血清Gas6 和TSP-1 水平与糖尿病视网膜病变的相关性研究

目的 探讨血清生长停滞特异基因 6(Growth arrest specific gene 6,Gas6)和血小板反应蛋白-1(thrombospondin-1,TSP-1)水平与糖尿病视网膜病变(diabetic retinopathy,DR)的相关性.方法 选择2017年3月～2019年3月在陕西省咸阳市中心医院和西安市第八医院就诊的152例2型糖尿病(Type 2 diabetes mellitus,T2DM)患者作为研究对象,依据DR分型标准分为增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)组(45例),非增殖性糖尿病视网膜病变(non-proliferative diabetic retinopathy,NPDR)组(52例)和单纯糖尿病(diabetes mellitus,DM)组(55例)。血清Gas6和TSP-1水平采用酶联免疫吸附法检测。空腹血糖(fasting serum glucose,FSG)采用己糖激酶法测定,糖化血红蛋白A1c(glycocsylated A1c,HbA1c)采用液相色谱法检测。采用彩色多普勒超声仪检测视网膜中央动脉收缩期最大流速(peak systolic velocity,PSV)和舒张末期血流速度(end diastolic velocity,EDV),比较分析以上指标的变化与DR的相关性。结果 血清Gas6在DM组、NPDR组和 PDR组中的水平分别为7.39±1.17,5.14±0.86和4.28±0.79ng/L; 而血清TSP-1在三组中的水平分别为163.96±52.41,113.26±41.07和92.38±35.24ng/L,与DM组比较,血清Gas6和TSP-1水平在NPDR组和 PDR组中显著降低; 其中PDR组降低更显著,以上结果比较的差异均有统计学意义(F=83.37～136.49,均P=000)。在NPDR组和PDR组中,血清Gas6 和TSP-1水平分别有正相关性(r= 0.819,0.837,P均<0.01)。在NPDR组中,Gas6和TSP-1水平分别与FPG和HbA1c水平有负相关性,而与视网膜中央动脉PSV和EDV有正相关性(r_Gas6=-0.826,-0.809,0.792, 0.778,均P<0.01; r_TSP-1= -0.802,-0.789,0.784,0.765,均P<0.01)。在PDR组中,Gas6和TSP-1水平分别与FSG,HbA1c 水平有负相关性,而与视网膜中央动脉PSV和EDV有正相关性r_Gas6= -0.857,-0.839,0.817,0.812,均P<0.01; r_TSP-1=-0.838,-0.824,0.813,0.794,均P<0.01)。结论 分析Gas6和TSP-1与 DR 的相关性可以预测DR的发生,评价DR的病情进展,并为DR发病机制的研究提供新的线索。

Correlational Research on the Levels of Gas6and TSP-1 in Serumin Diabetic Retinopathy

Objective To investigate the correlation between the levels of growth arrest specific gene 6(Gas6)and thrombospondin-1(TSP-1)in serum and diabetic retinopathy(DR).Methods 152 patients with type 2 diabetes mellitus(T2DM)who were treated from Xianyang Central Hospital and Xi'an Eighth Hospital in Shaanxi Province between March 2017 and March 2019 were divided into proliferative diabetic retinopathy(PDR: 45 cases)group, non-proliferative diabetic retinopathy(NPDR:52 cases)group and simple diabetes mellitus(DM: 55 cases)group according to DR classification criteria.Serum levels of Gas 6 and TSP-1 were measured by enzyme-linked immunosorbent assay.Fasting serum glucose(FSG)was measured by hexokinase. Glycated hemoglobin A1c(HbA1c)was detected by liquid chromatography.Maximum systolic flow of central retinal artery was measured by color doppler ultrasound.The correlation between DR and the changes of the above indicators was compared and analyzed.Results The serum levels of Gas6 in DM group, NPDR group and PDR group were 7.39±1.17,5.14±0.86 and 4.28±0.79ng/L,respectively, while the serum levels of TSP-1 in the three groups were 163.96±52.41,113.26±41.07 and 92.38±35.24ng/L,respectively. Compared with DM group, the serum levels of Gas6 and TSP-1 were significantly lower in NPDR group and PDR group,especially in PDR group.The differences between the above results were statistically significant(F=83.37～136.49,all P=0.000).In NPDR group and PDR group,the serum levels of Gas6 and TSP-1 were positively correlated(r=0.819,0.837,all P<0.01).In NPDR group, Gas6 and TSP-1 levels were negatively correlated with the levels of FPG and HbA1c, respectively, and were positively correlated with PSV and EDV of central retinal artery(r_Gas6=-0.826,-0.809, 0.792,0.778, all P<0.01; r_TSP-1=-0.802,-0.789, 0.784, 0.765,all P<0.01).In PDR group,levels of Gas6 and TSP-1 were negatively correlated with FPG, HbA1c,respectively, and were positively correlated with PSV and EDV of central retinal artery(r_Gas6=-0.857,-0.839,0.817,0.812,all P<0.01; r_TSP-1=-0.838,-0.824,0.813,0.794, all P<0.01).Conclusion Analysis of the correlation between Gas6 as well as TSP-1 and DR can predict the occurrence of DR,evaluate the progress of DR,and provide new clues for the study of the pathogenesis of DR.