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目的:观察2型糖尿病(T2DM)患者红细胞变形能力及细胞因子中肿瘤坏死因子-α(TNF-α)、血管细胞粘附分子(sVCAM-1)、内皮细胞生长因子(VEGF)在T2DM视网膜病变(DR)患者中的变化,探讨它在DR发病中的作用及临床意义。方法:选取85例T2DM患者和30例健康查体者,采用RIA法测定血清TNF-α浓度、采用ELISA法测定血清sVCAM-1、血浆VEGF水平,同时测定血液流变学指标,并分析各变量之间的相关性。结果:①T2DM各组血清TNF-α水平显著高于正常对照组(P均<0.01),且与餐后2h血糖(P2hBG)、糖化血红蛋白(HbA1c)、sVCAM-1呈正相关;②T2DM组红细胞变形能力明显低于正常对照组(P均<0.01),各组间亦有显著差异;③T2DM各组血清sVCAM-1水平显著高于正常对照组(P均<0.01),增殖型视网膜病变(PDR)组水平最高,与非增殖型视网膜病变(NPDR)组未见差异,但NPDR组高于非糖尿病视网膜病变(NDR)组(P<0.05);④PDR组血清VEGF水平显著高于正常对照组(P<0.05),NDR及NPDR组与正常对照组无统计学差异(P>0.05)。结论:T2DM血清TNF-α、sVCAM-1及红细胞变形能力的测定可作为早期预测DR和病情分析的指标;而VEGF可能主要在PDR期发挥促进新生血管形成的作用,对早期检测DR意义不大。
Objective: To observe the erythrocyte deformability and the expression of tumor necrosis factor-α (TNF-α), vascular cell adhesion molecule (sVCAM-1) and endothelial cell growth factor (VEGF) in T2DM patients with type 2 diabetes mellitus (T2DM) (DR) patients to explore its role in the pathogenesis of DR and its clinical significance. Methods: Totally 85 patients with T2DM and 30 healthy subjects were enrolled. Serum TNF-α levels were measured by RIA. Serum levels of sVCAM-1 and VEGF were measured by ELISA. Hemorheological parameters were also measured. The correlation between. Results: ①The levels of TNF-α in T2DM group were significantly higher than those in normal control group (P <0.01), and positively correlated with P2hBG, HbA1c and sVCAM-1 at T2DM; ②T2DM group’s erythrocyte deformability The level of sVCAM-1 in T2DM group was significantly higher than that in the normal control group (all P <0.01), and the proliferative retinopathy (PDR) group was significantly lower than that in the normal control group (all P <0.01) (P <0.05); (4) The level of serum VEGF in PDR group was significantly higher than that in normal control group (P <0.01), and the level of VEGF in NPDR group was significantly higher than that in non-diabetic retinopathy 0.05). There was no significant difference between NDR and NPDR group and normal control group (P> 0.05). Conclusion: The determination of TNF-α, sVCAM-1 and erythrocyte deformability in T2DM can be used as an index for the early prediction of DR and disease progression. However, VEGF may play an important role in promoting neovascularization during PDR, which is of little significance for early detection of DR .