不同程度糖尿病视网膜病变患者血浆炎性因子检测

目的研究不同程度糖尿病视网膜病变(DR)患者血浆肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、可溶性白介素-2受体(IL-2R)及C反应蛋白(CRP)水平,为探究炎性反应在DR发病机制中的作用提供依据。设计前瞻性比较性病例系列。研究对象2型糖尿病但无DR患者21例(DM无DR组),非增生性DR患者17例(NPDR组),增生性DR患者23例(PDR组),无糖尿病患者23例作为对照组(无DM组)。方法记录患者年龄、性别、病史资料。行视力、眼压、裂隙灯及眼底检查。采集静脉血检测糖化血红蛋白(HbA1c)、空腹血糖(Glu)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL)、高密度脂蛋白胆固醇(HDL)、甘油三酯(TG)、同型半胱氨酸(Hcy)、肌酐(CR),以及炎症相关指标TNF-α、IL-2R、IL-8 IL-6及CRP的水平。主要指标血浆炎性因子浓度。结果四组之间年龄、性别、既往高血压、冠心病及脑梗塞病史、TC、LDL、HDL、TG、Hcy和血浆CR均无显著统计学差异。HbA1c在PDR组(7.51±2.03)%、NPDR组(7.48±1.49)%、DM无DR组(7.09±1.54)%,均显著高于无DM对照组(5.35±0.54)%(P<0.001)。TNF-α水平在PDR组及NPDR组(42.54±31.80及32.07±28.84 pg/ml)显著高于无DM组(10.30±5.35 pg/ml)及DM无DR组(12.63±6.65 pg/ml)(P<0.001)。IL-8水平在PDR组及NPDR组(157.26±200.16及197.45±331.08 pg/ml)显著高于无DM组(30.23±29.41 pg/ml)及DM无DR组(29.70±22.04 pg/ml)(P=0.006)。四组之间IL-2R、IL-6及CRP浓度均无显著统计学差异。结论NPDR及PDR患者血浆炎性因子TNF-α及IL-8显著高于DM无DR及无DM对照者。血浆TNF-α升高为PDR的重要危险因素。血浆炎性因子与肌酐水平显著正相关,全身高炎症状态可能是糖尿病肾病及DR的共同危险因素。

Plasma inflammatory biomarkers in diabetic retinopathy patients with type 2 diabetes mellitus

Objective To explore the levels of plasma inflammatory biomarkers:tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-8(IL-8),soluble interleukin-2 receptor(IL-2R)and C reactive protein(CRP)in patients with different severity of diabetic retinopathy(DR),and to provide evidence for exploring the role of inflammatory reaction in the pathogenesis of DR.Design Prospective comparative case sieries.Participants 21 patients with type 2 diabetes mellitus(DM)but without DR(DM without DR group),17 patients with non-proliferative diabetic retinopathy(NPDR group),23 patients with proliferative diabetic retinopathy(PDR group),and 23 patients without DM(non DM group)were included.Methods The patient's age,sex and past medical history were recorded.All patients underwent test for visual acuity,intraocular pressure,slit lamp and fundus examination.Venous blood samples were collected and biochemical indicators:hemoglobin(HbA1c),fasting blood glucose(Glu),total cholesterol(TC),low density lipoprotein cholesterol(LDL),high density lipoprotein cholesterol(HDL),triglyceride(TG),homocysteine(Hcy),creatinine(CR)and inflammatory related indicators:TNF-α,IL-2R,IL-8,IL-6,and CRP.Main Outcome Measures Plasma inflammatory biomarker levels.Results There were no significant differences in age,sex,hypertension,history of coronary heart disease and cerebral infarction,TC,LDL,HDL,TC,Hcy and plasma CR among the four groups.HbA1c in PDR group(7.51±2.03%),NPDR group(7.48±1.49%)and DM without DR group(7.09±1.54%)was significantly higher than that in non DM group(5.35±0.54%)(P<0.001).The plasma levels of TNF-αin PDR group and NPDR group were significantly higher than those in non-DM group(10.30±5.35 pg/ml)and DM without DR group(12.63±6.65 pg/ml)(P<0.001).The levels of IL-8 in PDR and NPDR group(157.26±200.16 and 197.45±331.08 pg/ml)were significantly higher than those in non-DM group(30.23±29.41 pg/ml)and DM without DR group(29.70±22.04 pg/ml)(P=0.006).There was no significant difference in the concentrations of IL-2R,IL-6 and CRP among groups.Conclusion The plasma inflammatory factors TNF-αand IL-8 in patients with NPDR and PDR were significantly higher than those in patients without DM and in patient with DM but without DR.Increased plasma TNF-αlevel is an important risk factor for PDR.There is a significant positive correlation between plasma inflammatory factors and creatinine levels.Systemic hyperinflammation may be a common risk factor for diabetic nephropathy and diabetic retinopathy.