糖尿病视网膜病变与血清Ⅳ型胶原和层粘连蛋白以及粘附分子变化的相关性

目的 探讨糖尿病视网膜病变不同时期细胞外间质、血管基膜成分以及血管内皮细胞粘附分子在血循环中的变化，了解他们与血管基膜和血管内皮细胞损伤的相关性。方法 85例(男40例、女45例)2型糖尿病患者分无视网膜病变(NDR)组31例、背景期视网膜病变(BDR)组24例和增殖期视网膜病变(PDR)组30例，采用放射免疫法和ELISA法测其血清Ⅳ型胶原(ⅣC)、层粘蛋白(LN)和血管内皮细胞粘附分子(sVCAM—1)含量，同时设健康体检者20人为对照组。结果 三组糖尿病患者血清LN、ⅣC、sVCAM—1水平均高于对照组。PDR组的血清LN、ⅣC和sVCAM—1水平与对照组比较，差异有非常显著意义(P＜0．01)，与NDR组比较，差异也有非常显著意义(P＜0．01)；BDR组血清LN、ⅣC和sVCAM—1水平与对照组比较，差异有非常显著意义(P＜0．01)；BDR组血清LN、ⅣC和sVCAM—1水平与对照组比较，差异有非常显著意义(P＜0．01)；PDR组与BDR组比较，仅LN、ⅣC差异有非常显著意义(P＜0．01)；BDR组与NDR组比较，仅sVCAM—1差异有显著意义(P＜0．05)。三组糖尿病患者血清三项指标之间无相关性(分别为r＝0．119，r＝0．167和r＝-0．210；P＞0．05)。结论 血清ⅣC、LN和sVCAM—1用于联合检测，能较好地反映糖尿病微血管病变的发展过程，为其早期诊断和治疗提供依据，也可作为糖尿病视网膜病变严重程度的估计和预后判断的指标。

Study of the relationship of extracellular matrix and cell adhesion molecule with the damages of vascular basement membrance and endothelial cell in diabetic retinopathy

Objective To investigate the changes of the serum extracellular matrix (ECM), vascular basement membrane components and vascular endothelial cell adhesion molecule in various stages of diabetic retinopathy (DR), and to evaluate the relationship between these components and the damages of vascular basement membrane and endothelial cell. Methods 85 type 2 diabetes patients (40 men and 45 women) were divided into three groups based on severity of diabetic retinopathy graded as: no diabetic retinopathy group (NDR) in 31 cases, background diabetic retinopathy group (BDR) in 24 and proliferative diabetic retinopathy group (PDR) in 30. The serum levels of type IV collagen (IV C) and laminin (LN) were determined by radioimmunoassay. The serum level of soluble vascular cell adhesion molecule-1 (sVCAM-1) was measured in duplicate by enzyme-linked immunosorbent assay. 20 healthy persons were selected as control group(8 men and 12 women). Results The serum levels of LN, KC and sVCAM-1 in patients with NDR, BDR and PDR were higher than those of control group. In PDR group, the serum levels of LN, WC and sVCAM-1 were significantly different in comparison with control group(P<0. 01) and NDR group (P<0. 01). In BDP group, the serum levels of LN, IV C and sVCAM-1 were significantly different from control group (P<0. 01). In NDR group, serum IVC and sVCAM-1 levels (P<0. 01) were significantly different from control group except serum LN (P>0. 05). There were significant differences in serum WC and LN levels(P<0. 01), except sVCAM-1 (P>0. 05), between PDR and BDR groups. There was significant difference in serum sVCAM-1 (P<0. 05), but no significant difference in IV C and LN (P>0. 05), between BDR and NDR groups. No significant correlations were found among serum IV C,LN and sVCAM-1 in all diabetic patients(r = 0. 119, r = 0. 167 and r= - 0. 210; P>0. 05, respectively). Conclusion The results suggest that the combination measurement of serum levels of IV C, LN and sVCAM-1 in DR patients might better evaluate the development process of diabetic mi-croangiopathy, and be of help for early diagnosis and therapy of diabetic microangiopathy. Serum levels of IVC, LN and sVCAM-1 in DR patients may be reliable clinical markers for assessing the severity and prognosis of diabetic retinopathy.