晶状体内糖基化终末产物含量与糖尿病视网膜病变程度的关联分析

背景 糖基化终末产物(AGEs)在晶状体中沉积是糖尿病并发症发生的危险因素,研究发现AGEs与晶状体自发荧光有关,且晶状体蛋白为长寿蛋白,其中AGEs的蓄积与糖尿病视网膜病变(DR)程度的关系值得研究. 目的 探讨并分析晶状体中AGEs自发荧光强度变化是否对糖尿病严重程度有预测作用. 方法 采用横断面研究设计,对2015年9-12月在沈阳何氏眼科医院就诊的白内障患者100例100眼进行分析,按照患者有无糖尿病分为非糖尿病组40例40眼和糖尿病组60例60眼,糖尿病组患者再根据眼部并发症情况分为非DR组(NDR组)、非增生期DR组(NPDR组)和增生期DR组(PDR组),每个亚组均为20例20眼.所有患者均评估接受血浆糖化血红蛋白(HbA1c)和餐前血糖(FBG)测定,并采用晶状体荧光显微镜(Clearpath DS120)测定受检眼晶状体自发荧光强度,分析糖尿病患者晶状体自发荧光强度值与HbA1c水平和糖尿病程度的关系.结果 非糖尿病组、NDR组、NPDR组和PDR组间年龄和糖尿病病程总体比较差异均无统计学意义(F=2.587、2.899,均P＞0.05);NDR组、NPDR组和PDR组患者FBG和HbA1c水平均明显高于非糖尿病组,差异均有统计学意义(均P＜0.01).非糖尿病组、NDR组、NPDR组和PDR组受检眼晶状体自发荧光强度值分别为(0.159±0.032)、(0.256±0.024)、(0.319±0.013)和(0.394±0.035) cd,总体比较差异有统计学意义(F=90.265,P=0.000),其中NDR组、NPDR组和PDR组晶状体自发荧光强度值均明显高于非糖尿病组,且NDR组、NPDR组和PDR组随着病情的加重晶状体自发荧光强度值逐渐增加,差异均有统计学意义(均P＜0.01).糖尿病患者晶状体自发荧光强度值与血HbA1c水平呈中等线性正相关(r=0.654,P＜0.05).结论 糖尿病患者晶状体自发荧光强度值与DR严重程度和血HbA1c水平均有一定关联,在一定条件下可作为DR早期评估的指标之一.

Association analysis of advanced glycation end-products in lens with diabetic retinopathy severity

Background The deposition of advanced glycation end products (AGEs) in lens is the risk factor of diabetic complications.Researches revealed that AGEs has autofluorescence.Crystallin is a longevity protein.AGEs accumulation is probably associated with diabetic retinopathy (DR).Objective This study was to evaluate the association of AGEs autofluorescence intensity with diabetes and with DR.Methods A cross-sectional study was carried out under the approval of Ethic Committee of Shenyang He Eye Hospital and informed consent of each patient.One hundred eyes of 100 patients with age-related cataract aged 50-70 years were included in He Eye Hospital from September to December 2015.The patients were divided into non-diabetes group (40 patients) and diabetes group (60 patients),and then the patients in diabetes group were subdivided into non-DR (NDR) group,non-proliferating DR (NPDR) group and proliferating DR (PDR) group according to the DR grading criteria,20 patients for each.Glycosylated henoglobin A1c (HbA1c) and fasting plasma glucose (FPG) were detected for each subject,and the lens autofluorescence was assayed with lens fluorescence biomicroscope (Clearpath DS120).The association of lens autofluorescence intensity with serum HbA1c level or DR severity was analyzed.Results The age and diabetes course were matched among the non-diabetes group,NDR group,NPDR group and PDR group (F=2.587,2.899,both at P＞0.05),and the FBS and HbA1c level were evidently higher in the NDR group,NPDR group and PDR group than those in the non-diabetes group (all at P＜0.01).The autofluorescence intensity of lens was (0.159±0.032),(0.256±0.024),(0.319 ±0.013) and (0.394±0.035) cd in the non-diabetes group,NDR group,NPDR group and PDR group,respectively,showing a significant difference among the groups (F =90.265,P =0.000).The autofluorescence intensity of lens in the NDR group,NPDR group and PDR group was significantly increased in comparison with the non-diabetes group and the autofluorescence intensity of lens was gradually increased with the severity of DR (all at P＜0.01).A positive linear correlation was found between autofluorescence intensity of lens and serum HbA1 c level in diabetes patients (r =0.654,P ＜ 0.05).Conclusions The autofluorescence intensity of AGEs in lens appears to be associated with the severity of DR and HbA1 c.The autofluorescence intensity of AGEs in the lens of diabetes patient is probably one of the evaluation indexes of early stage of DR.