血管生成素2和miR-126与糖尿病大血管病变的相关性

目的 探讨血管生成素2 （Ang-2）和miR-126与T2DM患者大血管病变的关系. 方法 检测241例T2DM患者和104名健康对照（NC）者的临床指标、不同时相的胰岛素及C-P水平,测定单核细胞趋化蛋白-1（MCP 1）、血管内皮舒张因子（一氧化氮,NO）、血清miR-126和Ang-2表达水平,分析Ang-2与血管内皮细胞功能、miR-126表达水平的关系. 结果 T2DM合并大血管病变（T2 DM＋CVD）、T2DM未合并大血管病变（T2DM）组Ang-2水平与NC组比较差异有统计学意义（P＜0.05）.与T2DM、NC组比较,T2DM＋ CVD组Ang-2水平升高,miR-126表达水平降低（P＜0.05）.Ang-2与MCP-1呈正相关（r=0.456,P＜0.01）,与miR-126、NO呈负相关（r=-0.517,P＜0.01;r=-0.327,P＜0.05）. 结论 Ang-2和miR-126与糖尿病大血管病变密切相关.miR-126负性调节Ang-2表达.     

增殖性糖尿病视网膜病变病人玻璃体内的血管紧张素Ⅱ及血管内皮生长因子

研究增殖性糖尿病视网膜病变(PDR)严重性与玻璃体内血管紧张素Ⅱ(AGⅡ)和血管内皮生长因子(VEGF)水平的相关性。对象与方法在东京女子医科大学玻璃体视网膜手术期间获得PDR糖尿病病人51只眼的玻璃体样本,无视网膜病变的糖尿病病人6只眼玻璃体样本,伴眼病的非糖尿病病人的16只眼的玻璃体样本(对照组)。通过连接免疫吸附剂的酶的测定来测定玻璃体及血浆中VEGF水平。通过免疫测定AGⅡ水平。     

菩人丹超微粉对糖尿病大鼠视网膜血管生成素-2表达的影响

目的探讨菩人丹超微粉(PRD)对糖尿病大鼠视网膜血管生成素-2(Ang-2)表达的影响。方法 36只Wistar大鼠随机分为3组,正常对照组、糖尿病模型组和PRD治疗组,每组12只。糖尿病模型组和PRD治疗组大鼠均采用链脲佐菌素(STZ)连续腹腔注射建立2型糖尿病大鼠模型,以血糖≥16.7 mmol/L为成模标准。模型成功建立后,模型组大鼠不再作任何处理;PRD治疗组大鼠给予PRD灌胃(1.8 g·kg-1·d-1)3个月。采用免疫组织化学染色法、Western印迹法和逆转录聚合酶链反应(RT-PCR)分别检测视网膜Ang-2蛋白及mRNA的表达。结果糖尿病模型大鼠视网膜Ang-2蛋白及mRNA表达均明显高于正常对照组(P<0.01)。PRD治疗组大鼠视网膜Ang-2蛋白及mRNA表达均明显低于糖尿病模型组(P<0.01)。结论 PRD可通过下调糖尿病大鼠视网膜Ang-2的表达,发挥对糖尿病视网膜损伤的保护作用。     

血管生成素及其Tie-2受体与2型糖尿病视网膜病变的相关性研究

2型糖尿病增殖性视网膜病变(PDR)组血清血管生成素(Ang)2水平明显高于非增殖性视网膜病变组(NPDR)和2型糖尿病无视网膜病变组[分别为5.80(3.83～8.00)、4.42(2.56～5.55)和2.75(1.40～4.64)ng/m1,P＜0.01],NPDR组高于2型糖尿病无视网膜病变组(P＜0.01);Ang-1在NPDR组高于2型糖尿病无视网膜病变组[10.57(8.99～12.05)对9.21(7.71～11.2)ng/m1,P＜0.05];Tie-2受体在3组间差异无显著性(P＞0.05).提示血清Ang-2水平可能与2型糖尿病视网膜病变的严重程度相关.

Abstract：

Angiopoietin-2 levels were 5. 80 ( 3. 83-8. 00 ) , 4. 42 ( 2. 56-5. 55 ) , and 2. 75 ( l. 40-4. 64 )ng/ml in type 2 diabetic patients with proliferative retinopathy, patients with non-proliferative retinopathy, and patients without retinopathy, respectively. Statistical significances existed between any two groups (all P ＜0. 01 ). Angiopoietin-1 level in patients with non-proliferative retinopathy was higher than that in patients without retinopathy [10. 57 ( 8. 99-12. 05 ) vs 9. 21 (7. 71-11.2 ) ng/ml, P＜0. 05]. No difference in receptor Tie-2 was found among the 3 groups (P＞0. 05 ). The results suggested that serum angiopoietin-2 level might be associated with the severity of retinopathy in type 2 diabetic patients.     

促血管生成素-2与糖尿病肾病关系的研究进展

糖尿病肾病（diabetic nephropathy,DN）是糖尿病（diabetes mellitus,DM）最主要的微血管并发症之一,也是导致慢性肾功能衰竭的主要原因之一。如何阻止DN的发展是当今临床医学的重要难题。DN早期的病理特征是肾小球、肾小管细胞肥大伴基底膜增厚,临床表现为高滤过和微量蛋白尿。糖尿病肾病进展导致肾小球系膜基质增加,     

初发2型糖尿病患者视网膜病变与动脉内膜中层厚度的相关性

目的 探讨初发2型糖尿病患者视网膜病变(DR)与颈、股动脉内膜中层厚度(IMT)的关系.方法 选择确诊2型糖尿病且病程在1年以内的患者1236例,其中老年组218例,非老年组1018例.采用GATEwAY2Dfx型彩色多普勒超声仪测定颈、股动脉IMT,并行眼底检查.结果 共检出DR 179例,其中老年DR组36例,非老年DR组143例.老年DR组颈、股动脉IMT为(0.83±0.11)mm和(0.80±0.11)mm,老年对照组为(0.78±0.12)mm和(0.75±0.13)mm,两组比较差异有统计学意义(P＜0.05);非老年DR组颈、股动脉IMT为(0.78±0.13)mm和(0.77±0.13)mm,非老年对照组为(0.72±0.14)mm和(0.71±0.13)mm,两组比较差异有统计学意义(P＜0.01).老年组颈、股动脉IMT≥0.8 mm组DR患病率为21.3%和23.0%,与IMT＜0.8 mm组的8.3%和8.5%比较,差异有统计学意义(P＜0.01);非老年组分别为21.3%、23.0%和8.3%、8.5%,差异有统计学意义(P＜0.01和P＜0.05).以DR为因变量,以年龄、血压、空腹血糖、高密度脂蛋白(HDL-C)、空腹胰岛素(FINS)、颈、股动脉IMT为自变量进行Logistic回归分析,在校正年龄、血脂、胰岛素等因素后,颈、股动脉IMT仍与DR相关(P＜0.01).结论 初发2型糖尿病患者DR与颈、股动脉IMT具有明显的相关性,早期DR改变即与IMT相关.     

2型糖尿病患者血清血管生成因子浓度的变化

选取42例2型糖尿病患者(DM组)、23例糖尿病合并不稳定型心绞痛患者(DM+UAP组)和36名正常健康者(对照组).收集血清,然后使用蛋白芯片检测血清中血管内皮生长因子(VEGF)、血管形成蛋白(Ang)-1、Ang-2、血管生成素、血管抑制素、碱性成纤维细胞生长因子和血小板源性生长因子BB浓度.结果显示,DM组与对照组比较,所有7个因子的血清浓度差异均无统计学意义,而DM+UAP组Ang-2和VEGF水平较对照组显著增高[(3 532.10±1 813.72对2444.50±1 152.21)pg/ml,(286.90±217.01对171.92±106.63)pg/ml,均P＜0.01].7个血管生成因子浓度与HbA1C、空腹血糖、餐后2h血糖、甘油三酯、高密度脂蛋白胆同醇和低密度脂蛋白胆固醇均无显著相关.     

血管紧张素Ⅱ与2型糖尿病动脉粥样硬化的相关性

目的探讨血管紧张素Ⅱ(AngⅡ)与2型糖尿病(T2DM)颈动脉粥样硬化之间的关系。方法选取住院T2DM患者110例,其中颈动脉内膜正常组43例,颈动脉内膜增厚组35例,颈动脉硬化斑块组32例;性别、年龄相当的健康体检者30例作为对照组。检测血压、血浆AngⅡ、血糖、血脂。超声多普勒测定颈动脉内膜中层厚度(CIMT)。结果 T2DM患者中颈动脉硬化斑块组血浆AngⅡ水平明显高于颈动脉内膜增厚组和颈动脉内膜正常组(均P<0.01),颈动脉内膜增厚组血浆AngⅡ水平明显高于颈动脉内膜正常组(P<0.01);T2DM患者血浆AngⅡ和CIMT水平明显高于对照组(均P<0.01)。多元逐步线性回归分析显示高AngⅡ、糖化血红蛋白(Hb A1c)、低密度脂蛋白胆固醇(LDL-C)、体重指数(BMI)水平是T2DM患者CIMT增厚的危险因素(r=0.011,0.013,0.051,0.013,P<0.01或P<0.05)。T2DM患者血浆AngⅡ水平与CIMT、收缩压及舒张压呈正相关(r=0.529,0.232,0.248,P<0.01或P<0.05);校正收缩压和舒张压后,血AngⅡ水平仍与CIMT相关(r=0.532,P<0.01)。结论高血AngⅡ水平可能是T2DM合并颈动脉粥样硬化的危险因素之一。     

血管内皮生长因子基因多态性与糖尿病视网膜病变的相关性

目的探讨血管内皮生长因子（VEGF）-460C/T基因多态性与糖尿病视网膜病变（DR）的相关性。方法病史超过10年的2型糖尿病（T2DM）患者204例,分为非增殖型视网膜病变组（NP-DR,65例）、增殖型视网膜病变组（PDR,64例）及单纯2型糖尿病组（DM,75例）。用PCR-RFLP方法检测各组基因型,比较各组基因型和等位基因的频率。结果DR组VEGF-460位点TT基因型频率显著低于DM组（P〈0.01）,C等位基因频率显著高于DM组（P〈0.01）;NPDR组与PDR组基因型和等位基因频率差异无统计学意义（P〉0.05）。DM中CC、CT、TT基因型的DR发生率分别为69.8%、68.9%和42.2%,CC和CT基因型的DR发生率显著高于TT基因型（P〈0.01）。结论VEGF-460C/T多态性与DR的发生发展有关,C等位基因可能是DR的易感基因。     

促血管生成素1/促血管生成素2的比值与血管病变的关系

促血管生成素家族中促血管生成素1和促血管生成素2分别都能促进血管内皮细胞存活,但同时出现时,促血管生成素2拮抗促血管生成素1的内皮保护作用.促血管生成素1与促血管生成素2的比值与动脉粥样硬化病变、循环系统胚胎发育疾病、血管炎症病变以及糖尿病的血管并发症都密切相关.维持促血管生成素1与促血管生成素2的稳态平衡,或者使其比值向有利方向倾斜,才能发挥促血管生成素家族最有力的血管维护功能.     

老年人非外伤性玻璃体大量积血的病因分析

目的探讨老年人非外伤性玻璃体大量积血的病因. 方法对非外伤性玻璃体大量积血的老年患者81例83只眼的病因资料进行总结分析. 结果 81例中,视网膜静脉阻塞导致玻璃体大量积血的患者最多,33例（40.7%）;其次,为增殖型糖尿病性视网膜病变患者31例（38.3%）;渗出型老年性黄斑变性患者10例（12.4%）.视网膜静脉阻塞患者中,玻璃体大量积血迟发于视网膜静脉阻塞的时间间隔≥3个月为21只眼（63.6%）,眼底检查均发现新生血管;＜3个月者为9只眼（27.3%）,眼底检查未发现新生血管. 结论视网膜静脉阻塞、增殖型糖尿病性视网膜病变和渗出型老年性黄斑变性是老年人非外伤性玻璃体大量积血的主要病因.眼底新生血管的形成、破裂和出血是老年人非外伤性玻璃体大量积血的主要原因.     

Predictors of postoperative bleeding after vitrectomy for vitreous hemorrhage in patients with diabetic retinopathy

Aims/Introduction

To clarify the association between perioperative variables and postoperative bleeding in pars plana vitrectomy for vitreous hemorrhage in diabetic retinopathy.

Materials and Methods

The present retrospective study enrolled 72 eyes of 64 patients who were admitted to Osaka University Hospital between April 2010 and March 2014, and underwent vitrectomy for vitreous hemorrhage as a result of diabetic retinopathy.

Results

Postoperative bleeding developed in 12 eyes. Using binomial logistic regression analysis, we found that the duration of operation was the only significant variable associated with postoperative bleeding within 12 weeks after vitrectomy. Furthermore, Poisson regression analysis identified fasting blood glucose just before vitrectomy, no treatment with antiplatelet drugs and treatment with antihypertensive drugs, as well as duration of operation, to be significantly associated with the frequency of bleeding within 52 weeks after vitrectomy.

Conclusions

Long duration of operation can be used to predict bleeding within both 12 and 52 weeks after vitrectomy. In addition, fasting blood glucose just before vitrectomy, no treatment with antiplatelet drugs and treatment with antihypertensive drugs might be risk factors for postoperative bleeding up to 1 year after vitrectomy.     

结合珠蛋白基因多态性与糖尿病视网膜病变（二）

目的探讨结合珠蛋白（Hp）多态性与2型糖尿病（T2DM）患者糖尿病视网膜病变（DR）发病的关系。方法418例T2DM患者分为3组：糖尿病无视网膜病变（NDR）组、非增生型糖尿病视网膜病变（NPDR）组、增生型糖尿病视网膜病变（PDR）组,另选取100名性别构成、年龄与之相匹配的健康者作为对照（NC）组。采用PCR技术扩增Hp1和Hp2特异目的片段,利用聚丙烯酰胺凝胶电泳技术对Hp分型,分析Hp多态性及各项临床指标与DR的关系。结果NDR组、NPDR组与PDR组两两组间,T2DM组与NC组间,Hp基因型及等位基因频率均无统计学差异（P〉0．05）。经Logistic回归分析显示：DM病程、SBP、TC、24h尿白蛋白（24h UAlb）是DR的独立危险因素（P〈0．05）,Hp与DR发病无关。结论Hp多态性与天津地区DR发病可能无相关性。     

Association of C-peptide with diabetic vascular complications in type 2 diabetes

AimFasting serum C-peptide is a biomarker of insulin production and insulin resistance, but its association with vascular complications in type 2 diabetes mellitus (T2DM) has never been fully elucidated. This study aimed to investigate whether C-peptide is associated with cardiovascular disease (CVD) and diabetic retinopathy (DR).MethodsA total of 4793 diabetes patients were enrolled from seven communities in Shanghai, China, in 2018. CVD was defined as a self-reported combination of previous diagnoses, including coronary heart disease, myocardial infarction and stroke. DR was examined using fundus photographs. Logistic regression analyses were performed, and multiple imputed data were used to obtain stabilized estimates.ResultsPrevalence of CVD increased with increasing C-peptide levels (Q1, Q2, Q3 and Q4: 33%, 34%, 37% and 44%, respectively; P_{for trend} < 0.001), whereas DR prevalence decreased with increasing C-peptide quartiles (Q1, Q2, Q3 and Q4: 21%, 19%, 15% and 12%, respectively; P_{for trend} < 0.001). On logistic regression analysis, C-peptide levels were significantly associated with CVD prevalence (1.27, 95% CI: 1.13–1.42; P < 0.001) and C-peptide quartiles (Q1: reference; Q2: 1.31, 95% CI: 1.00–1.70; Q3: 1.53, 95% CI: 1.16–2.01; Q4: 1.76, 95% CI: 1.32–2.34; P_{for trend} < 0.001). Given the interaction between C-peptide and BMI and the association between C-peptide and CVD (P_{for interaction} = 0.015), study participants were divided into two subgroups based on BMI which revealed that the association persisted despite different BMI statuses. However, DR prevalence decreased with increasing C-peptide levels (0.73, 95% CI: 0.62–0.86; P < 0.001) and quartiles (Q1: reference; Q2: 1.00, 95% CI: 0.76–1.33; Q3: 0.69, 95% CI: 0.50–0.94; Q4: 0.51, 95% CI: 0.36–0.72; P_{for trend} < 0.001).ConclusionC-peptide was positively associated with CVD, but inversely associated with DR progression. The association between C-peptide and CVD could be due to associated metabolic risk factors.     

Prevention of blindness in diabetic retinopathy

Summary Diabetic retinopathy, hitherto the most common cause of blindness in those between 30–64 years of age has become treatable. Both diabetic maculopathy and proliferative retinopathy can be treated effectively by photocoagulation. The treatment is most successful if given early, before visual loss becomes irreversible. Recently, vitrectomy with additional microsurgical techniques has been developed and shown to be effective in restoring vision to many patients blind from the complications of proliferative retinopathy.     

2型糖尿病患者血清胆红素水平与糖尿病视网膜病变的相关性研究

目的探讨不同性别2型糖尿病患者血清胆红素水平与糖尿病视网膜病变(DR)患病风险的相关性。方法共纳入1304例2型糖尿病患者,收集其临床资料,并均进行眼底检查。根据眼底检查结果分为DR组与非DR(NDR)组,分析血清总胆红素、直接胆红素、间接胆红素水平与DR发生的相关性。结果与NDR组相比,DR组总胆红素、直接胆红素、间接胆红素水平显著降低。单因素分析显示,在女性中总胆红素与DR的发生呈负相关(P<0.05),间接胆红素、直接胆红素与DR的发生无明显相关性;在男性中,总胆红素、间接胆红素与DR的发生呈负相关(P<0.01)。调整相关混杂因素后,平滑曲线拟合显示在女性中,总胆红素、间接胆红素水平与DR发生风险呈U型关系;在男性中,总胆红素、间接胆红素与DR发生风险呈负相关。多元回归分析结果显示,调整混杂因素后,在男性中,总胆红素每增加1μmol/L,DR的发生风险降低8%(OR=0.92,95%CI 0.88~0.98,P<0.01);间接胆红素每增加1μmol/L,DR的发生风险降低9%(OR=0.91,95%CI 0.84~0.96,P<0.01)。在女性中,当总胆红素<12.8μmol/L时,总胆红素每增加1μmol/L,DR发生风险降低17%(OR=0.83,95%CI 0.72~0.95,P<0.01);当总胆红素≥12.8μmol/L时,每增加1μmol/L,DR发生风险增加10%(OR=1.10,95%CI 1.01~1.20,P<0.05)。当间接胆红素<9.8μmol/L时,间接胆红素每增加1μmol/L,DR发生风险降低20%(OR=0.80,95%CI 0.68~0.94,P<0.01);当间接胆红素≥9.8μmol/L时,间接胆红素每增加1μmol/L,DR发生风险增加13%(OR=1.13,95%CI 1.01~1.25,P<0.05)。结论在2型糖尿病女性患者中,总胆红素、间接胆红素水平与DR患病风险存在U型关系,在男性患者中,总胆红素、间接胆红素与DR患病风险呈负相关关系,直接胆红素与DR患病风险无明显相关性。     

血清尿酸与我国2型糖尿病患者视网膜病变的相关性研究

目的 探讨血清尿酸（SUA）与我国T2DM患者DR的关系. 方法 采用四分位法将T2DM患者SUA水平分为4组,眼底镜诊断有无DR.采用Logistic多元回归分析SUA与DR发病率的关系. 结果 SUA＞ 212 μmol/L后即为DR危险因素.随着SUA升高（212～288、289～335、≥366μmol/L）,影响程度增加,OR（95％CI）值分别为3.85（1.98～6.84）、5.12（2.25～8.10）、5.71（2.99～8.87）. 结论 SUA是DR的危险因素,降低SUA水平应为其治疗的重要环节.