目的：比较增生型糖尿病视网膜病变(PDR)行玻璃体切割术前用雷珠单抗或曲安奈德玻璃体腔内注射前后玻璃体腔内细胞因子的变化。

方法：前瞻性研究。将2015-05/2017-02我院收治的PDR患者88例112眼纳入研究。依照随机方法分为行玻璃体切割术前玻璃体腔注射0.5mg/0.05mL雷珠单抗组(43例57眼)、行玻璃体切割术前玻璃体腔注射4mg/0.1mL曲安奈德组(45例55眼)，两组患者分别在玻璃体腔注射药物前抽取0.5mL玻璃体液后于玻璃体腔内注射雷珠单抗或曲安奈德。注药后7d行玻璃体切割术术前再次抽取玻璃体液0.5mL。采用双抗酶联免疫吸附试验(ELISA)测定玻璃体液的胎盘生长因子(PIGF)。用Luminex200液相芯片分析系统检测单核细胞趋化蛋白1(MCP-1)、单核细胞趋化蛋白3(MCP-3)、白介素-6(IL-6)、白介素-8(IL-8)、血小板源性生长因子-AB/BB(PDGF-AB/BB)和血管内皮生长因子-A(VEGF-A)浓度。

结果：雷珠单抗组玻璃体腔内PIGF与VEGF-A水平注射后较注射前均明显降低，而IL-6、IL-8水平增高(PIGF：65.36±15.16 vs 19.42±6.34pg/mL； VEGF-A：315.16±14.34 vs 21.32±2.54pg/mL，IL-6：37.32±4.04 vs 52.42±5.32pg/mL； IL-8：111.723±21.32 vs 198.73±19.03pg/mL，P<0.001)。而MCP-1、MCP-3及PDGF-AB/BB的水平无明显变化(P>0.05)。曲安奈德组玻璃体腔内PIGF水平显著增加(74.28±17.34 vs 136.12±15.34pg/mL，P<0.05)。而MCP-1水平明显减少(2789.32±143.54 vs 2038.21±105.34pg/mL，P<0.05)。MCP-3、IL-6、IL-8、PDGF-AB/BB、VEGF-A表达均无明显改变(P>0.05)。两组患者治疗后进行对比，雷珠单抗注射后玻璃体中PIGF、VEGF-A含量明显低于曲安奈德注射后含量(P<0.01)，IL-8、MCP-1水平则显著增加(P<0.05)。此外，雷珠单抗组术中出血情况明显低于曲安奈德组(P<0.05)。

结论：玻璃体腔注射雷珠单抗能显著降低PIGF、VEGF-A表达，同时促进IL-6、IL-8水平增加； 而玻璃体腔内注射曲安奈德能减少MCP-1表达，促进PIGF水平增加。

METHODS:A total of 88 PDR patients(112 eyes)with PDR from May 2015 to February 2017 in our hospital were enrolled in this study. The patients were randomly divided into ranibizumab group(57 eyes)and triamcinolone acetonide group(55 eyes). Ranibizumab(0.5mg/0.05mL)or triamcinolone acetonide(4mg/0.1mL)were given intravitreal respectively, after vitreous samples(0.5mL)were collected before the injection. Vitreous samples(0.5mL)were collected again 7d after the injection right before the PPV operation. The concentration of placental growth factor(PIGF)was measured by enzyme-linked immunosorbent assays(ELISA); the concentrations of monocyte chemotactic protein 1(MCP-1)and monocyte chemotactic protein 3(MCP-3), interleukin 6(IL-6)and interleukin 8(IL-8), platelet-derived growth factor-AB/BB(PDGF-AB/BB)and vascular endothelial growth factor-A(VEGF-A)were detected by Luminex200.

RESULTS:Afterranibizumab injection, the concentrations of PlGF and VEGF decreased significantly(PIGF:65.36±15.16 vs 19.42±6.34pg/mL; VEGF-A:315.16±14.34 vs 21.32±2.54 pg/mL, P<0.001), whereas those of IL-6, IL-8 increased significantly(IL-6:37.32±4.04 vs 52.42±5.32 pg/mL; IL-8:111.723±21.32 vs 198.73±19.03 pg/mL,P<0.001). There were no remarkable changes in MCP-1, MCP-3, and PDGF-AB/BB levels after ranibizumab injection(P>0.05). In triamcinolone acetonide group, the concentration of PIGF increased significantly after injection(74.28±17.34 vs 136.12±15.34 pg/mL,P<0.05), while that of MCP-1 decreased significantly(2789.32±143.54 vs 2038.21±105.34 pg/mL,P<0.05). There were no remarkable changes in the expression of MCP-3, IL-6, IL-8, PDGF-AB/BB and VEGF-A(P>0.05). In addition, the concentrations are lower for PIGF and VEGF-A(P<0.01)and higher for IL-8 and MCP-1(P<0.05)in eyes treated with ranibizumab, compared with those treated with triamcinolone acetonide. The incidence of intraoperative bleeding was significantly lower for ranibizumab group than that for triamcinolone acetonide group(P<0.05).

CONCLUSION: The levels of PIGF and VEGF-A decreased, while those of IL-6 and IL-8 increased in eyes with PDR after ranibizumab injection. After triamcinolone acetonide injection, the concentration of MCP-1 decreased, while that of PIGF increased.