糖尿病视网膜病变患者外周血浆内皮素与血管内皮生长因子的变化及临床意义

目的探讨血浆内皮素-1（ET-1）和血管内皮生长因子（VEGF）在糖尿病视网膜病变（DR）不同临床分型中的应用价值,及其与DR病程的相关性。方法前瞻性调查研究。散瞳眼底镜检查及眼底荧光造影作为分组金标准,在2型糖尿患者群中测定96例存在视网膜病变患者（病例组）及144例尚未出现视网膜病变患者（对照组）外周血浆ET-1与VEGF。进行相关性分析并应用受试者工作特征曲线（ROC曲线）比较。结果血浆ET-1在DR不同临床分型的组间轻度非增殖性DR（NPDR）,中、重度NPDR和增殖性DR（PDR）组分别为（178±24）、（197±51）、（231±77）ng／L]差异有统计学意义（F=12．186,P〈0、01）,而外周血VEGF组间分别为（31±10）、（31±8）、（32±10）ng／L]差异无统计学意义（F：1、329,P〉0．05）。与DR临床分型相比,血浆ET-1、病程均呈正相关（r=0．504,0．291,均P〈0．01）,外周血VEGF呈负相关（r=-0．252,P〉0．01）。DR不同临床分型的ROC曲线分析,血浆ET-1均位于机会对角线以上,而外周血VEGF曲线均位于机会对角线以下。血浆ET-1轻度NPDR曲线下面积为0．742,中、重度NPDR为0．723,PDR为0．857。而外周血VEGF曲线下面积分别为0．296、0．297、0．293。血浆ET-1在DR不同分型的诊断界点分别为173、197、180ng／L。结论外周血浆ET-1在DR不同临床分型的检测价值均明显优于VEGF,对于确定DR高危人群和预测病情严重程度有重要意义。外周血VEGF浓度与眼局部VEGF表达可能并不一致。DR的发病及病情随DM病程的延长而加重。

Changes of plasma endothelin-1 and vascular endothelial growth factor in diabetic retinopathy and the clinical application value thereof

OBJECTIVE: To investigate the levels of plasma endothelin (ET)-1 and vascular endothelial growth factor (VEGT) in type 2 diabetes mellitus patients, evaluate their clinical application values in different clinical types of diabetic retinopathy (DR), and to investigate the correlation between the levels of plasma ET-1, serum VEGF and the types of DR. METHODS: Peripheral blood samples were collected from 240 patients with type 2 diabetes mellitus, 96 with retinopathy and 144 without retinopathy as controls, diagnosed by ophthalmoscopy and fundus fluorescein angiography. The level of plasma ET-1 was detected with radioimmunoassay, and the serum VEGF was measured by ELISA. Pearson correlation analysis and receiver operating characteristic (ROC) curve analysis were conducted. RESULTS: The expression plasma ET-1 levels of the DM patients with mild non-proliferative retinopathy (NPDR), moderate and severe NPDR and proliferative diabetic retinopathy (PDR), were (178+/-24), (197+/-51), and (231+/-77) ng/L respectively (F=12.186, P<0.01).; and all significantly higher than that of those without DR (155+/-26) ng/L, all P<0.01]. There was no difference in the expression of VEGF in different courses of DR (31+/-10), (31+/-8), and (32+/-10) ng/L respectively, F=1.329, P>0.05]. The plasma ET-1 was positively correlated with the type of DR (r=0.504, P<0.01) and the courses of DR (r=0.291, P<0.01). There was a negative correlation between the VEGF level and the type of DR (r=-0.252, P>0.01). ROC curve analysis showed that the plasma ET-1 curve lied in the top left corner, and the curve of VEGF lied under the chance diagonal in all the three different types of DR. The under-curve area of plasma ET-1 were 0.742 at the level of mild retinopathy, 0.723 at the level of moderate and severe NPDR, and 0.857 at the level of PDR. The under-curve areas of VEGF were 0.296, 0.297, and 0.293 respectively. The cut-off points in different types of DR were 173, 197, and 180 ng/L respectively. CONCLUSION: Plasma ET-1 is superior to VEGF in diagnosing different types of DR. The expression of VEGF in the blood may not accord with that in the retina. The pathogenetic condition of DR in type 2 diabetes mellitus is aggravated with the course of DR.