血清CysC和CTRP9水平对2型糖尿病视网膜病变的诊断价值

目的探讨血清胱抑素C(CysC)和C1q肿瘤坏死因子相关蛋白9(CTRP9)水平对2型糖尿病患者糖尿病视网膜病变(DR)及糖尿病黄斑水肿(DME)的诊断价值。方法采用横断面研究方法, 纳入2021年4月至2022年4月在甘肃省人民医院就诊的135例2型糖尿病患者, 年龄45～75岁, 按照DR分级标准将患者分为无DR(NDR)组、非增生型DR(NPDR)组和增生型DR(PDR)组, 每组45例。根据有无DME将NPDR组和PDR组患者分为DME组51例和非DME组39例。另选取45名健康体检者作为正常对照组。采集受检者空腹外周静脉血, 检测血清中糖化血红蛋白、空腹血糖、三酰甘油、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、CysC和CTRP9水平。比较各组CysC和CTRP9表达差异。采用多因素Logistic回归分析模型评估DR及DME的独立影响因素, 采用受试者工作特征(ROC)曲线评价血清CysC和CTRP9对DR及DME的诊断价值。结果正常对照组、NDR组、NPDR组和PDR组血清CysC水平分别为0.74(0.67, 0.83)、1.03(0.85, 1.22)、1.4...     

应用超高速SS-OCTA定量评估DR患者的脉络膜毛细血管血流灌注

目的：利用超高速扫频源光学相干断层扫描血管成像(SS-OCTA)测量脉络膜毛细血管(CC)灌注密度(PFD)评估不同糖尿病视网膜病变(DR)患者脉络膜毛细血管血流特征。方法：横断面研究。选取2022-03/12在合肥市第二人民医院就诊的受试者139例139眼：包括糖尿病患者115例115眼和对照组24例24眼。根据早期糖尿病视网膜病病变研究(ETDRS)标准对彩色视网膜图像进行DR分级,将糖尿病患眼分为无DR组、非增殖性糖尿病视网膜病变(NPDR)组、NPDR合并糖尿病黄斑水肿(DME)组、增殖性糖尿病视网膜病变(PDR)组。采用超高速SS-OCTA设备扫描以黄斑中央凹为中心3mm×3mm的区域,利用系统内置软件测量CC灌注面积,计算PFD,采用多元线性回归评估CC的PFD与DR程度的相关性。结果：DR程度与CC血流灌注相关,调整各种混杂因素后,与对照组相比,NPDR组中心凹CC的PFD减少9.358个单位(95%CI -18.484～-0.232,P=0.045),旁中心凹减少9.284个单位(95%CI -18.487～-0.090,P=0.048); NPDR合并DME组中心凹CC PFD减少18.173个单位(95%CI -28.583～-7.762,P=0.001),旁中心凹减少17.032个单位(95%CI -27.521～-6.544,P=0.002); PDR组中心凹CC PFD减少28.309个单位(95%CI -39.978～-16.640,P<0.001),旁中心凹减少25.841个单位(95%CI -37.597～-14.085,P<0.001)。结论：超高速SS-OCTA测量CC血流密度可以客观量化黄斑灌注,黄斑区CC血流灌注密度与DR严重程度相关,随着DR进展黄斑区CC灌注密度降低,未来纵向研究可阐明CC灌注与DR进展之间的因果关系。     

糖尿病视网膜病变继发毛细血管扩张的影响因素分析

目的：探讨糖尿病视网膜病变(DR)继发毛细血管异常扩张的影响因素。 方法：前瞻性研究。选取2021-01/2023-01于我院就诊的DR患者153例240眼，分析DR继发毛细血管异常扩张的影响因素。结果：根据是否继发毛细血管异常扩张将纳入患者分为扩张组(40例77眼)和非扩张组(113例163眼)，两组患者合并糖尿病性黄斑水肿情况、硬性渗出分级及空腹血糖水平具有显著差异(P<0.05)。Logistic回归分析结果显示，合并糖尿病性黄斑水肿、硬性渗出分级较高、高血糖水平是DR继发毛细血管异常扩张的危险因素(P<0.05)。结论：DR继发毛细血管异常扩张的发生可能与合并糖尿病性黄斑水肿、3级硬性渗出及高血糖水平有关。     

糖尿病视网膜病变患者血清β2-糖蛋白Ⅰ的表达

目的探讨血清β2-糖蛋白Ⅰ(beta2-glycoproteinⅠ,β2-GPⅠ)在不同时期糖尿病视网膜病变(diabetic retinopathy,DR)患者中的变化,了解血清β2-GPⅠ与DR的关系。方法收集60例2型糖尿病患者血清标本,将其分为3组:20例无明显DR(no-DR,NDR)患者为NDR组;20例非增生性DR(non-proliferative DR,NPDR)患者为NPDR组;20例增生性DR(proliferative DR,PDR)患者为PDR组。同时收集20例健康人血清为正常对照(normal control,NC)组。应用Westernblot方法,对各组随机抽取的4份血清样本中β2-GPⅠ水平进行分析。结果β2-GPⅠ水平在NPDR组、PDR组大量表达,在NDR组中量表达,在NC组少量表达。NC组、NDR组、NPDR组和PDR组各条带面积平均光密度值,分别为(440564.9±66597.4)mm-2、(655561.6±85640.8)mm-2、(859969.7±85461.0)mm-2、(954887.4±125764.4)mm-2。与NC组比较,β2-GPⅠ水平在NDR组、NPDR组、PDR组显著升高,差异均有统计学意义(均为P<0.01);与NDR组比较,β2-GPⅠ水平在NPDR组、PDR组显著升高,差异均有统计学意义(均为P<0.01);与NPDR组比较,PDR组无明显升高,差异无统计学意义(P>0.05)。结论在DR发生过程中,血清β2-GPⅠ水平上调,β2-GPⅠ可能具有潜在的早期诊断DR的价值。     

不同程度近视散光患者TransPRK术后功能性光学区的临床分析

目的：评估术前近视散光大小及角膜前表面曲率对经上皮准分子激光角膜表面切削术(TransPRK)后功能性光学区(FOZ)的影响。方法：采用回顾性分析,选择近视及近视散光患者78例130眼应用TransPRK治疗,根据柱镜度不同分为：对照组,柱镜度0D; 中度散光组,柱镜度-0.50～-2.00D; 高度散光组,柱镜度&#x003E;-2.00～&#x003C;-6.00D。测量并比较术后6mo三组FOZ大小,分析拟矫屈光度、角膜前表面曲率变化、角膜像差变化、Q值变化与FOZ的相关性。结果：术后6mo,对照组平均FOZ为5.16±0.12mm,中度散光组为5.29±0.23mm,高度散光组为5.49±0.23mm(P&#x003C;0.001)。高度散光组FOZ明显大于中度散光组和对照组(P&#x003C;0.05,&#x003C;0.001); Pearson相关分析表明,等效球镜度变化量、角膜总高阶像差(HOAs)变化量、彗差变化量、球差变化量与FOZ均呈负相关(均P&#x003C;0.05); 陡峭曲率(K2)、平均曲率(Km)、角膜散光变化量、Q值变化量与FOZ均呈正相关(均P&#x003C;0.01)。多元线性回归分析表明,在去除其他危险因素后,术前K2仍与FOZ呈正相关(P&#x003C;0.001)。结论：高度散光患者在TransPRK后获得较大FOZ和引入较少彗差。术前陡峭曲率高近视散光眼将取得较大FOZ。     

糖尿病视网膜病变患者血清CMKLR1水平及临床意义

目的：探讨糖尿病视网膜病变(DR)患者血清CMKLR1水平及临床意义。

方法：选取2015-02/2018-03在我院治疗的2型糖尿病(T2DM)患者140例,其中单纯T2DM患者45例,DR患者95例(NPDR患者54例,PDR患者41例),并纳入健康志愿者40例。收集临床资料并检测血清CMKLR1水平。

结果：PDR患者糖尿病病程长于NPDR和NDR患者,且NPDR患者长于NDR患者(均P<0.05)。T2DM患者FPG和血清TG水平升高,HDL-C水平降低,且DR患者LDL-C水平高于NDR患者和健康志愿者(均P<0.05)。PDR患者血清CMKLR1水平高于NPDR、T2DM患者和健康志愿者,且NPDR患者高于NDR患者和健康志愿者,NDR患者高于健康志愿者(均P<0.05)。DR患者血清CMKLR1水平与糖尿病病程、HbA1c和LDL-C呈正相关(r=0.374、0.248、0.304,均P<0.05),其中糖尿病病程和血清CMKLR1水平是DR发生的危险因素(OR=1.594、1.830,均P<0.05)。

结论：DR患者血清中CMKLR1水平升高,且与病情进展有关,是影响DR发生发展的重要危险因素。     

2型糖尿病并发视网膜病变患者血清脂联素和超敏C-反应蛋白浓度的变化

目的:探讨2型糖尿病并发视网膜病变(diabetic retinopathy,DR)患者血清脂联素和超敏C-反应蛋白(high sensitivity C-reactive protein,hs-CRP)浓度的变化。方法:病例对照研究。采用酶联免疫吸附法和速率散射比浊法检测49例非糖尿病视网膜病变(NDR)的糖尿病患者,46例非增生性糖尿病视网膜病变(NPDR)组患者,41例增生性糖尿病视网膜病变(PDR)组患者以及45例对照组受检者血清脂联素和超敏C-反应蛋白(hs-CRP)浓度的变化,采用单因素设计的定量资料的方差分析,多个均数之间两两比较采用q检验,相关分析采用直线相关分析。结果:NDR组患者血清脂联素浓度8.76±3.61mg/L,hs-CRP浓度3.12±1.24mg/L;NPDR组患者血清脂联素浓度6.22±2.53mg/L,hs-CRP浓度4.89±1.66mg/L;PDR组患者血清脂联素浓度3.98±1.86mg/L,hs-CRP浓度6.95±2.59mg/L;对照组血清脂联素浓度13.55±5.87mg/L,hs-CRP浓度2.01±0.85mg/L。正常对照组与NDR组、NDR组与NPDR组、NPDR组与PDR组的血清脂联素比较,差异有统计学意义(q=5.4401,P=0.000;q=3.1535,P=0.002;q=4.8756,P=0.000)。正常对照组与NDR组、NDR组与NPDR组、NPDR组与PDR组血清hs-CRP浓度比较,差异具有统计学意义(q=2.4367,P=0.0017;q=2.0572,P=0.003;q=2.6184,P=0.001)。DR患者血清hs-CRP与血清脂联素水平呈负相关(r=-0.643,P<0.01)。结论:DR患者血清脂联素浓度水平与血清hs-CRP浓度水平存在显著负相关,血清脂联素浓度水平下降,伴随着血清hs-CRP浓度水平的升高,且与糖尿病视网膜病变的严重程度相关。     

改良Van Herick前房角宽度评估法的临床观察

目的：探讨在Van Herick法基础上更方便准确评估前房角宽度的方法。方法：纳入2021-01/12于我院就诊的年龄相关性白内障患者58例69眼，参考Van Herick法分为房角宽度≥1/2颞侧角膜厚度(CT)组(37例44眼)和&#x003C;1/2CT组(21例25眼)，应用超声生物显微镜测量中央前房深度和周边房角度数。结果：房角宽度≥1/2CT组和&#x003C;1/2CT组患者中央前房深度有明显差异(2.64±0.27 mm vs 2.23±0.29 mm，P&#x003C;0.01)，且两组间上方、颞侧、下方和鼻侧象限房角度数均有明显差异(P&#x003C;0.01)。房角宽度≥1/2CT组患者上方与下方象限房角度数无显著差异(P&#x003E;0.05)，其余各象限房角度数均有差异(P&#x003C;0.05)； 房角宽度&#x003C;1/2CT组患者上方与鼻、颞侧象限，下方与颞侧象限房角度数均有差异(P&#x003C;0.05)。结论：裂隙灯下采用Van Herick法评估颞侧房角宽度，同时评估下方象限房角宽度，可以更简单、快速、准确地评估前房角的整体情况。     

2型糖尿病视网膜病变血清C肽测定及临床意义

目的 探讨血清C肽与2型糖尿病视网膜病变(DR)之间的关系及其临床意义.方法 将2型糖尿病住院病人167例分为3组,其中无糖尿病视网膜病变组(NDR组)60例,非增殖性糖尿病视网膜病变组(NPDR组)76例,增殖性糖尿病视网膜病变组(PDR组)31例.采用化学发光免疫分析法分别测定其空腹血清C肽含量并记录其他可能影响糖尿病视网膜病变发生、发展的因素.根据所测血清C肽值重新将病人分为C肽低值组(LCP组)37例,C肽正常值组(NCP组)78例,C肽高值组(HCP组)52例.结果 NDR组、NPDR组、PDR组空腹血清C肽平均水平呈降低趋势,三组之间空腹血清C肽平均水平比较差异有统计学意义(P＜0.01).LCP组、NCP组、HCP组之间DR发生率比较差异有统计学意义(x2=46.702,P＜0.01).Logistic回归分析显示空腹血清C肽水平与DR有明显相关性(B=-1.415,P=0.000),病程与DR有明显相关性(B=0.404,P=0.000).C肽水平和糖尿病病程呈负相关(r=-0.479,P=0.000),C肽水平与DR的程度呈负相关(r=-0.654,P=0.000).结论 血清C肽在2型DR的发生、发展过程中可能有重要的病理意义,其水平降低可能是2型糖尿病患者DR进展的临床标志.

Abstract：

Objective To explore the relationship of serum C-peptide with diabetic retinopathy (DR)and its clinical significance. Methods A total of 167 inpatients with type 2 diabetes were separated into three groups, NDR group (n=60 examination of ocular fundus showed normal), NPDR group (n=76 examination of ocular fundus showed nonproliferative diabetic retinopathy), PDR group (n=31 examination of ocular fundus showed proliferative diabetic retinopathy). Their fasting serum C-peptide (FCP) was tested with chemiluminescent immunoassay. At the same time, other factors that might affect the onset and progression of DR were recorded. Then all the patients were divided according to their C-peptide fasting levels in quartiles again, low C-peptide group (LCP) [n=37], normal C-peptide group (NCP) [n=78], high C-peptide group (HCP) [n=52].Results In three groups, the mean value of FCP in PDR group was the lowest, the NPDR group had the lower concentration than NDR group, [(0.61±0.33) ng/ml vs (1.34± 0.68) ng/ml vs (2.11 ± 0.80) ng/ml, P ＜0.01]. The incidence of DR among LCP group, NCP group and HCP group showed a significant difference (x2=46.702, P ＜0.01). Logistic regression analysis showed that only C-peptide (B=-1.415, P=0.000), duration of diabetes (B=0.404, P =0.000) were independently associated with DR. A negative correlation was evident between C-peptide levels and duration of diabetes (r=-0.479, P =0.000), a negative correlation was also found between C-peptide levels and DR (r=-0.654, P =0.000). Conclusions Serum C-peptide may have important significance in pathological form of Type 2 DR. The decrease of C-peptide levels may be a maker of the development of DR in type 2 diabetes.     

光学相干断层扫描血管成像量化分析糖尿病患者黄斑区毛细血管参数

目的：应用光学相干断层扫描血管成像技术(OCTA)量化2型糖尿病患者黄斑区毛细血管的早期变化。方法：回顾性病例研究。分别纳入49名健康受试者、52例无视网膜病变的2型糖尿病患者(noDR)和43例轻度非增殖性糖尿病视网膜病变(mNPDR)患者，并得到在黄斑区3 mm×3 mm浅层毛细血管丛和深层毛细血管丛的OCTA图像。去除大血管后分别计算毛细血管灌注密度、血管长度密度(VLD)和平均血管直径(AVD)并进行比较。应用受试者工作特征曲线评估该参数监测2型糖尿病患者视网膜微血管早期改变的能力。结果：比较三组间VLD和AVD，差异均有统计学意义(P&#x003C;0.001)。与健康受试者相比，noDR组的AVD均显著增加(P&#x003C;0.05)。mNPDR组患者深层及浅层的VLD较noDR组显著下降(均P&#x003C;0.01)。深层AVD鉴别noDR组与健康受试者的曲线下面积(AUC)为0.796，鉴别mNPDR组和健康受试者的AUC最高为0.920，其次为深层VLD(AUC=0.899)，显著高于其他参数。结论：在糖尿病视网膜病变的临床前阶段，2型糖尿病患者的深层及浅层AVD均显著高于健康人，VLD均显著高于mNPDR患者。与健康人相比，深度AVD较其他参数更能检出noDR患者早期视网膜毛细血管的变化。     

Contribution of glucose and its metabolites to diabetic cataracts

Despite extensive research, the mechanisms responsible for diabetic cataract formation are still unknown. While recent data have favoured non-enzymatic glycation as the most likely mechanism, there is relatively little information on the types of glycolytic metabolites and die way in which they are involved in diabetic cataracts. This study has a twofold purpose. First, it briefly reviews some of die mechanisms believed to be involved in diabetic cataracts. Second, two hypodieses are presented implicating glycolytic metabolites as major contributors to diabetic, as well as age-related cataract formation. The first hypodiesis suggests that excess glucose and fructose build up during diabetes, accelerating die process of age-related cataract formation so diat the opacities appear much earlier in life dian they otherwise would. The second hypothesis proposes Uiat die progressive interaction between triose phosphates widi lens proteins, or odier lens constituents, contributes to human age related cataract formation. (Clin Exp Optom 1993; 76: 6:208–214)     

The activated form of gelatinase B/matrix metalloproteinase-9 is associated with diabetic vitreous hemorrhage

We aimed to investigate the presence and activation status of matrix metalloproteinase (MMP)-2 and MMP-9 in vitreous samples from proliferative diabetic retinopathy (PDR) patients. Paired vitreous and serum samples were obtained from patients undergoing vitrectomy for the treatment of rhegmatogenous retinal detachment (RD) (65 patients) and PDR (67 patients). PDR patients were diagnosed for the presence of hemorrhage and/or patent new vessels. Quantitative assays were performed for vitreous protein content, MMP-2, MMP-9, tissue inhibitor of metalloproteinases-1 (TIMP-1) and hemoglobin. Qualitative evaluation of the MMP-2 and MMP-9 activation status was performed by zymography. Vitreous samples contained proMMP-2 but levels were unselectively related to total protein content. ProMMP-9 and activated MMP-9 levels were significantly increased in PDR patients (p<0.001 for both comparisons). In addition, TIMP-1 levels were significantly increased in PDR patients (p=0.004) and functionally inhibited activation of MMP-9 in vitreous samples. None of the parameters significantly differed between PDR patients with patent new vessels and those with inactive disease. However, activated MMP-9 levels in vitreous samples of PDR patients with hemorrhage (75.7+/-106.3 scanning units per 2 microl) were significantly higher than those in PDR patients without hemorrhage (7.1+/-16.2 scanning units per 2 microl) (p<0.001) and strongly correlated with hemoglobin levels (r=0.7525; p<0.001). Activated MMP-9 was not detected in paired serum samples. We conclude that activated MMP-9 might be involved in hemorrhagic transformation in patients with PDR.     

Proteasome modulator 9 gene is linked to diabetic and non-diabetic retinopathy in T2D

Background: Diabetic retinopathy is a long-term complication of type 2 diabetes (T2D). Non-diabetic retinopathy may be present in T2D patients as well and non-T2D patients with hypertension and/or atherosclerosis. The aim of this study was to identify linkage of the proteasome modulator 9 (PSMD9) T2D risk variants IVS3+nt460, IVS3+nt437, E197G to diabetic retinopathy and retinopathy including also atherosclerotic or hypertensive retinopathy in Italian T2D families.

Materials and Methods: A total of 126 siblings of our 200 T2D siblings/families were characterized for diabetic retinopathy or retinopathy. The clinical characterization is based on a fundus oculi exam and on fluorangiography of the participating subjects. Diabetic retinopathy includes both pre-proliferative and proliferative retinopathy. The common gene variants were directly amplified by PCR and by fluorescent-based automation. A parametric and non-parametric linkage study of the gene variants with diabetic retinopathy and retinopathy was then performed using Merlin software. Finally, 1000 simulation analyses were performed to test for the statistical power of the significant results (P-value ≤ 0.05).

Results: This study shows a linkage of the PSMD9 IVS3+nt460 (rs74421874), IVS3+nt437 (rs3825172) and E197G (rs14259) single nucleotide polymorphisms (SNPs) to diabetic and non-diabetic retinopathy by using the non-parametric as well as the parametric linkage analysis. The strongest signal is present for the PSMD9 variants with the diabetic retinopathy, in particular under the additive model. The 1,000 simulations performed for each significant test confirmed that the results are not due to random chance.

Conclusions: In summary, the PSMD9 IVS3+nt460, IVS3+nt437, E197G SNPs are linked to diabetic retinopathy and non-diabetic retinopathy in Italians.     

非肥胖性糖尿病小鼠的早期视网膜病变

目的:研究早期糖尿病视网膜病变的小鼠模型。方法:NOD小鼠随机分为正常对照组(4,12wk组,n=8)和糖尿病组(4,12wk组,n=12),每组取4wk和12wk处死小鼠,光镜和电镜观察视网膜结构的改变。结果:糖尿病组4wk时毛细血管基底膜增厚,可见内皮细胞、周细胞和神经节细胞超微结构改变。12wk时基底膜明显增厚,内皮细胞、周细胞和神经节细胞凋亡增加。结论:在糖尿病早期发生了视网膜神经元细胞超微结构病变和微血管病变。     

糖尿病性角膜病变的研究进展

晚期糖尿病(diabetes mellitus,DM)患者常出现的糖尿病性视网膜病变能够被发现,而糖尿病性角膜病变(diabetic keratopathy,DK)却时常被人们忽略.近年来的许多研究表明,DK对角膜的结构、代谢、生理功能等多个方面均有重要影响.目前临床上尚无根治DK的有效疗法,现主流疗法多集中于对症治疗...     

2型糖尿病住院患者糖尿病视网膜病变的相关危险因素分析

目的:探讨2型糖尿病视网膜病变(DR)的发病危险因素。方法:选择2014-01/06收治的2型糖尿病患者380例,分为DR组126例和对照组即糖尿病无视网膜病变(NDR)组254例,进行询问病史、体格检查、实验室检查和相关辅助检查,采用Logistic回归分析法对DR的相关危险因素进行单因素及多因素分析。结果:单因素Logistic回归分析结果表明,病程、收缩压、甘油三酯、总胆固醇、低密度脂蛋白、尿蛋白、眼压、颈动脉内中膜厚度、周围神经病变是DR发生的相关危险因素。对以上因素进行多因素Logistic回归分析,只发现病程是DR发生的相关危险因素。结论:DR的发生是多因素共同作用的结果,病程是DR发生的独立危险因素。     

糖尿病角膜神经病变的研究现状

角膜神经的正常分布具有保护眼表、维持角膜知觉等重要作用.糖尿病角膜神经病变可以引起角膜感觉异常、组织损伤、视力受损等表现,发病机制尚未完全阐明,主要与糖代谢紊乱、周围神经病变、氧化应激等有关.研究认为糖尿病角膜神经纤维缺失或长度、密度降低与角膜敏感性、糖尿病视网膜病变、干眼症等因素相关,其主要治疗方法包括控制血糖、营养神经、促神经生长等.     

糖尿病性角膜病变的研究进展

糖尿病性角膜病变是糖尿病眼病主要表现之一,是一种潜在的致盲性眼病.糖尿病对角膜各层组织结构、代谢及功能均有重要影响.糖尿病性角膜病变的发病机制尚未完全明确.本文就糖尿病性角膜各层组织结构改变以及角膜神经改变的研究现状作一综述.     

C肽与糖尿病视网膜病变

在过去的20a里,虽然不是所有的学者都认可,但很多通过人或动物的研究都表明,C肽在防止和逆转糖尿病的某些并发症方面发挥着重要作用。此综述的目的就是简要介绍C肽的作用及其作用机理,详细介绍目前有关C肽对糖尿病视网膜病变影响的认识。     

Intraocular pressure in diabetic persons

Intraocular pressure measurements were taken in 2366 diabetic persons and 381 nondiabetic persons who lived in southern Wisconsin. Diabetic persons tended to have higher mean intraocular pressure than the nondiabetic persons. Higher blood pressure, earlier time of day of IOP measurement, absence of cataract and, in some comparisons, female gender, were significantly associated with higher intraocular pressure. In this study rates of a positive history of glaucoma were higher in diabetic persons than in nondiabetic persons and the population participating in the Health Interview Survey. These findings suggest that ophthalmologists must be aware of the increased risk of glaucoma when evaluating diabetic patients.