视网膜静脉阻塞继发黄斑水肿患者抗血管内皮生长因子治疗后视力获益的影响因素分析-现代医学

视网膜静脉阻塞继发黄斑水肿患者抗血管内皮生长因子治疗后视力获益的影响因素分析

单位：青岛市第八人民医院眼科, 山东青岛 266100

分类号：R774.1;R774.5

出版年·卷·期（页码）：2026·54·第六期（953-959）

摘要：

目的：探究视网膜静脉阻塞继发黄斑水肿(RVO-ME)患者抗血管内皮生长因子(anti-VEGF)治疗后视力获益的影响因素。方法：选择2022年1月至2025年2月于我院接受anti-VEGF治疗的174例(174单眼)RVO-ME患者，随访6个月根据患者视力获益情况分为视力获益良好组和视力获益不良组。收集并比较两组临床资料，采用Logistic回归模型明确RVO-ME患者anti-VEGF治疗后视力获益的独立相关因素，以受试者工作特征(ROC)曲线评价各关联因素及联合预测对患者视力获益的区分效能。结果：174例RVO-ME患者anti-VEGF治疗后视力获益良好113例，获益不良61例。多因素非条件Logistic回归分析显示，视力下降时间长(OR=1.107，95%CI 1.042～1.177)、高基线最佳矫正视力(BCVA)(OR=6.747，95%CI 2.398～18.985)、外界膜中断(OR=2.552，95%CI 1.058～6.158)、高基线视网膜内层结构紊乱(DRIL)评分(OR=2.362，95%CI 1.054～5.296)是RVO-ME患者anti-VEGF治疗后视力获益的危险因素(均P＜0.05)；基线视网膜深浅血流密度比值高(OR=0.039，95%CI 0.007～0.221)和遵医行为[一般(OR=0.250，95%CI 0.081～0.770)、良好(OR=0.103，95%CI 0.029～0.368)]是RVO-ME患者anti-VEGF治疗后视力获益的保护因素(均P＜0.05)。联合指标的曲线下面积(AUC)为0.933，优于视力下降时间、基线BCVA、基线视网膜深浅血流密度比值、基线DRIL评分、外界膜中断和遵医行为这些单一指标，同时联合指标的灵敏度和特异度良好，分别为81.97%和89.38%。结论：视力下降时间、基线BCVA、基线视网膜深浅血流密度比值、基线DRIL评分、外界膜中断、遵医行为均是RVO-ME患者anti-VEGF治疗后视力获益的影响因素，且各指标联合预测效能最佳，可为医护人员区分患者视力获益情况提供参考。

Objective: To investigate the factors influencing visual benefit after anti-vascular endothelial growth factor(anti-VEGF) therapy in patients with macular edema secondary to retinal vein occlusion(RVO-ME).Methods: A total of 174 RVO-ME patients(174 single eyes) who received anti-VEGF treatment in our hospital from January 2022 to February 2025 were enrolled. Based on visual benefit at the 6-month follow-up, the patients were divided into a good visual benefit group and a poor visual benefit group. Clinical data were collected and compared between the two groups. Logistic regression analysis was performed to identify independent factors associated with visual benefit, and receiver operating characteristic(ROC) curves were used to evaluate the discriminative performance of each factor and their combination. Results: Among the 174 patients, 113 achieved good visual benefit and 61 experienced poor visual benefit. Multivariate unconditional Logistic regression revealed that longer duration of visual decline(OR=1.107, 95%CI 1.042-1.177), higher baseline best-corrected visual acuity(BCVA)(OR=6.747, 95%CI 2.398-18.985), disruption of the external limiting membrane(OR=2.552, 95%CI 1.058-6.158), and higher baseline disorganization of retinal inner layers(DRIL) score(OR=2.362, 95%CI 1.054-5.296) were risk factors for poor visual benefit(all P<0.05). In contrast, a higher baseline deep-to-superficial retinal vessel density ratio(OR=0.039, 95%CI 0.007-0.221) and better treatment compliance(moderate compliance OR=0.250, 95%CI 0.081-0.770; good compliance OR=0.103, 95%CI 0.029-0.368) were protective factors(all P<0.05). The area under the ROC curve(AUC) of the combined model was 0.933, which was superior to that of any single indicator(duration of visual decline, baseline BCVA, baseline deep-to-superficial vessel density ratio, baseline DRIL score, disruption of the external limiting membrane, and compliance), with a sensitivity of 81.97% and a specificity of 89.38%.Conclusion:Duration of visual decline, baseline BCVA, baseline deep-to-superficial retinal vessel density ratio, baseline DRIL score, disruption of the external limiting membrane, and treatment compliance are all factors influencing visual benefit after anti-VEGF therapy in RVO-ME patients. The combined prediction model demonstrates the best discriminative performance and can serve as a reference for clinicians to identify the likelihood of visual benefit.

参考文献：

[1] 刘松涛,吕辉,刘向玲.人工智能技术对视网膜静脉阻塞的诊断价值分析[J]. 眼科新进展,2025,45(1):46-49.
[2] ZHANG R,DONG L,FU X,et al.Trends in the prevalence of common retinal and optic nerve diseases in China:an artificial intelligence based national screening[J]. Trans Vis Sci Tech,2024,13(4):28.
[3] 孙梅,郝晓凤,谢立科,等.视网膜静脉阻塞继发黄斑水肿的OCT影像指标研究进展[J]. 国际眼科杂志,2023,23(1):58-61.
[4] 宋君露,刘明.视网膜分支静脉阻塞性黄斑水肿患者复发风险模型的构建与验证[J]. 现代医学,2026,54(2):266-273.
[5] 王军梅,王淑娜,章雪敏,等.视网膜分支静脉阻塞继发黄斑水肿anti-VEGF治疗后复发的相关因素分析[J]. 国际眼科杂志,2025,25(9):1500-1504.
[6] SI S,CHEN A,JI Y,et al.Poor response to first intravitreal injection for predicting unfavorable outcomes of retinal vein occlusion related macular edema[J]. Eur J Ophthalmol,2024,34(4):1201-1210.
[7] 葛坚.眼科学[M]. 2版.北京:人民卫生出版社,2010:305-305.
[8] 赵元程.基于黄斑区影像特征构建糖尿病视网膜病变视力损伤风险预测模型[D]. 重庆:中国人民解放军陆军军医大学,2024.
[9] 茹艺,范俊,雷蔚,等.视网膜分支静脉阻塞继发黄斑水肿雷珠单抗治疗后视力预后的列线图模型构建与验证[J]. 中华眼底病杂志,2023,39(6):464-470.
[10] CIULLA T A,KAPIK B,HU A,et al.Anatomic biomarkers of macular edema associated with retinal vein occlusion[J]. Ophthalmol Retina,2022,6(12):1206-1220.
[11] COSTA J V,MOURA-COELHO N,ABREU A C,et al.Macular edema secondary to retinal vein occlusion in a real-life setting:a multicenter,nationwide,3-year follow-up study[J]. Graefe's Arch Clin Exp Ophthalmol,2021,259(2):343-350.
[12] LIANG C,LIU L,ZHAO T,et al.Predicting visual acuity after retinal vein occlusion anti-VEGF treatment:development and validation of an interpretable machine learning model[J]. J Med Syst,2025,49(1):57.
[13] 贾楠,王丽娟,付佐娣,等.血尿酸水平变异性与2型糖尿病肾病和视网膜病变进展的相关性[J]. 中国医师进修杂志,2024,47(5):450-455.
[14] SASSEN S H,SASSEN J,SASSMANNSHAUSEN M,et al.Early photoreceptor alterations after retinal detachment repair[J]. Invest Ophthalmol Vis Sci,2025,66(9):32.
[15] MURTAZA F,GOUD R,BELHOUARI S,et al.Prognostic features of preoperative OCT in retinal detachments a systematic review and meta-analysis[J]. Ophthalmol Retina,2023,7(5):383-397.
[16] TAO Y,GE L,SU N,et al.Exploration on OCT biomarker candidate related to macular edema caused by diabetic retinopathy and retinal vein occlusion in SD-OCT images[J]. Sci Rep,2024,14:14317.
[17] 韩爽,张正培,管莉娜,等.视网膜外层形态对视网膜分支静脉阻塞继发黄斑水肿患者视力预后的影响[J]. 中华眼外伤职业眼病杂志,2022,44(6):459-465.
[18] 张鹏宇.雷珠单抗治疗BRVO-ME的预后及ME复发的影响因素[D]. 合肥:安徽医科大学,2023.
[19] MOUSSA M,LEILA M,BESSA A S,et al.Grading of macular perfusion in retinal vein occlusion using en-face swept-source optical coherence tomography angiography:a retrospective observational case series[J]. BMC Ophthalmol,2019,19(1):127.
[20] 李泽.视网膜静脉阻塞anti-VEGF治疗后的视力预后敏感指标预测[D]. 通辽:内蒙古民族大学,2023.
[21] 刘历东,郑艳菲,云慧,等.视网膜分支静脉阻塞患者治疗前后视网膜厚度及血流密度的对比研究[J]. 内蒙古医科大学学报,2025,47(4):367-372,377.
[22] 张瑞芬,袁方.视网膜分支静脉阻塞继发黄斑水肿患者联合用药后远期视力恢复的风险预测模型[J]. 中国医师进修杂志,2025,48(7):628-634.

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