从VEGF在湿性年龄相关性黄斑变性发病过程中的作用机制看抗VEGF药物治疗

摘要

年龄相关性黄斑变性(AMD)的发病机制较复杂,其中湿性AMD对视力的威胁更为严重,其主要病理特征是黄斑区脉络膜的新生血管形成,血管内皮细胞生长因子( VEGF)在发病和新生血管的发展过程中发挥着重要作用.湿性AMD的物理治疗方法较多,但均无法改善患者的视力,近年来拮抗VEGF作用的药物疗法成为湿性AMD治疗的新途径.抗VEGF单克隆抗体是目前临床上应用较多的药物,能够消除新生血管,改善患者视力.针对VEGF其他环节的药物,如VEGF捕获剂、小分子干扰RNA及酪氨酸激酶抑制剂等,正处于试验阶段,其治疗效果值得期待.由于这些药物均为抗VEGF的制剂,因此充分了解VEGF在湿性AMD发病和发展过程中的作用机制有助于合理使用这些药物.%Age-related macular degeneration (AMD) is the leading cause of visual impairment among older population worldwide,and wet AMD is more threatened to vision because of the choroidal neovascularization.Some physical therapies are thought to destroy the lesions but can not improve the visual acuity.Therefore,anti-VEGF drug therapy is becoming a new approach to the management of wet AMD.Vascular endothelial growth factor(VEGF) is thought to play an important role in the complicated pathogenesis,which can be addressed by disease reduction strategies.Among the anti-VEGF drug therapies,anti-VEGF monoclonal antibodies are proved to maintain and improve visual acuity.Other therapies have been or now being developed for the treatment of neovascular AMD with the goal of inhibiting VEGF.These inhibitors include VEGF receptor decoy aflibercept,small interfering RNA-based therapies (bevasiranib) and tyrosine kinase inhibitors (vatalanib),which could offer the potential for further advances.To completely realize the active mechanism of VEGF in wet AMD is helpful for the rational use of anti-VEGF drugs.