玻璃体腔注药患者治疗依从性与视力预后关系真实世界研究

doi:10.12183/j.scjpm.2025.1207

摘要/Abstract

摘要： 目的本研究基于真实世界场景,聚焦玻璃体腔注药术患者群体,旨在明确治疗依从性对远期视力预后的影响,剖析影响依从性的关键因素,为制定视力损害预防策略提供依据。方法以2022年4月到2024年3月于沧州市某医院收治的玻璃体腔注药患者为研究对象,根据首次治疗后随访12个月末最终视力将患者分别设为预后不良组（n=72）、预后良好组（n=232）,构建logistic回归模型分析治疗依从性对玻璃体腔注药患者视力预后的影响。结果预后不良组治疗依从性评分为（5.58±0.86）分,低于预后良好的（6.26±0.72）分,差异有统计学意义（t=5.977,P<0.01）。304例患者治疗依从性评分中位数为6.25分,以治疗依从性评分二分位数分组（Q1和Q2）,Q1组156例（治疗依从≥6.25分）,Q2组148例（治疗不依从<6.25分）。与Q1组相比,未调整混杂因素下,Q2组发生视力预后不良的风险为2.640倍（OR=2.640,95% CI：1.516~4.597）;调整混杂因素后,Q2组发生视力预后不良的风险为2.894倍（OR=2.894,95% CI：1.064~7.875）,可见治疗依从性降低确实与玻璃体腔注药患者视力预后不良发生存在关联性。结论治疗依从性是影响玻璃体腔注药患者视力预后的重要因素,不依从治疗会显著提高患者远期视力预后不良的风险。可以根据影响依从性的因素,找到重点人群和薄弱环节,制定预防性干预措施,提高治疗依从性,预防患者远期视力变差。

关键词: 玻璃体腔注药, 视力, 治疗依从性, 关系, 影响因素, 真实世界研究

Abstract: Objective This real-world study investigates the impact of treatment adherence on long-term visual prognosis among patients undergoing intravitreal injection therapy. It aims to identify key factors influencing adherence to inform the development of preventative strategies against visual impairment. Methods A retrospective analysis was conducted on patients receiving intravitreal injections at a hospital in Cangzhou City between April 2022 and March 2024. Based on their final visual acuity at the 12-month follow-up after initial treatment, patients were stratified into a poor prognosis group (n=72) and a good prognosis group (n=232). A logistic regression model was constructed to analyze the effect of treatment adherence on visual outcomes. Results The mean treatment adherence score in the poor prognosis group was significantly lower than that in the good prognosis group (5.58±0.86 vs. 6.26±0.72; t=5.977, P<0.01). The median adherence score for the entire cohort of 304 patients was 6.25. Patients were dichotomized based on this median score into a high-adherence group (Q1, n=156, score ≥6.25) and a low-adherence group (Q2, n=148, score <6.25). In an unadjusted model, the risk of poor visual prognosis was 2.640 times higher in the Q2 group compared to the Q1 group (OR=2.640, 95% CI: 1.516-4.597). After adjusting for confounding factors, the risk in the Q2 group remained significantly elevated at 2.894 times that of the Q1 group (OR=2.894, 95% CI: 1.064-7.875). These findings indicate a substantive association between diminished treatment adherence and an increased risk of adverse visual outcomes in this patient population. Conclusions Treatment adherence is a critical determinant of visual prognosis in patients receiving intravitreal injections. Non-adherence significantly elevates the risk of poor long-term visual outcomes. By identifying the factors that undermine adherence, targeted interventions can be designed for high-risk populations and critical deficiencies in care pathways, thereby enhancing treatment adherence and preserving long-term vision.

Key words: Intravitreal injection, Visual acuity, Treatment adherence, Relationship, Influencing factors, Real-world study

中图分类号:

R195

张习, 崔兵杰, 田笑雨, 刘英月, 冀向宁, 侯四清. 玻璃体腔注药患者治疗依从性与视力预后关系真实世界研究[J]. 华南预防医学, 2025, 51(11): 1207-1211.

ZHANG Xi, CUI Bingjie, TIAN Xiaoyu, LIU Yingyue, JI Xiangning, HOU Siqing. A real-world study on the relationship between treatment adherence and visual prognosis in patients receiving intravitreal injection[J]. South China Journal of Preventive Medicine, 2025, 51(11): 1207-1211.

参考文献

[1] 周吕琴,姜波,王泽飞,等. 玻璃体腔抗VEGF药物注射中两种眼压控制方法比较分析[J]. 临床眼科杂志,2022,30(1):46-49.
[2] 肖琼,刘丽梅,伍晨婵,等. 中老年人群黄斑变性的影响因素研究[J]. 预防医学,2024,36(3):228-231.
[3] Kodjikian L, Mehanna CJ, Cohen SY, et al.The role of future treatments in the management of neovascular age-related macular degeneration in Europe[J]. Eur J Ophthalmol, 2021, 31(5): 2179-2188.
[4] Daien V, Finger RP, Talks JS, et al.Evolution of treatment paradigms in neovascular age-related macular degeneration: A review of real-world evidence[J]. Br J Ophthalmol, 2021, 105(11): 1475-1479.
[5] 戴虹,卢颖毅,赵晶. 新生血管性年龄相关性黄斑变性治疗面临的挑战与对策[J]. 中华眼科杂志,2024,60(3):215-219.
[6] 陈强,曲珊珊,黄欣. 中文版MMAS-8评价心血管慢病患者用药依从性的信效度分析与实践[J]. 中国药房,2019,30(2):268-271.
[7] Nielsen. The construct validity of the Perceived Stress Scale[J]. Opt Commun, 2016, 84(1): 22-30.
[8] 张帆,朱树贞,邓平基. 领悟社会支持量表在国内住院病人社会支持研究中的应用评价[J]. 护理研究,2018,32(13):2048-2052.
[9] Sivaprasad S, Ghanchi F, Kelly SP, et al.Evaluation of standard of care intravitreal aflibercept treatment of diabetic macular oedema treatment-naive patients in the UK: DRAKO study 12-month outcomes[J]. Eye, 2022, 36(1): 64-71.
[10] Studnička J, Němčanský J, Vysloužilová D, et al.Diabetic Macular Edema—Diagnostics and Treatment Guidelines[J]. Cesk Slov Oftalmol, 2023, 79(5): 238-247.
[11] Cho SC, Park KH, Park SJ, et al.Discontinuation of treatment and retreatment of neovascular age-related macular degeneration in the real-world: Bundang AMD cohort study report 5[J]. Front Med, 2023, 10: 1204026.
[12] Daniels AB, Chang EY, Chew EY, et al.Consensus guidelines for ocular surveillance of von Hippel-Lindau disease[J]. Ophthalmology, 2024, 131(5): 622-633.
[13] 李滨,张世新,罗琼,等. 枣庄地区中青年2型糖尿病患者治疗依从性及慢性并发症现状分析[J]. 华南预防医学,2024,50(5):429-432.
[14] Angermann R, Hofer M, Huber AL, et al.The impact of compliance among patients with diabetic macular oedema treated with intravitreal aflibercept: A 48-month follow-up study[J]. Acta Ophthalmol, 2022, 100(2): 546-552.
[15] Yoshida S, Murakami T, Nozaki M, et al.Review of clinical studies and recommendation for a therapeutic flow chart for diabetic macular edema[J]. Graefes Arch Clin Exp Ophthalmol, 2021, 259(4): 815-836.
[16] Matsunaga K, Rajagopalan A, Nallasamy S, et al.Disparities in amblyopia treatment outcomes: the impact of sociodemographic factors, treatment compliance, and age of diagnosis[J]. Ophthalmology, 2025, 132(3): 335-342.
[17] Muñoz-Villegas P, Martínez-Bautista H, Olvera-Montaño O.Determinants of adherence to treatment in patients with ophthalmic conditions[J]. Expert Rev Clin Pharmacol, 2023, 16(12): 1249-1259.
[18] Lu L, Shi G, Sun Y, et al.Assessment of medication adherence among elderly ophthalmic patients during transition from hospital to home: A cross-sectional study[J]. Int Ophthalmol, 2025, 45(1): 388.
[19] Thinggaard BS, Pedersen M, Sorensen TL, et al.Patient perspectives and barriers in the treatment of neovascular age-related macular degeneration in Denmark: A qualitative study[J]. BMJ Open, 2023, 13(11): e077175.
[20] Moore SG, Richter G, Modjtahedi BS.Factors affecting glaucoma medication adherence and interventions to improve adherence: A narrative review[J]. Ophthalmol Ther, 2023, 12(6): 2863-2880.
[21] Fajnkuchen F, Delyfer MN, Conrath J, et al.Expectations and fears of patients with diabetes and macular edema treated by intravitreal injections[J]. Acta Diabetol, 2020, 57(9): 1081-1091.
[22] Dave S, Binns A, Vinuela-Navarro V, et al.What advice is currently given to patients with age-related macular degeneration (AMD) by eyecare practitioners, and how effective is it at bringing about a change in lifestyle? A systematic review[J]. Nutrients, 2022, 14(21): 4652.
[23] 徐倩,翁洁,曹娟. 年龄相关性白内障及黄斑变性视力障碍患者社会支持、抑郁对生活质量的影响[J]. 精神医学杂志,2023,36(3):255-259.
[24] 郭静波,李沙沙,孙丽红,等. 眼科老年患者医院-家庭过渡期用药偏差现况及影响因素研究[J]. 护理管理杂志,2024,24(10):877-881.
[25] 张晓光,于静,袁月,等. 真实世界下眼内注射抗VEGF治疗眼底血管性疾病无应答的影响因素[J]. 国际眼科杂志,2024,24(11):1831-1835.
[26] Chouhan S, Kalluri Bharat RP, Surya J, et al.Preliminary report on optical coherence tomography angiography biomarkers in non-responders and responders to intravitreal anti-VEGF injection for diabetic macular oedema[J]. Diagnostics, 2023, 13(10): 1735.