目的 探討雷珠單抗與長(zhǎng)春胺聯(lián)合治療缺血性視網(wǎng)膜靜脈阻塞的臨床療效。方法 選擇2020年5月—2022年5月商丘第一人民醫(yī)院收治的80例缺血性視網(wǎng)膜靜脈阻塞患者，按照隨機(jī)數(shù)字表法分為對(duì)照組和治療組，每組各40例。對(duì)照組患者口服長(zhǎng)春胺緩釋膠囊，1粒/次，2次/d。在對(duì)照組的基礎(chǔ)上，治療組經(jīng)玻璃體內(nèi)注射雷珠單抗注射液，0.5mg/次，1次/月。兩組用藥12周。觀察兩組患者臨床療效，比較治療前后兩組患者癥狀緩解時(shí)間，視力與視野相關(guān)指標(biāo)，視盤(pán)周?chē)窠?jīng)厚度和視網(wǎng)膜神經(jīng)節(jié)細(xì)胞復(fù)合體厚度，血清腫瘤壞死因子-α（TNF-α）、血管內(nèi)皮生長(zhǎng)因子（VEGF）、C反應(yīng)蛋白（CRP）和白細(xì)胞介素-6（IL-6）水平，及不良反應(yīng)。結(jié)果 治療后，治療組總有效率為97.50%，明顯高于對(duì)照組（77.50%，P＜0.05）。治療后，治療組患者癥狀緩解時(shí)間均明顯早于低于對(duì)照組（P＜0.05）。治療后，兩組平均視力、平均光敏感度指標(biāo)均升高，而視野平均偏差、視野校正形態(tài)標(biāo)準(zhǔn)差指標(biāo)均降低（P＜0.05）；且治療組視力與視野相關(guān)指標(biāo)改善優(yōu)于對(duì)照組（P＜0.05）。治療后，兩組視盤(pán)周?chē)窠?jīng)厚度、視網(wǎng)膜神經(jīng)節(jié)細(xì)胞復(fù)合體厚度指標(biāo)均下降（P＜0.05）；且治療組的視盤(pán)周?chē)窠?jīng)厚度、視網(wǎng)膜神經(jīng)節(jié)細(xì)胞復(fù)合體厚度指標(biāo)均低于對(duì)照組（P＜0.05）。治療后，兩組血清因子白細(xì)胞介素-6（IL-6）、血管內(nèi)皮生長(zhǎng)因子（VEGF）、腫瘤壞死因子-α（TNF-α）、C反應(yīng)蛋白（CRP）水平均降低（P＜0.05）；且治療后治療組IL-6、VEGF、TNF-α、CRP水平均低于對(duì)照組（P＜0.05）。治療組不良反應(yīng)發(fā)生率明顯低于對(duì)照組（P＜0.05）。結(jié)論 長(zhǎng)春胺緩釋膠囊與雷珠單抗注射液聯(lián)合治療效果確切，癥狀得到有效緩解，視力及光敏感程度有效改善，并能降低炎性反應(yīng)，且安全性良好。

Objective To investigate the clinical effect of ranibizumab combined with vincamine in treatment of ischemic retinal vein occlusion. Methods Patients (80 cases) with ischemic retinal vein occlusion in First People's Hospital of Shangqiu from May 2020 to May 2022 were randomly divided into control and treatment group, and each group had 40 cases. Patients in the control group were po administered with Vincamine Sustained Release Capsules, 1 grain/time, twice daily. Patients in the treatment group received intravitreal injection of Ranibizumab Injections on the basis of the control group, 0.5 mg/time, once monthly. Patients in two groups were treated for 12 weeks. After treatment, the clinical evaluation was evaluated, the improvement time of symptom, visual acuity and visual field related indicators, thickness of peripheral optic nerve and retinal ganglion cell complex, levels of serum IL-6, VEGF, TNF-α and CRP, adverse incidence in two groups before and after treatment were compared. Results After treatment, the clinical effective rate of the treatment group was 97.50%, which was significantly higher than that of the control group (77.50%, P<0.05). After treatment, the time of symptom relief in the treatment group was significantly earlier than that in the control group (P<0.05). After treatment, the average visual acuity and average light sensitivity indexes were increased, but the average deviation of visual field and the standard deviation of visual field correction were decreased in both groups (P<0.05). The improvement of visual acuity and visual field related indexes in the treatment group was better than that in the control group (P<0.05). After treatment, the thickness indexes of perioptic nerve and retinal ganglion cell complex decreased in both groups (P<0.05). The thickness of perioptic nerve and retinal ganglion cell complex in treatment group were lower than those in control group (P<0.05). After treatment, the serum levels of interleukin-6 (IL-6), vascular endothelial growth factor (VEGF), tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP) were decreased in both groups (P<0.05). After treatment, the levels of IL-6, VEGF, TNF-α and CRP in treatment group were lower than those in control group (P<0.05). The incidence of adverse reactions in the treatment group was significantly lower than that in the control group (P<0.05). Conclusion Ranibizumab combined with vincamine in treatment of ischemic retinal vein occlusion have definite therapeutic effects, the symptoms can be effectively relieved, vision and light sensitivity can be effectively improved, and inflammatory reaction can be reduced, and the safety is good.

R988.1

河南省醫(yī)學(xué)科技攻關(guān)計(jì)劃項(xiàng)目（2018020945）