Effect of ranibizumab joint laser photocoagulation on diabetic macular edema: a systematic review
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摘要:
目的 系统评价雷珠单抗联合激光光凝对糖尿病黄斑水肿的疗效。 方法 计算机检索PubMed、EMbase、Cochrane Library、CBM、Wang Fang Data和CNKI数据库，搜索雷珠单抗联合激光光凝治疗糖尿病黄斑水肿的相关随机对照研究，检索时限均为从建库至2016年12月。由两位研究者独立筛选文献、提取资料，并评价纳入研究的偏倚风险后，采用RevMan 5.3 软件进行Meta分析。 结果 共纳入7个随机对照研究，包含患者518例，眼数为556眼。Meta分析结果显示：联合组在1、3、6月最佳矫正视力的测量值均高于对照组，其差异均有统计学意义[SMD=-0.37，95%CI（0.05，0.69），P=0.02；SMD=1.17，95%CI（0.56，1.78），P=0.0002；SMD=2.34，95%CI（0.16，4.51），P=0.04]，且随着时间的增加，联合组的视力恢复的更多，联合组在1、3、6月中央黄斑厚度的测量值较对照组明显减少，其差异均有统计学意义[SMD=-1.34，95%CI（-2.41，-0.28），P=0.01；SMD=-1.36，95%CI（-2.37，-0.34），P=0.009；SMD=-1.05，95% CI（-1.34，-0.76），P<0.00001]。 结论 雷珠单抗联合格栅光凝治疗治疗糖尿病黄斑水肿的效果优于单用雷珠单抗或格栅光凝，不良反应少，未见严重不良反应，值得在糖尿病黄斑水肿的治疗中应用和推广。 Abstract:Objective To systematically review the effect of ranibizumab joint laser photocoagulation on diabetic macular edema. Methods Databases including PubMed, EMbase, Cochrane Library, CBM, Wang Fang Data and CNKI were electronically searched to collect randomized controlled trials(RCTs) about the effect of ranibizumab joint laser photocoagulation in treatment of diabetic macular edema from inception to December 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. The meta-analysis was performed through RevMan 5.3 software. Results A total of 7 RCTs involving 518 patients and 556 eyes were included. The results of meta-analysis showed that: BCVA measured values in joint group were higher than the control group on 1, 3, 6 months. The differences were significant [SMD=-0.37,95%CI(0.05, 0.69), P=0.02; SMD=1.17, 95%CI(0.56, 1.78), P=0.0002; SMD=2.34, 95% CI(0.16, 4.51), P=0.04]. With the increase of time, the more visual acuity were on joint group. CMT measured values in joint group were significant less than the control group on 1, 3, 6 months [SMD=-1.34,95%CI (-2.41, -0.28), P=0.01; SMD=-1.36, 95%CI (-2.37, -0.34), P=0.009; SMD=-1.05, 95% CI (-1.34, -0.76), P<0.00001]. Conclusion Ranibizumab joint grid photocoagulation therapy for the treatment of diabetic macular edema than ranibizumab or grid photocoagulation, less adverse reaction and no serious adverse reactions. It is worth to apply grid photocoagulation and generalization in treatment of diabetic macular edema. -
Key words:
- ranibizumab /
- grid photocoagulation /
- macular edema /
- systematical review /
- randomized controlled trial
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表 1 纳入研究的基本特征
作者及
年代例数
（男/女）眼数
（眼）纳入年代 年龄
（联合组/对照组）糖尿病
类型糖尿病时间
（联合组/对照组，年）BCVA CMT（μm） 联合组 对照组 联合组 对照组 姜虎林
2014[3]25/35 60 2012.11-2013.6 53.1* 2 NA 0.187±0.044 0.193±0.057 513.56±109.88 528.45±103.45 李艳丽
2015[4]70 70 2013.3-2015.4 NA 1 or 2 NA 0.141±0.201 0.512±0.103 484.92±94.43 485.12±89.58 徐浩
2015[5]42/46 88 2013.12-2014.11 48.8±14.2* 1 or 2 NA 45.21±12.16 46.22±10.14 445.21±52.16 449.22±48.14 朱嘉丽
2015[6]27/33 93 2012.5-2015.5 56.52±8.69/
54.81±9.361 or 2 8.89±5.65/
9.15±4.880.14±0.15 0.17±0.11 446.39±60.35 451.72±67.88 贾秋菊
2016[7]68/54 122 2013.4-2016.1 54.7±7.9/
55.4±6.82 7.6±2.8/
7.6±3.50.14±0.03 0.15±0.04 549.79±59.56 452.35±61.23 张亚丽
2015[8]20/28 48 2012.9-2013.9 56.2±6.5/
58.3±5.72 9.7±6.4/
8.8±7.34.11±0.12 4.14±0.16 422.75±146.38 454±121.3 Yan
2016[9]41/29 75 2013.3-2014.5 66.3±7.8* 1 or 2 14.9±5.1* 0.319±0.187 0.327±0.205 509.691±57.817 502.402±57.768 BCVA: 最佳矫正视力, 测量工具为标准对数视力表或ETDRS表; CMT: 中央黄斑厚度; *表示总体; NA: 未提供. 
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