시망막증생막형성적병리궤제、억제신생혈관화섬유혈관막적형성급기진전시치료PDR적중요연구방향지일. 목적 연구파리체강주사avastin후PDR증생막중혈관내피생장인자(VEGF)、결체조직생장인자(CTGF)급색소상피연생인자(PEDF)표체적변화. 방법 채용전첨성수궤대조연구설계.선택2008년1-6월재천진의과대학안과의원의행수술치료적PDR환자24례26안,용수궤수자표법장환자수궤분위단순파리체절할술조화avastin주사+파리체절할술조,매조12례13안,량조간성별、년령급병정등기선자료균필배.Avastin주사+파리체절할술조환자파리체강주사avastin1.25 mg(0.05 ml),10d후행파리체절할술；단순파리체절할술조환자부행파리체절할술.술중수집술안시망막증생막,채용면역조직화학법검측증생막중VEGF、CTGF화PEDF적표체. 결과 2개조환안시망막증생막중VEGF、CTGF화PEDF적표체균위우세포질.여단순파리체절할술조비교,avastin주사+파리체절할술조환자시망막증생막중VEGF양성표체솔명현하강(30.77％ vs.100.00％),CTGF양성표체솔상승(92.31％ vs.62.54％),차이균유통계학의의(U=4.000,P＜0.01;U=7.500,P=0.048),이avastin주사+파리체절할술조여단순파리체절할술조간PEDF적양성표체솔차이무통계학의의(100.00％ vs.92.31％,U=65.500,P=0.299). 결론 PDR환자파리체강주사avastin후시망막증생막중VEGF적표체솔명현강저,CTGF적표체솔명현승고,이PEDF적표체솔무명현변화.
Background A main cause of visual impairment in proliferative diabetic retinopathy (PDR) is vitreous hemorrhage and retinal detachment due to contraction of fibrovascular membrane.To explore the pathogenic mechanism of fibrovascular membrane is a new target for the prevention and management of PDR.Objective This study was to determine the change in expression of vascular endothelial growth factor (VEGF),connective tissue growth factor(CTGF) and pigment epithelium derived factor(PEDF) in the proliferative membranes of patients with PDR after intravitreal injection of avastin,an anti-VEGF agent.Methods This study was approved by the Medical Ethic Committee of Tianjin Medical College,and written informed consent was obtained from each patient before enrollment.A prospective randomized-controlled study was designed.Twenty-six eyes of 24 patients with PDR scheduled for surgery were enrolled from January to June,2008 in Tianjin Medical College Eye Hospital.The patients were randomized into the simple vitrectomy group and avastin injection combined with vitrectomy group,with matched gender,age and disease duration.1.25 mg (0.05 ml) of avastin was intravitreally injected prior to surgery,and vitrectomy was performed 10 days after injection in the avastin injection combined with vitrectomy group,and only vitrectomy was given in the simple vitrectomy group.Preretinal membrane was collected during the surgery.Expression of VEGF,CTGF and PEDF in the preretinal membranes was assayed by immunochemistry.Results VEGF,CTGF and PEDF were expressed in the cytoplasm.The rate of VEGF expression in the preretinal membranes was 30.77％ in the avastin injection combined with vitrectomy group,showing a significant reduction in comparison with the simple vitrectomy group(100.00％)(U =4.000,P＜0.01).The rate of expression CTGF was remarkable elevated in the avastin injection combined with vitrectomy group compared with the simple vitrectomy group (92.31％ vs.62.54％)(U=7.500,P=0.048).However,no significant difference was found in the expression rate of PEDF between the two groups(100.00％ vs.92.31％) (U =65.500,P =0.299).Conclusions The results suggest that intravitreal injection of anti-VEGF drugs resulted in the decrease of VEGF expression and increased CTGF expression in proliferative membranes from patients with PDR.