高级检索
中华实验眼科杂志
期刊首页
过刊列表
高级检索
稿件发表
• 临床研究 •
ENGLISH ABSTRACT
康柏西普辅助玻璃体切割术治疗增生性糖尿病视网膜病变的Meta分析
司霞
孙楚枫
陈月
冯婉玉
封宇飞
作者及单位信息
·
DOI： 10.3760/cma.j.cn115989-20200715-00498
A Meta-analysis of the effects of intravitreal conbercept as an adjunct before vitrectomy in proliferative diabetic retinopathy
Si Xia
Sun Chufeng
Chen Yue
Feng Wanyu
Feng Yufei
Authors Info & Affiliations
Si Xia
Department of Pharmacy, Peking University People's Hospital, Beijing 100044, China
Sun Chufeng
Department of Pharmacy, Peking University People's Hospital, Beijing 100044, China
Chen Yue
Department of Pharmacy, Peking University People's Hospital, Beijing 100044, China
Feng Wanyu
Department of Pharmacy, Peking University People's Hospital, Beijing 100044, China
Feng Yufei
Department of Pharmacy, Peking University People's Hospital, Beijing 100044, China
·
DOI： 10.3760/cma.j.cn115989-20200715-00498
352
201
0
0
2
0
PDF下载
APP内阅读
摘要

目的系统评价术前玻璃体腔注射康柏西普(IVC)对玻璃体切割术(PPV)治疗增生性糖尿病视网膜病变(PDR)的疗效及安全性。

方法计算机检索EMbase、PubMed、Cochrane Library、中国期刊全文数据库(CNKI)、万方数据库和维普数据库中已发表的术前IVC联合PPV治疗PDR的随机对照试验(RCT)研究、队列研究及病例对照研究，根据纳入标准和排除标准独立对文献进行筛选及数据提取。采用改良Jadad量表对纳入的随机对照试验研究进行质量评价，采用纽卡斯尔渥太华量表(NOS)对纳入的队列研究或病例对照研究进行质量评价。应用RevMan 5.3软件对数据进行Meta分析。

结果共纳入11个随机对照试验研究、2个队列研究和10个病例对照研究，包含1 625例患者1 844眼。所有RCT文献质量评分均≥3，所有队列研究和病例对照研究的NOS评分均≥5。Meta分析结果显示，术前IVC组总疗效明显优于单纯PPV组，差异有统计学意义( RR＝1.31，95% CI：1.21～1.42， P<0.001)。与单纯PPV组相比，术前IVC组可以缩短手术时间(MD＝-21.11，95% CI：-26.39～-15.83， P<0.001)，降低VEGF水平(MD＝-15.33，95% CI：-19.40～-11.26， P<0.001)，减少术中出血、医源性视网膜裂孔及术后玻璃体再出血和一过性眼压升高的发生率，差异均有统计学意义(均 P<0.05)。

结论术前IVC辅助PPV治疗PDR的临床疗效优于单用PPV，并发症减少，未见严重不良反应。

康柏西普;增生性糖尿病视网膜病变;玻璃体切割术;血管内皮生长因子;Meta分析
ABSTRACT

ObjectiveTo evaluate the efficacy and safety of preoperative intravitreal conbercept (IVC) as an adjunct to pars plana vitrectomy (PPV) in the treatment of proliferative diabetic retinopathy (PDR).

MethodsA systematic search in EMbase, PubMed, Cochrane Library, Chinese periodical full text database (CNKI), Wanfang database and VIP database were conducted, studies about the effectiveness and safety of IVC combined with PPV in the management of PDR were collected.Two researchers independently screened the studies according to the inclusion criteria and exclusion criteria, and extracted the data.The quality of the randomized controlled trial (RCT) was evaluated by the modified Jadad scale, and the quality of the cohort study or case-control study was evaluated by the Newcastle Ottawa scale (NOS). Rev Man 5.3 was applied for data analysis.

ResultsA total of 11 RCTs, 2 cohort studies and 10 case-control studies involving 1 625 patients and 1 844 eyes were included.The final Jadad score for each RCT was more than 3, and the final NOS score for each cohort study and case-control study was more than 5.The results of Meta-analysis showed that the total effectiveness of treatment was significantly higher in the preoperative IVC group than that in the simple PPV group ( RR=1.31, 95% CI: 1.21-1.42, P<0.001). The average operation duration was significantly shorter in the preoperative IVC group compared with that in the simple PPV group (MD=-21.11, 95% CI: -26.39--15.83, P<0.001). The level of VEGF was significantly lower in the preoperative IVC group than that in the simple PPV group (MD=-15.33, 95% CI: -19.40--11.26, P<0.001). Preoperative IVC could reduce the incidences of intraoperative bleeding, iatrogenic retinal breaks, postoperative recurrent vitreous hemorrhage and temporary increase of intraocular pressure, with statistically significant differences between them (all at P<0.05).

ConclusionsPreoperative intravitreal injection of conbercept shows better effect and safer than vitrectomy alone, and it has no serious side effect.

Conbercept;Proliferative diabetic retinopathy;Vitrectomy;Vascular endothelial growth factor;Meta-analysis
Feng Wanyu, Email: mocdef.aabnisekijoaynimner
Copyright by Chinese Medical Association
No content published by the journals of Chinese Medical Association may be reproduced or abridged without authorization. Please do not use or copy the layout and design of the journals without permission.
All articles published represent the opinions of the authors, and do not reflect the official policy of the Chinese Medical Association or the Editorial Board, unless this is clearly specified.
引用本文

司霞,孙楚枫,陈月,等. 康柏西普辅助玻璃体切割术治疗增生性糖尿病视网膜病变的Meta分析[J]. 中华实验眼科杂志,2020,38(09)：773-780.

DOI:10.3760/cma.j.cn115989-20200715-00498

PERMISSIONS

Request permissions for this article from CCC.

评价本文
*以上评分为匿名评价

版权归中华医学会所有。

未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。

除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。

增生性糖尿病视网膜病变(proliferative diabetic retinopathy，PDR)是糖尿病的严重并发症之一，是糖尿病中晚期微血管病变的结果，同时患者血液处于高凝状态，加重视网膜血管病变，如不及时防治，可导致患者视力减退，甚至失明 [ 1 ]。玻璃体切割术(pars plana vitrectomy，PPV)可以有效治疗晚期PDR，但随着新生血管增多及原有血管纤维化，剥离纤维新生血管膜时常引起视网膜撕裂或严重出血。血管内皮生长因子(vascular endothelial grow factor，VEGF)是刺激视网膜新生血管形成的重要细胞因子 [ 2 ]。研究发现，糖尿病患者体内VEGF呈高水平表达，促进新生血管形成，严重损伤患者视力。已有大量研究证实术前玻璃体腔注射抗VEGF药物如雷珠单抗和贝伐单抗辅助PPV治疗PDR安全有效 [ 3 , 4 ]。康柏西普是中国自主研发的重组融合蛋白，于2013年底在国内上市，可以同时抑制VEGF-A、VEGF-B和胎盘生长因子(placental growth factor，PlGF)，与单抗类抗VEGF药物相比，其具有亲和力强、靶点多、价格适中等优点 [ 5 , 6 ]。目前，康柏西普主要用于治疗湿性年龄相关性黄斑变性，其辅助PPV治疗PDR仍属于超适应证用药。本研究采用循证医学的研究方法，对康柏西普辅助PPV治疗PDR的安全性和有效性进行Meta分析，以期为临床应用提供参考。
试读结束，您可以通过登录机构账户或个人账户后获取全文阅读权限。
参考文献
[1]
Cheung N , Mitchell P , Wong TY . Diabetic retinopathy[J]．Lancet， 2010，376(9735):124-136.
返回引文位置Google Scholar
百度学术
万方数据
[2]
Aiello LP , Avery RL , Arrigg PG ，et al. Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders[J]．N Engl J Med， 1994，331(22):1480-1487. DOI： 10.1056/NEJM199412013312203 .
返回引文位置Google Scholar
百度学术
万方数据
[3]
Simunovic MP , Maberley DA . Anti-vascular endothelial growth factor therapy for proliferative diabetic retinopathy：a systematic review and Meta-analysis[J]．Retina， 2015，35(10):1931-1942. DOI： 10.1097/IAE.0000000000000723 .
返回引文位置Google Scholar
百度学术
万方数据
[4]
Farahvash MS , Majidi AR , Roohipoor R ，et al. Preoperative injection of intravitreal bevacizumab in dense diabetic vitreous hemorrhage[J]．Retina， 2011，31(7):1254-1260. DOI： 10.1097/IAE.0b013e31820a68e5 .
返回引文位置Google Scholar
百度学术
万方数据
[5]
Zhao M , Feng W , Zhang L ，et al. Cost-effectiveness analysis of conbercept versus ranibizumab for the treatment of age-related macular degeneration in China[J]．Value health， 2015，18(7):A421.
返回引文位置Google Scholar
百度学术
万方数据
[6]
雷春燕，雷博．眼科新一代抗血管内皮生长因子药物的基础研究及临床试验进展[J]．中华实验眼科杂志， 2014，32(10):938-942. DOI： 10.3760/cma.j.issn.2095-0160.2014.10.016 .
返回引文位置Google Scholar
百度学术
万方数据
Lei CY , Lei B ．Curative effect and safety of the new generation of anti-vascular endothelial growth factor drugs in neovascular eye diseases[J]．Chin J Exp Ophthalmol， 2014，32(10):938-942. DOI： 10.3760/cma.j.issn.2095-0160.2014.10.016 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[7]
Yang X , Xu J , Wang R ，et al. A randomized controlled trial of conbercept pretreatment before vitrectomy in proliferative diabetic retinopathy[J/OL]．J Ophthalmol， 2016，2016:2473234[2019-02-11]. https://pubmed.ncbi.nlm.nih.gov/27034822/. DOI： 10.1155/2016/2473234 .
返回引文位置Google Scholar
百度学术
万方数据
[8]
Su L , Ren X , Wei H ，et al. Intravitreal conbercept(KH902)for surgical treatment of severe proliferative diabetic retinopathy[J]．Retina， 2016，36(5):938-943. DOI： 10.1097/IAE.0000000000000900 .
返回引文位置Google Scholar
百度学术
万方数据
[9]
冉起，冯驰，周文娟．康柏西普辅助玻璃体切除术治疗糖尿病视网膜病变[J]．中国医药导刊， 2016，18(7):708-709,711.
返回引文位置Google Scholar
百度学术
万方数据
Ran Q , Feng C , Zhou WJ . Effects of conbercept assisted resection of vitreous body in the treatment of diabetic retinopathy[J]. 2016，18(7):708-709,711.
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[10]
李建军，张英辉，王秀超．康柏西普眼用注射液辅助玻璃体切除术治疗进展型增殖期糖尿病性视网膜病变的临床效果[J]．临床和实验医学杂志， 2016，15(17):1730-1733. DOI： 10.3969/j.issn.1671-4695.2016.17.026 .
返回引文位置Google Scholar
百度学术
万方数据
Li JJ , Zhang YH , Wang XC . The clinical effect of conbercept assisted vitrectomy for the treatment of diabetic retinopathy[J]．J Clin Exp Med， 2016，15(17):1730-1733. DOI： 10.3969/j.issn.1671-4695.2016.17.026 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[11]
张招德．康柏西普辅助玻璃体手术治疗增殖性糖尿病性视网膜病变的临床疗效[J]．中外医疗， 2016，35(36):73-75. DOI： 10.16662/j.cnki.1674-0742.2016.36.073 .
返回引文位置Google Scholar
百度学术
万方数据
Zhang ZD . Clinical effect of concomitant vitreous surgery on proliferative diabetic retinopathy[J]．Chin Foreign Med Treatment， 2016，35(36):73-75. DOI： 10.16662/j.cnki.1674-0742.2016.36.073 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[12]
王科. 23G玻璃体切割术前玻璃体腔注射康柏西普治疗增生性糖尿病视网膜病变效果[J]．保健文汇， 2016，(5):74.
返回引文位置Google Scholar
百度学术
万方数据
[13]
宋华．康柏西普联合玻璃体切除术治疗进展型糖尿病性视网膜病变45例[J]．社区医学杂志， 2017，15(12):67-68.
返回引文位置Google Scholar
百度学术
万方数据
[14]
孙连义，赵梅生，李凤至，等．玻璃体腔注药联合微创玻璃体切除治疗糖尿病视网膜病变的临床疗效研究[J]．现代生物医学进展， 2017，17(23):4579-4582. DOI： 10.13241/j.cnki.pmb.2017.23.043 .
返回引文位置Google Scholar
百度学术
万方数据
Sun LY , Zhao MS , Li FZ ，et al. Clinical curative effect of vitreous cavity injection combined with transconjunctival sutureless vitrectomy on the patients with poliferative diabetic retinopathy[J]．Prog Modern Biomed， 2017，17(23):4579-4582. DOI： 10.13241/j.cnki.pmb.2017.23.043 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[15]
敖秀芹，高德君，沈美丽．康柏西普在增殖性糖尿病视网膜病变手术中的临床疗效观察[J]．世界临床医学， 2017，11(23):83,86.
返回引文位置Google Scholar
百度学术
万方数据
[16]
张晖，史建江．康柏西普眼用注射液辅助玻璃体切除术治疗进展型增殖期糖尿病性视网膜病变的临床效果观察[J]．养生保健指南， 2017，(45):71. DOI： 10.3969/j.issn.1006-6845.2017.45.066 .
返回引文位置Google Scholar
百度学术
万方数据
[17]
刘斌虎，马蕾．玻璃体腔注射抗-VEGF药物联合微创玻璃体切除治疗糖尿病视网膜病变的临床疗效[J]．家庭医药， 2018，(2):165-166. DOI： 10.3969/j.issn.1671-4954.2018.02.215 .
返回引文位置Google Scholar
百度学术
万方数据
[18]
陈小瑾．康柏西普联合玻璃体切割术治疗增生性糖尿病视网膜病变的疗效分析[J]．湖南师范大学学报：医学版， 2016，13(6):136-138. DOI： 10.3969/j.issn.1673-016X.2016.06.047 .
返回引文位置Google Scholar
百度学术
万方数据
Chen XJ . Analysis of the efficacy of the conbercept combined with vitrectomy in the treatment of proliferative diabetic retinopathy[J]．J Hunan Normal Univ：MedSci， 2016，13(6):136-138. DOI： 10.3969/j.issn.1673-016X.2016.06.047 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[19]
朴天华，张召弟，杨岚，等．玻璃体腔内注射康柏西普联合玻璃体切除术治疗增殖性糖尿病视网膜病变的临床效果[J]．海峡药学， 2016，28(9):95-97. DOI： 10.3969/j.issn.1006-3765.2016.09.038 .
返回引文位置Google Scholar
百度学术
万方数据
Pu TH , Zhang ZD , Yang L ，et al. The Clinical effect of intravitreal injection of conbercept combined with vitreous body resection in the treatment of proliferative diabetic retinopathy[J]．Strait Pharm J， 2016，28(9):95-97. DOI： 10.3969/j.issn.1006-3765.2016.09.038 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[20]
曾广川，李萍萍，叶阳君．玻璃体腔注射康柏西普对PDR玻璃体切割的辅助作用[J]．中华实验眼科杂志， 2017，35(10):920-923. DOI： 10.3760/cma.j.issn.2095-0160.2017.10.014 .
返回引文位置Google Scholar
百度学术
万方数据
Zeng GC , Li PP , Ye YJ . Effects of intravitreal injection of conbercept on vitrectomy for proliferative diabetic retinopathy[J]．Chin J Exp Ophthalmol， 2017，35(10):920-923. DOI： 10.3760/cma.j.issn.2095-0160.2017.10.014 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[21]
肖紫云，李家璋，张茂菊，等．康柏西普对增殖型糖尿病视网膜病玻璃体切割术的影响[J]．福建医科大学学报， 2017，51(3):195-198.
返回引文位置Google Scholar
百度学术
万方数据
Xiao ZY , Li JZ , Zhang MJ ，et al. The effect of conbercept in the operation of proliferative diabetic retinopathy[J]．J Fujian Med Univer， 2017，51(3):195-198.
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[22]
吴志勇，姚宜，闵云花，等．康柏西普辅助微创玻璃体切除术治疗增生性糖尿病视网膜病变的临床观察[J]．临床眼科杂志， 2017，25(2):141-144. DOI： 10.3969/j.issn.1006-8422.2017.02.013 .
返回引文位置Google Scholar
百度学术
万方数据
Wu ZY , Yao Y , Min YH ，et al. Intravitreal conbercept and minimally invasive vitrectomy as the treatment for proliferative diabetic retinopathy[J]．J Clin Ophthalmol， 2017，25(2):141-144. DOI： 10.3969/j.issn.1006-8422.2017.02.013 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[23]
周林，李芳芳．玻璃体腔注射康柏西普联合23G玻璃体切割手术治疗增生型糖尿病视网膜病变疗效观察[J]．海南医学， 2017，28(15):2458-2461. DOI： 10.3969/j.issn.1003-6350.2017.15.014 .
返回引文位置Google Scholar
百度学术
万方数据
Zhou L , Li FF . Effect of intravitreal injection of conbercept combined with 23G vitrectomy to treat proliferative diabetic retinopathy[J]．Hainan Med J， 2017，28(15):2458-2461. DOI： 10.3969/j.issn.1003-6350.2017.15.014 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[24]
周用谋，陆颖丽，黄继化. 25G＋玻璃体切割联合玻璃体腔注射康柏西普治疗严重PDR[J]．国际眼科杂志， 2017，17(12):2321-2324. DOI： 10.3980/j.issn.1672-5123.2017.12.33 .
返回引文位置Google Scholar
百度学术
万方数据
Zhou YM , Lu YL , Huang JH . Clinical effect of 25G＋vitrectomy combined with intravitreal injection of conbercept in the treatment of severe proliferative diabetic retinopathy[J]. 2017，17(12):2321-2324. DOI： 10.3980/j.issn.1672-5123.2017.12.33 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[25]
陈方方．康柏西普辅助23G玻璃体切割术对增殖性糖尿病视网膜病变治疗的观察[J]．大家健康：下旬版， 2017，11(12):130. DOI： 10.3969/j.issn.1009-6019(x).2017.12.174 .
返回引文位置Google Scholar
百度学术
万方数据
[26]
王文，张玲．康柏西普联合玻璃体切除术治疗进展型糖尿病性视网膜病变临床观察[J]．中国卫生标准管理， 2017，8(20):90-92. DOI： 10.3969/j.issn.1674-9316.2017.20.047 .
返回引文位置Google Scholar
百度学术
万方数据
Wang W , Zhang L ．Clinical observation of combined use of conbercept and vitrectomy in the treatment of advanced diabetic retinopathy[J]．Chin Health Standard Management， 2017，8(20):90-92. DOI： 10.3969/j.issn.1674-9316.2017.20.047 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[27]
郭婧，陈松，王昀，等．玻璃体视网膜手术联合玻璃体腔注射康柏西普或雷珠单抗治疗严重PDR的临床观察[J]．中华实验眼科杂志， 2017，35(10):914-919. DOI： 10.3760/cma.j.issn.2095-0160.2017.10.013 .
返回引文位置Google Scholar
百度学术
万方数据
Guo J , Chen S , Wang Y ，Clinical effect of vitreoretinal surgery combined with intravitreal injection of conbercept or ranibizumab on severe proliferative diabetic retinopathy[J]．Chin J Exp Ophthalmol， 2017，35(10):914-919. DOI： 10.3760/cma.j.issn.2095-0160.2017.10.013 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[28]
尹妮，赵帅，朱红娜．康柏西普预处理联合玻璃体切割术治疗增生型糖尿病视网膜病变[J]．眼科新进展， 2017，37(8):770-772. DOI： 10.13389/j.cnki.rao.2017.0195 .
返回引文位置Google Scholar
百度学术
万方数据
Yin N , Zhao S , Zhu HN . Conbercept pre-treatment combined with vitrectomy for proliferative diabetic retinopathy[J]．Rec Adv Ophthalmol， 2017，37(8):770-772. DOI： 10.13389/j.cnki.rao.2017.0195 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[29]
周怀胜，马海智，梁婉玲，等．玻璃体腔内注射康柏西普辅助25G玻切术治疗PDR的疗效分析[J]．国际眼科杂志， 2018，18(2):363-366. DOI： 10.3980/j.issn.1672-5123.2018.2.42 .
返回引文位置Google Scholar
百度学术
万方数据
Zhou HS , Ma HZ , Liang WL ，et al. Effects of vitrectomy with preoperative intravitreal conbercept for proliferative diabetic retinopathy[J]. 2018，18(2):363-366. DOI： 10.3980/j.issn.1672-5123.2018.2.42 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
[30]
Meleth AD , Carvounis PE . Outcomes of vitrectomy for tractional retinal detachment in diabetic retinopathy[J]．Int Ophthalmol Clin， 2014，54(2):127-139. DOI： 10.1097/IIO.0000000000000021 .
返回引文位置Google Scholar
百度学术
万方数据
[31]
延艳妮，魏文斌，周金琼．增生性糖尿病视网膜病变围手术期抗VEGF药物使用时机的选择[J]．国际眼科纵览， 2015，39(5):333-336. DOI： 10.3760/cma.j.issn.1673-5803.2015.05.008 .
返回引文位置Google Scholar
百度学术
万方数据
Yan YN , Wei WB , Zhou JQ . The using timing of anti-vascular endothelial growth factor at perioperative period for proliferative diabetic retinopathy[J]．Int Rev Ophthalmol， 2015，39(5):333-336. DOI： 10.3760/cma.j.issn.1673-5803.2015.05.008 .
Goto CitationGoogle Scholar
Baidu Scholar
Wanfang Data
备注信息
A
冯婉玉，Email： mocdef.aabnisekijoaynimner
B
所有作者均声明不存在利益冲突
评论 （0条）
注册
登录
时间排序
暂无评论，发表第一条评论抢沙发
最新推荐
更多
效应修饰作用分析方法与案例解析系列（一）：流行病学和经典Meta分析中的效应修饰
刘凤琪 等
中华流行病学杂志 2024,45(01)
雷珠单抗辅助玻璃体切割术治疗增殖型糖尿病视网膜病变患者的疗效
易伟 等
国际医药卫生导报 2024,30(11)
玻璃体腔注射康柏西普辅助玻璃体切割术治疗严重增生性糖尿病视网膜病变的临床效果
王萍 等
中华实验眼科杂志 2019,37(10)
玻璃体切割术治疗增生性糖尿病视网膜病变中应用曲安奈德的止血作用及其机制
周琰倢 等
中华实验眼科杂志 2017,35(05)
MedAI助手（体验版）
文档即答
智问智答
机器翻译
回答内容由人工智能生成，我社无法保证其准确性和完整性，该生成内容不代表我们的态度或观点，仅供参考。
生成快照
文献快照

你好，我可以帮助您更好的了解本文，请向我提问您关注的问题。

0/2000

《中华医学会杂志社用户协议》 | 《隐私政策》

《SparkDesk 用户协议》 | 《SparkDesk 隐私政策》

网信算备340104764864601230055号 | 网信算备340104726288401230013号

技术支持：

历史对话
本文全部
还没有聊天记录
设置
模式
纯净模式沉浸模式
字号
小中大