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

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。

Changes in the serum cytokines and retinal hemodynamic of the central arteries in diabetic retinopathy patients

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.