目的：研究雷珠单抗联合激光治疗增殖性糖尿病视网膜病变(PDR)疗效及对患者房水纤溶酶原激活物抑制剂(PAI)、组织溶酶原激活物(t-PA)、血管内皮生长因子(VEGF)水平的影响。

方法：选取2015-03/2017-03我院PDR患者76例76眼，根据治疗方法不同分为全视网膜光凝(PRP)治疗前行玻璃体腔注射雷珠单抗治疗组(观察组)和单纯PRP治疗组(对照组)，比较两组患者治疗时所用激光能量和密度以及治疗后患者最佳矫正视力(BCVA)、黄斑中心凹厚度(CMT)、房水中PAI、t-PA、VEGF水平、术后并发症及预后情况。

结果：观察组光斑数量、激光能量和能量密度均低于对照组(P<0.05)； 治疗后，两组BCVA逐渐升高，CMT逐渐降低，组内不同时间差异有统计学意义(P<0.05)，且观察组同一时间BCVA高于对照组，CMT低于对照组(P<0.05)； 治疗后，两组患者房水中VEGF、t-PA和PAI水平逐渐升高，但均明显低于术前水平(P<0.05)，组内不同时间差异有统计学意义(P<0.05)，且观察组同一时间房水中VEGF、t-PA和PAI水平低于对照组(P<0.05)； 两组术后黄斑水肿发生率分别为17%和37%(P<0.05)。两组患者术后1a PDR复发率分别为6%和16%(P>0.05)。

结论：雷珠单抗联合激光治疗PDR能明显降低房水中VEGF、t-PA和PAI表达水平，降低患者CMT，改善患者BCVA，同时联合治疗有利于减少激光治疗时光斑数量、激光能量和能量密度，降低激光对视网膜损害。

METHODS: Totally 76 cases of patients(76 eyes)with PDR were divided into observation group(n=41)and control group(n=35)according to the use of ranibizumab or not. Control group was given routine laser surgery, and observation group was added with ranibizumab for adjuvant treatment. The laser energy and density used in treatment, and the best corrected visual acuity(BCVA), central macular thickness(CMT)and levels of PAI, t-PA and VEGF in aqueous humor after treatment, postoperative complications and prognosis were compared between the two groups.

RESULTS: The sunfleck quantity, laser energy and energy density in observation group were lower than those in control group(P<0.05). After treatment, the BCVA in the two groups was gradually increased while the CMT was gradually decreased, and the difference within-groups at different times was statistically significant(P<0.05), and the BCVA in observation group was higher than that in control group at the same time while the CMT was lower than that in control group(P<0.05). After treatment, the levels of VEGF, t-PA and PAI in aqueous humor were gradually increased, and were significantly lower than preoperative levels(P<0.05), and there was a statistically significant difference at different time points within-groups(P<0.05), and the levels of VEGF, t-PA and PAI in aqueous humor in observation group were lower than those in control group at the same time(P<0.05). The incidence rates of postoperative macular edema in the two groups were 17% and 37% respectively(P<0.05). The PDR recurrence rates at 1a after operation were 6% and 16% respectively(P>0.05).

CONCLUSION: Laser combined with ranibizumab for PDR can significantly reduce the expression levels of serum VEGF, t-PA and PAI in aqueous humor, decrease the CMT, and improve the BCVA. And combined therapy is beneficial to reduce the sunfleck quantity, laser energy and energy density during treatment, and lower the laser damage towards the retina.