综述
ENGLISH ABSTRACT
不同剂量抗血管内皮生长因子药物治疗ROP的研究进展
蒋可可
张杰 [综述]
作者及单位信息
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DOI: 10.3760/cma.j.cn115989-20200809-00573
Research status of different doses of anti-vascular endothelial growth factor drugs in retinopathy of prematurity
Jiang Keke
Zhang Jie
Authors Info & Affiliations
Jiang Keke
Weifang Eye Hospital, National Key Clinical Specialty, Zhengda Guangming Eye Group, Weifang 261041, China
Zhang Jie
Weifang Eye Hospital, National Key Clinical Specialty, Zhengda Guangming Eye Group, Weifang 261041, China
·
DOI: 10.3760/cma.j.cn115989-20200809-00573
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摘要

随着对血管内皮生长因子(VEGF)在早产儿视网膜病变(ROP)发病机制中作用的研究不断深入。国内外陆续开展了各种抗VEGF药物1/2成人剂量玻璃体腔注射治疗ROP试验并初步取得显著疗效。然而,进一步的研究表明抗VEGF药物可以通过玻璃体腔进入全身血液循环,暂时降低患儿的血清VEGF水平,从而给处于快速生长发育期的早产儿带来潜在的全身不良反应。目前,国内外专家开始重点关注1/2成人剂量治疗ROP的全身不良反应风险,并相继开展了各种低剂量抗VEGF药物治疗ROP的相关研究。目前,大部分研究为小样本回顾性研究,缺乏大样本多中心的前瞻性研究,各剂量抗VEGF药物治疗ROP均属探索阶段。本文就各剂量抗VEGF药物治疗ROP的疗效及问题进行综述,为ROP的治疗提供参考。

早产儿视网膜病变;血管内皮生长因子;血管生成抑制剂;剂量;治疗效果
ABSTRACT

With the further study of vascular endothelial growth factor (VEGF) in the pathogenesis of retinopathy of prematurity (ROP), a variety of anti-VEGF drugs with 1/2 adult dose have been used at home and abroad to treat ROP, and initially achieved remarkable curative effect.However, further studies have shown that anti-VEGF drugs can enter the systemic circulation through the vitreous cavity, which temporarily reduces serum VEGF levels in children.As a result, it may have potential systemic side effects for premature infants during the period of rapid growth and development.At present, experts at home and abroad have begun to pay attention to the risk of systemic side effects of ROP treated with 1/2 adult dose, and have conducted a variety of low-dose anti-VEGF drugs in the treatment of ROP.However, most of the studies are retrospective studies with small samples, and there is a lack of multicenter prospective studies with large samples.Therefore, all doses of anti-VEGF drugs in the treatment of ROP need to be further investigated.This article reviews the efficacy and problems of different doses of anti-VEGF drugs in the treatment of ROP to provide a reference for the treatment of ROP.

Retinopathy of prematurity;Vascular endothelial growth factor;Angiogenesis inhibitors;Dose;Treatment outcome
Zhang Jie, Email: mocdef.6ab2110688636951
引用本文

蒋可可,张杰. 不同剂量抗血管内皮生长因子药物治疗ROP的研究进展[J]. 中华实验眼科杂志,2024,42(07):669-674.

DOI:10.3760/cma.j.cn115989-20200809-00573

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早产儿视网膜病变(retinopathy of prematurity,ROP)是发生于早产儿的一种增殖性新生血管疾病,其主要病理性改变是视网膜血管闭塞引发缺血缺氧,进而诱发病理性新生血管形成,是导致婴儿盲的主要原因 [ 1 , 2 ]。抗VEGF药物在眼科的适应证主要是年龄相关性黄斑变性、糖尿病性黄斑水肿、视网膜静脉阻塞引起的黄斑水肿及脉络膜新生血管等 [ 3 , 4 ]。然而,抗VEGF药物治疗ROP在全球多为超适应证用药。目前仅有0.2 mg雷珠单抗被欧盟批准用于治疗ROP(2019年11月),但无相应的安全有效剂量标准。鉴于VEGF在ROP发病机制中的重要作用,眼科临床医师开始尝试应用1/2成人剂量抗VEGF药物治疗ROP,并取得初步疗效 [ 5 , 6 , 7 , 8 , 9 ]。然而,目前研究表明各类抗VEGF药物玻璃体腔注射后均可进入全身血液循环并降低新生儿全身的VEGF浓度,从而影响新生儿脑、肺脏、肾脏及视网膜血管等的发育 [ 10 , 11 , 12 ]。由于药物的全身暴露性与玻璃体腔注药剂量呈正相关,更多的研究倾向于采用低剂量抗VEGF药物治疗ROP以减少药物暴露 [ 13 , 14 , 15 , 16 ]。但各种剂量的选择缺乏理论依据,均属探索阶段,缺乏大样本随机对照的长期研究以评估治疗的安全性。因此,制定ROP抗VEGF药物治疗的安全、有效的剂量标准成为当务之急。本文就VEGF对新生儿眼部及全身发育的作用,以及不同剂量单抗类和融合蛋白类抗VEGF药物治疗ROP的疗效及问题进行综述,以期为ROP的治疗提供参考。
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张杰,Email: mocdef.6ab2110688636951
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所有作者均声明不存在利益冲突
C
山东省自然科学基金面上项目 (ZR2021MH411)
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