糖尿病视网膜病变患者血清中细胞因子及视网膜中央动脉血流动力学的变化
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摘要
目的探讨糖尿病视网膜病变(diabetic retinopathy,DR)血清中各细胞因子及视网膜中央动脉血流动力学的变化情况,为临床DR研究提供参考。方法依据视网膜检查情况将176例(176眼)糖尿病患者分为三组,分别为无DR(non-DR,NDR)组(42例)、增生型DR(proliferative DR,PDR)组(66例)以及非增生型DR(non-proliferative DR,NPDR)组(68例),并纳入32例健康者为对照组,检测所有受试者血清内血管内皮生长因子(vascular endothelial growth factor,VEGF)、碱性成纤维细胞生长因子(basic fibroblast growth factor,bFGF)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、可溶性血管细胞黏附分子-1(soluble vascular cell adhesion molecule-1,sVCAM-1)、可溶性细胞间黏附分子-1(soluble intercellular adhesion molecule-1,sICAM-1)的表达水平,并应用彩色多普勒超声检测视网膜中央动脉相关血流动力学指标的情况。结果 NDR组、PDR组、NPDR组血清中VEGF、bFGF、TNF-α、sVCAM-1、sICAM-1的表达水平均明显高于对照组;PDR组以上各指标表达水平均明显高于NDR组与NPDR组;NPDR组以上指标表达水平均明显高于NDR组,差异均有统计学意义(均为P<0.05);NDR组、PDR组、NPDR组的视网膜中央动脉舒张末期最低血流速度(Vmin)、收缩期峰值血流速度(Vmax)、平均血流速度(Vmean)及搏动指数(pulsation index,PI)均明显低于对照组,阻力指数(resistance index,RI)均明显高于对照组;PDR组Vmin、Vmax、Vmean及PI均明显低于NDR、NPDR组,RI则显著高于NDR组、NPDR组;NPDR组Vmin、Vmax、Vmean及PI均明显低于NDR组,RI显著高于NDR组,差异均有统计学意义(均为P<0.05)。结论 DR患者血清中各细胞因子及视网膜中央动脉血流动力学的变化与DR的发生发展有关。
Objective To investigate the changes in cytokines in the serum of diabetic retinopathy(DR) and the blood flow dynamics of the central retinal artery.Methods According to the retinal examination,176 patients(176 eyes) with diabetes were divided into three groups:non-DR(NDR) group(42 patients),proliferative DR(PDR) group(66 patients) and non-proliferative DR(NPDR) group(68 patients),and another thirty-two healthy people were in the control group.All the subjects were tested for vascular endothelial growth factor(VEGF) and alkali fibroblasts basic fibroblast growth factor(bFGF),tumor necrosis factor-α(TNF-α),soluble vascular cell adhesion molecule-1(sVCAM-1),soluble intercellular adhesion molecule-1(sICAM-1).The color Doppler ultrasonography should be used to detect the condition of the central pulsating blood flow dynamics index in the visual retina.Results The expression levels of VEGF,bFGF,TNF-α,sVCAM-1 and sICAM-1 in the NDR group,PDR group and NPDR group were significantly higher than those in the control group.The expression levels of the above indicators in the PDR group were significantly higher than those in the NDR group and NPDR group.The expression levels of the above indicators in the NPDR group was significantly higher than those in the NDR group(all P<0.05);the end-diastolic blood flow velocity(Vmin),peak systolic blood flow velocity(Vmax),mean blood flow velocity(Vmean),and pulsation index(PI) of the central retinal artery in the NDR group,PDR group,and NPDR group were significantly lower than those in the control group,the resistance index(RI) was significantly higher than that of the control group;the Vmin,Vmax,Vmean and PI in the PDR group were significantly lower than those in the NDR and NPDR groups,and the RI was significantly higher as comparison with the NDR group and the NPDR group.The Vmin,Vmax,Vmean and PI were significantly lower in the NDR group than in the NDR group,and the difference was statistically significant(all P<0.05).Conclusion The changes in the cytokines and retinal hemodynamic of the central arteries in the serum are related to the development of DR.
Objective To investigate the changes in cytokines in the serum of diabetic retinopathy(DR) and the blood flow dynamics of the central retinal artery.Methods According to the retinal examination,176 patients(176 eyes) with diabetes were divided into three groups:non-DR(NDR) group(42 patients),proliferative DR(PDR) group(66 patients) and non-proliferative DR(NPDR) group(68 patients),and another thirty-two healthy people were in the control group.All the subjects were tested for vascular endothelial growth factor(VEGF) and alkali fibroblasts basic fibroblast growth factor(bFGF),tumor necrosis factor-α(TNF-α),soluble vascular cell adhesion molecule-1(sVCAM-1),soluble intercellular adhesion molecule-1(sICAM-1).The color Doppler ultrasonography should be used to detect the condition of the central pulsating blood flow dynamics index in the visual retina.Results The expression levels of VEGF,bFGF,TNF-α,sVCAM-1 and sICAM-1 in the NDR group,PDR group and NPDR group were significantly higher than those in the control group.The expression levels of the above indicators in the PDR group were significantly higher than those in the NDR group and NPDR group.The expression levels of the above indicators in the NPDR group was significantly higher than those in the NDR group(all P<0.05);the end-diastolic blood flow velocity(Vmin),peak systolic blood flow velocity(Vmax),mean blood flow velocity(Vmean),and pulsation index(PI) of the central retinal artery in the NDR group,PDR group,and NPDR group were significantly lower than those in the control group,the resistance index(RI) was significantly higher than that of the control group;the Vmin,Vmax,Vmean and PI in the PDR group were significantly lower than those in the NDR and NPDR groups,and the RI was significantly higher as comparison with the NDR group and the NPDR group.The Vmin,Vmax,Vmean and PI were significantly lower in the NDR group than in the NDR group,and the difference was statistically significant(all P<0.05).Conclusion The changes in the cytokines and retinal hemodynamic of the central arteries in the serum are related to the development of DR.
引文
[1] LI S F,HU J Y,LI T T,WU Q.The current status and progress of the pathological changes and related molecular mechanisms of neuroretinal injury in diabetic retinopathy[J].Chin J Ocul Fundus Dis,2017,33(3):298-301.李疏凤,胡健艳,李婷婷,吴强.糖尿病视网膜病变神经损伤的病理改变及其相关分子机制的研究现状与进展[J].中华眼底病杂志,2017,33(3):298-301.
[2] LI C Y,ZHU A T.Choice of the operative opportunity for diabetic retinopathy complicated with vitreous hemorrhage[J].J Xinxiang Med Univ,2018,35(8):731-734.李春艳,朱安泰.糖尿病视网膜病变并发玻璃体积血手术时机选择[J].新乡医学院学报,2018,35(8):731-734.
[3] ZHANG M,LIU Q Y,MENG Q L,CUI Y,ZHANG L X,LUO Z L,et al.Risk factors for incidence and progression of retinopathy in type 2 diabetes in Dongguan city[J].Chin J Exp Ophthalmol,2014,32(1):68-74.张敏,刘清洋,孟倩丽,崔颖,张立新,罗仲伶,等.广东省东莞市横沥镇居民2型糖尿病患者糖尿病视网膜病变危险因素分析[J].中华实验眼科杂志,2014,32(1):68-74.
[4] NATIONAL EYE FUNDUS DISEASE COOPERATIVE GROUP.DR staging standard[J].Chin J Ophthalmol,1985,21(2):157-158.全国眼底病协作组.DR分期标准[J].中华眼科杂志,1985,21(2):157-158.
[5] LI D J,WU D,ZHANG X X.Research progress of diabetic retinal ganglion cell injury[J].Int Eye Sci,2016,16(4):670-672.李东洁,吴迪,张旭乡.糖尿病视网膜神经节细胞损伤的研究进展[J].国际眼科杂志,2016,16(4):670-672.
[6] LI X,ZARBIN M A,BHAGAT N.Anti-vascular endothelial growth factor injections:The new standard of care in proliferative diabetic retinopathy[J].Dev Ophthalmol,2017,60:131-142.
[7] JIN G M,PIAO L S,TIAN L J.Hemodynamic changes of central retinal artery diabetic retinopathy patients of NADPH oxidase subunit p22phox gene C242T polymorphism[J].CHN J Mod Med,2014,24(25):26-29.金光明,朴莲善,田莲姬.NADPH 氧化酶 p22phox 亚基基因多态性与糖尿病视网膜病变患者视网膜中央动脉血流动力学变化的关系[J].中国现代医学杂志 2014,24(25):26-29.
[8] PAN A P,YANG Y X,TU H L.Changes and significance of serum adiponectin and vascular endothelial growth factor in patients with type 2 diabetic retinopathy[J].J Clin Transf Lab Med,2017,19(2):170-172,184.潘爱平,杨云霞,徐洪磊.2型糖尿病视网膜病变患者血清脂联素与VEGF水平的变化及意义[J].临床输血与检验,2017,19(2):170-172,184.
[9] TAKEUCHI M,SATO T,SAKURAI Y.Association between aqueous humor and vitreous fluid levels of Th17 cell-related cytokines in patients with proliferative diabetic retinopathy[J].PLoS One,2017,12(5):e0178230.
[10] YUAN J F,MING M.Analysis of the changes of ocular vascular hemodynamics ultrasonic detection and the occurrence and development of related factors in type 2 diabetic retinopathy[J].Int Eye Sci,2015,15(11):1938-1941.袁江峰,明敏.2型糖尿病视网膜病变眼部血管血流动力学超声检测及其发生发展相关因素分析[J].国际眼科杂志,2015,15(11):1938-1941.
[11] CHEN H X,ZHANG L P,CHEN Y H,LAI K B,LI G Q,TANG W B.Clinical significance of homocysteine,blood lipid and blood rheology indicators in patients with diabetic retinopathy[J].Lab Med Clin,2014,11(9):1179-1182.陈辉雄,张丽萍,陈玉华,赖康保,李观强,唐万兵.探讨同型半胱氨酸血脂及血液流变学在糖尿病视网膜病变中的意义[J].检验医学与临床,2014,11(9):1179-1182.
[12] WANG X M,YOU Q Y.Study on the relation between Ang-2/Tie,VEGF and type 2 diabetes mellitus with retinopathy[J].Chin J Gen Pract,2014,13(9):1391-1393.王兴木,尤巧英.Ang-2/Tie、VEGF与2型糖尿病视网膜病变关系的研究[J].中华全科医学,2014,13(9):1391-1393.
[13] GAO X,YANG H,MA L,KAN Y M,ZHANG S H,LI X S.Detection on hemodynamics of supratrochlear artery and retrobulbar arteries by using color doppler flow imaging(CDFI)in diabetic patients[J].Chin J Gen Pract,2015,24(6):949-950,955.高鑫,杨华,马琳,阚艳敏,张树华,李晓松.彩色多普勒超声检测糖尿病患者滑车上动脉及球后动脉的血流动力学改变[J].中华全科医学,2015,24(6):949-950,955.
[14] ZHOU C,NIU J Y,CAI J,ZHANG X R.Study on the change of cytokines and retinal blood flow index for patients with diabetic retinopathy[J].Int Eye Sci,2015,15(6):1030-1032.周纯,牛佳媛,蔡洁,张雪荣.糖尿病视网膜病变细胞因子及视网膜血流变化的意义[J].国际眼科杂志,2015,15(6):1030-1032.
[15] GUO R Y.Correlation of serum lipid metabolism and central retinal artery hemodynamics with diabetic retinopathy[J].J Hainan Med Univ,2016,22(18):2185-2187.郭冉阳.血脂代谢及视网膜中央动脉血流动力学与糖尿病视网膜病变的相关性研究[J].海南医学院学报,2016,22(18):2185-2187.
[2] LI C Y,ZHU A T.Choice of the operative opportunity for diabetic retinopathy complicated with vitreous hemorrhage[J].J Xinxiang Med Univ,2018,35(8):731-734.李春艳,朱安泰.糖尿病视网膜病变并发玻璃体积血手术时机选择[J].新乡医学院学报,2018,35(8):731-734.
[3] ZHANG M,LIU Q Y,MENG Q L,CUI Y,ZHANG L X,LUO Z L,et al.Risk factors for incidence and progression of retinopathy in type 2 diabetes in Dongguan city[J].Chin J Exp Ophthalmol,2014,32(1):68-74.张敏,刘清洋,孟倩丽,崔颖,张立新,罗仲伶,等.广东省东莞市横沥镇居民2型糖尿病患者糖尿病视网膜病变危险因素分析[J].中华实验眼科杂志,2014,32(1):68-74.
[4] NATIONAL EYE FUNDUS DISEASE COOPERATIVE GROUP.DR staging standard[J].Chin J Ophthalmol,1985,21(2):157-158.全国眼底病协作组.DR分期标准[J].中华眼科杂志,1985,21(2):157-158.
[5] LI D J,WU D,ZHANG X X.Research progress of diabetic retinal ganglion cell injury[J].Int Eye Sci,2016,16(4):670-672.李东洁,吴迪,张旭乡.糖尿病视网膜神经节细胞损伤的研究进展[J].国际眼科杂志,2016,16(4):670-672.
[6] LI X,ZARBIN M A,BHAGAT N.Anti-vascular endothelial growth factor injections:The new standard of care in proliferative diabetic retinopathy[J].Dev Ophthalmol,2017,60:131-142.
[7] JIN G M,PIAO L S,TIAN L J.Hemodynamic changes of central retinal artery diabetic retinopathy patients of NADPH oxidase subunit p22phox gene C242T polymorphism[J].CHN J Mod Med,2014,24(25):26-29.金光明,朴莲善,田莲姬.NADPH 氧化酶 p22phox 亚基基因多态性与糖尿病视网膜病变患者视网膜中央动脉血流动力学变化的关系[J].中国现代医学杂志 2014,24(25):26-29.
[8] PAN A P,YANG Y X,TU H L.Changes and significance of serum adiponectin and vascular endothelial growth factor in patients with type 2 diabetic retinopathy[J].J Clin Transf Lab Med,2017,19(2):170-172,184.潘爱平,杨云霞,徐洪磊.2型糖尿病视网膜病变患者血清脂联素与VEGF水平的变化及意义[J].临床输血与检验,2017,19(2):170-172,184.
[9] TAKEUCHI M,SATO T,SAKURAI Y.Association between aqueous humor and vitreous fluid levels of Th17 cell-related cytokines in patients with proliferative diabetic retinopathy[J].PLoS One,2017,12(5):e0178230.
[10] YUAN J F,MING M.Analysis of the changes of ocular vascular hemodynamics ultrasonic detection and the occurrence and development of related factors in type 2 diabetic retinopathy[J].Int Eye Sci,2015,15(11):1938-1941.袁江峰,明敏.2型糖尿病视网膜病变眼部血管血流动力学超声检测及其发生发展相关因素分析[J].国际眼科杂志,2015,15(11):1938-1941.
[11] CHEN H X,ZHANG L P,CHEN Y H,LAI K B,LI G Q,TANG W B.Clinical significance of homocysteine,blood lipid and blood rheology indicators in patients with diabetic retinopathy[J].Lab Med Clin,2014,11(9):1179-1182.陈辉雄,张丽萍,陈玉华,赖康保,李观强,唐万兵.探讨同型半胱氨酸血脂及血液流变学在糖尿病视网膜病变中的意义[J].检验医学与临床,2014,11(9):1179-1182.
[12] WANG X M,YOU Q Y.Study on the relation between Ang-2/Tie,VEGF and type 2 diabetes mellitus with retinopathy[J].Chin J Gen Pract,2014,13(9):1391-1393.王兴木,尤巧英.Ang-2/Tie、VEGF与2型糖尿病视网膜病变关系的研究[J].中华全科医学,2014,13(9):1391-1393.
[13] GAO X,YANG H,MA L,KAN Y M,ZHANG S H,LI X S.Detection on hemodynamics of supratrochlear artery and retrobulbar arteries by using color doppler flow imaging(CDFI)in diabetic patients[J].Chin J Gen Pract,2015,24(6):949-950,955.高鑫,杨华,马琳,阚艳敏,张树华,李晓松.彩色多普勒超声检测糖尿病患者滑车上动脉及球后动脉的血流动力学改变[J].中华全科医学,2015,24(6):949-950,955.
[14] ZHOU C,NIU J Y,CAI J,ZHANG X R.Study on the change of cytokines and retinal blood flow index for patients with diabetic retinopathy[J].Int Eye Sci,2015,15(6):1030-1032.周纯,牛佳媛,蔡洁,张雪荣.糖尿病视网膜病变细胞因子及视网膜血流变化的意义[J].国际眼科杂志,2015,15(6):1030-1032.
[15] GUO R Y.Correlation of serum lipid metabolism and central retinal artery hemodynamics with diabetic retinopathy[J].J Hainan Med Univ,2016,22(18):2185-2187.郭冉阳.血脂代谢及视网膜中央动脉血流动力学与糖尿病视网膜病变的相关性研究[J].海南医学院学报,2016,22(18):2185-2187.