血清可溶性肿瘤坏死因子受体与2型糖尿病视网膜病变相关性研究

目的　研究血清可溶性肿瘤坏死因子受体（ｓｏｌｕｂｌｅｔｕｍｏｒｎｅｃｒｏｓｉｓｆａｃｔｏｒｒｅｃｅｐｔｏｒ，ｓＴＮＦＲ）与２型糖尿病视网膜病变的相关性。方法　６６例２型糖尿病患者通过眼底检查和眼底荧光血管造影按照ＥＤＴＲＳ分期分为３组:无糖尿病视网膜病变（ｎｏｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ，ＮＤＲ；ｎ＝２２）组、非增殖型糖尿病视网膜病变（ｎｏｎｐｒｏｌｉｆｅｒａｔｉｖｅｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ，ＮＰＤＲ；ｎ＝２４）组和增殖型糖尿病视网膜病变（ｐｒｏｌｉｆｅｒａｔｉｖｅｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ，ＰＤＲ；ｎ＝２０）组。２１名健康人作为对照组。检测４组研究对象血清中肿瘤坏死因子（ｔｕｍｏｒｎｅｃｒｏｓｉｓｆａｃｔｏｒ，ＴＮＦ）-α、ｓＴＮＦＲ-１、ｓＴＮＦＲ-２水平。组间统计分析采用非参数Ｍａｎｎ-ＷｈｉｔｎｅｙＵ检验。结果　血清中ＴＮＦ-α中位数分别为:对照组０ｐｇ·ｍＬ－１、ＮＤＲ组３．４５ｐｇ·ｍＬ－１、ＮＰＤＲ组３．９２ｐｇ·ｍＬ－１、ＰＤＲ组８．１２ｐｇ·ｍＬ－１。对照组与ＰＤＲ组（Ｐ＜０．００１）、ＮＤＲ组与ＰＤＲ组（Ｐ＝０．００８）比较差异均有统计学意义。血清中ｓＴＮＦＲ-１水平中位数:对照组１．５０ｎｇ·ｍＬ－１、ＮＤＲ组１．８８ｎｇ·ｍＬ－１、ＮＰＤＲ组２．５８ｎｇ·ｍＬ－１、ＰＤＲ组３．００ｎｇ·ｍＬ－１。对照组与ＮＰＤＲ组（Ｐ＜０．００１）、对照组与ＰＤＲ组（Ｐ＜０．００１）、ＮＤＲ组与ＮＰＤＲ组（Ｐ＝０．００７）、ＮＤＲ组与ＰＤＲ组（Ｐ＜０．００１）比较，差异均有统计学意义。血清中ｓＴ-ＮＦＲ-２中位数分别为:对照组３．８８ｎｇ·ｍＬ－１、ＮＤＲ组５．０１ｎｇ·ｍＬ－１、ＮＰＤＲ组５．２１ｎｇ·ｍＬ－１、ＰＤＲ组６．３３ｎｇ·ｍＬ－１。除了ＮＤＲ组与ＮＰＤＲ组（Ｐ＝０．０７０）间差异无统计学意义外，其他组间差异均有统计学意义（均为Ｐ＜０．０５）。结论　血清中ｓＴＮＦＲ与２型糖尿病视网膜病变密切相关，表明ｓＴＮＦＲ在糖尿病视网膜病变的发生发展中起到了一定的作用。对ｓＴＮＦＲ进行进一步研究可以寻找治疗糖尿病视网膜病变新的靶点。

Association between sTNFR and diabetic retinopathy in type 2 diabetic patients

Objective To investigate the associations of serum levels of soluble tumor necrosis factor receptor ( sTNFR) with diabetic retinopathy in type 2 diabetic patients. Methods A cross-sectional design was utilized for this study. 66 patients with type 2 diabetes underwent fundus exanunation or fundus fluorescein angiography according to the Early Treatment Diabetic Retinopathy Study ( EDTRS) and were divided into three groups : no diabetic retinopathy ( NDR , n = 22) ,non-proliferative diabetic retinopathy ( NPDR . n = 24 ) and proliferative diabetic retinopathy ( PDR . n = 20 ) . 21 healthy subjects were enrolled for control group. Serum levels of tumor necrosis factor ( TNF) -eL ,sTNFR-I and sTNFR-2 were analyzed. Statistical analysis was performed using nonparametric Mann-Whitney U test. Results The median serum TNF-e/ levels was 0 pg . mL-1 in control group,3. 45 pg . mL-1 in NDR group,3. 92 pg . mL-l in NPDR group and 8. 12 pg . mL-l in PDR group. Statistical significances were found between control group and PDR group (P < 0. 001) . NDR group and PDR group (P = 0. 008 ) . The median serum sTNFR-I levels was l. 50 ng . mL -l in control group , 1. 88 ng . mL -l in NDR group,2. 58 ng . mL -l in NPDR group and 3. 00 ng . mL -l in PDR group. Statistical significances were found between control group and NPDR group ( P < 0. 001 ) , control group and PDR group (P < 0. 001 ) , NDR group and NPDR group (P = 0. 007 ) . NDR group and PDR group ( P < 0. 001) . The median serum sTNFR-2 levels was 3. 88 ng ’ mL-1 in control group,5. 01 ng . mL -l in NDR group , 5. 21 ng . mL-l in NPDR group and 6. 33 ng ’ mL-l in PDR group. Statistical significances were found between all groups (P < 0. 05 ) , except between group NDR group and NPDR group (P = 0. 07 ) . Conclusion The serum levels of sTNFR-I . sTNFR-2 .TNF-e/are highly correlated with DR in type 2 diabetic patients , suggesting that sTNFR may play an important role in the development of DR. Research for sTNFR may be able to find a new therapeutic targets for DR.