抑制血管生成药安维汀玻璃体腔注射后房水细胞因子的变化

摘要

BACKGROUND:Studies on the inhibitory mechanism of Avastin for proliferative diabetic retinopathy are mostly confined to the vascular endothelial growth factor, while connective tissue growth factor and angiogenesis inhibitor also play an important role in the disease. OBJECTIVE:To evaluate the changes of cytokines in the aqueous undergoing Avastin intravitreous injection or not prior to pars plana vitrectormy in the treatment of proliferative diabetic retinopathy. METHODS:Thirty patients with proliferative diabetic retinopathy (30 eyes) were selected and randomly divided into groups A, B and C, each group containing 10 patients. Group A was treated with single pars plana vitrectormy;and group B and group C had 0.05 mL/1.25 mg and 0.1 mL/1.25 mg Avastin via intravitreous injection at 7 days before pars plana vitrectormy, respectively. Aqueous humor samples were col ected during pars plana vitrectormy. The levels of vascular endothelial growth factor, connective tissue growth factor and pigment epithelium-derived factor were assessed by using ELISA technique. RESULTS AND CONCLUSION:The levels of connective tissue growth factor and pigment epithelium-derived factor in the aqueous humor of two Avastin injection groups were increased significantly compared to the group with single pars plana vitrectormy. However, the level of vascular endothelial growth factor was lower in the Avastin injection groups. In addition, there was no significant difference between two Avastin injection groups. These results reveal that intravitreous injection of Avastin assisted vitrectomy for proliferative diabetic retinopathy is more effective than single pars plana vitrectormy treatment. The underlying mechanisms may be that Avastin could inhibit the intraocular angiogenesis by not only reducing the secretion of some growth factors but also increasing the levels of anti-angiogenesis related cytokines.%背景：关于抑制血管生成药安维汀(Avastin)治疗增殖型糖尿病视网膜病变的机制研究大多数均局限在血管内皮生长因子本身，而结缔组织生长因子、血管增生抑制因子也在其疾病中扮演着重要的角色。　　目的：考察增殖性糖尿病视网膜病变玻璃体切割术前应用安维汀玻璃体腔注射前后房水细胞因子的变化。　　方法：选取增殖性糖尿病视网膜病变患者30例(30眼)，采用随机数字表法分为3组，每组10例(10眼)。玻璃体切割组：直接行玻璃体切割手术；安维汀注射0.05 mL组：于玻璃体切割前7 d玻璃体腔注射0.05 mL安维汀(1.25 mg)；安维汀注射0.1 mL组：于玻璃体切割前7 d玻璃体腔注射0.1 mL安维汀(2.5 mg)。分别于术中抽取少量房水，检查血管内皮生长因子、结缔组织生长因子及色素上皮衍生因子的表达变化。　　结果与结论：与玻璃体切割组比较，安维汀注射组房水中血管内皮生长因子含量降低，色素上皮衍生因子和结缔组织生长因子含量增高，并能抑制血管内皮生长因子的表达，差异有显著性意义；安维汀注射0.05 mL组与安维汀注射0.1 mL组相比，差异无显著性意义。结果说明玻璃体腔注射安维汀在增殖性糖尿病视网膜病变玻璃体切割前辅助应用可以减少与增殖相关的细胞因子的含量，同时增加了拮抗新生血管生长的细胞因子。