神经生长因子治疗糖尿病视网膜病变初探

Investigation of nerve growth factor in treatment of diabetic retinopathy

摘要:

目的:评价神经生长因子治疗糖尿病视网膜病变神经损害的安全性和有效性。方法:纳入2010-06/09间来北京大学第一医院眼科就诊的各期糖尿病视网膜病变有神经损害患者24例47眼,其中男13例25眼,女11例22眼,平均年龄60.38±11.95岁。肌肉注射神经生长因子30μg qd,连续注射3wk。记录治疗前后的矫正后logMAR视力、非接触眼压,眼前节及眼底情况,行动态视野、图形视觉诱发电位（pattern visual evoked potential,P-VEP）结果、闪光视网膜电图（flash electroretinogram,FERG）结果以评价治疗效果。通过对比治疗前后血常规、空腹血糖、尿常规、肝肾功能检查结果并记录用药期间不良事件来评价治疗的安全性。结果:用药前logMAR视力均值为0.32±0.31,用药后logMAR视力减小到均值为0.28±0.35,P=0.31；用药后视力较用药前有改善趋势,但无统计学差异。用药前视野平均缺损（MD）值为-13.11±7.57dB,用药后视野平均缺损（MD）值减少为-11.82±7.14,但差别无统计学差异。在电生理的各项指标中,用药后暗适应FERG（视杆细胞反应）a波比用药前潜伏期减少,振幅增加,但无显著统计学差异。P-VEP检测中P100潜伏期及振幅在用药前后未见明显改善。用药不良反应主要为注射部位的疼痛、硬结,发生率为59%,未见明显肝肾损害。结论:神经生长因子对于DR神经损害有一定改善作用,但尚需要扩大样本量进一步研究。

Abstract:

AIM:To evaluate the effectiveness and safety of nerve growth factor for the treatment of diabetic retinopathy(DR).METHODS:Patients diagnosed withDR at Peking University First Hospital from June 2010 to September 2010 were enrolled to receive nerve growth factor treatment. The nerve growth factor 30μg per day was injected by intramuscular for 21 days. LogMAR vision, mean defect and electrophysiological parameters including electroretinogram (EGR) and pattern visual evoked potential (P-VEP) were examined and compared before and after the treatment. Blood routine examination, urine routine, blood-fasting sugar, liver function, renal function before and after the treatment as well as other adverse events related to the treatment were also examined to evaluate the safety of the treatment. RESULTS:Twenty-four consecutive patients were enrolled to receive nerve growth factor treatment. There were 13 males (25 eyes) and 11 females (22 eyes), with an average age of 60.4 years. The average LogMAR vision were 0.32±0.31 and 0.28±0.35 (P=0.31) respectively before and after the treatment. Mean defect before and after the treatment were -13.11±7.57dB and -11.82±7.14dB. Dark flash electroretinogram(FERG) a wave after the treatment demonstrated shorter incubation period and increased amplitude than that before treatment although there was no statistical significance. The incubation period and amplitude of P100 wave were not improved after the treatment. Liver and renal function impairments were not noted and the main adverse event was pain and hard node at the site of injection, with an incidence of 59%.CONCLUSION:Nerve growth factor shows marginal success in therapy of nerve degeneration of DR, but further study should be conducted to expand the sample size. 