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目的糖尿病增殖期视网膜病变(PDR)是导致失明的主要危险因素之一,目前发病机制尚未完全明确。通过研究血清单核细胞趋化蛋白-1(MCP-1)、8-异前列腺素F2a(8-iso-PGF2a)与2型糖尿病PDR的关系,探讨炎症反应和氧化应激在2型糖尿病PDR中的作用机制及临床意义。方法选择2012年6月至12月血压正常的非增殖期和增殖期的2型糖尿病视网膜病变病人106例,其中非增殖期病人50例(NPDR组)和增殖期病人56例(PDR组)。测定血清MCP-1、8-iso-PGF2a、空腹血糖(FBG)、24小时尿微量白蛋白(24hUMA)和糖化血红蛋白(HbA1c),比较它们之间的差异,分析PDR发生的相关危险因素。结果 PDR病人血清中的MCP-1、8-iso-PGF2a和24hUMA明显高于NPDR病人(P均<0.01),血清MCP-1、24hUMA分别与血8-iso-PGF2a呈正相关(r=0.915,0.865,P<0.01)。血清8-iso-PGF2a是24hUMA和血清MCP-1的独立影响因素(β=0.865,0.915;P=0.000)。糖尿病视网膜病变家族史、24hUMA、血清MCP-1、8-iso-PGF2a是PDR病变的独立危险因素(OR=1.21,1.63,1.86,1.57)。结论氧化应激和炎症反应可能共同参与糖尿病PDR的发展,血清MCP-1和8-iso-PGF2a有可能作为预测糖尿病视网膜病变进展的标志物,但尚需大样本的临床研究进一步证实。
Purpose Diabetic proliferative-retinopathy (PDR) is one of the major risk factors for blindness. The pathogenesis of this disease is not yet fully understood. To investigate the relationship between inflammatory response and oxidative stress in type 2 diabetic PDR by studying the relationship between monocyte chemoattractant protein-1 (MCP-1), 8-iso-prostaglandin F2a (8-iso-PGF2a) and type 2 diabetes mellitus In the mechanism of action and clinical significance. Methods 106 patients with type 2 diabetic retinopathy of non-proliferative phase and proliferative phase between June 2012 and December 2012 were enrolled. Among them, there were 50 non-proliferative patients (NPDR group) and 56 proliferative patients (PDR group). The serum MCP-1, 8-iso-PGF2a, fasting blood glucose (FBG), 24-hour urine microalbuminuria (24hUMA) and HbA1c were measured and the differences between them were compared to analyze the related risk factors of PDR. Results Serum MCP-1, 8-iso-PGF2a and 24hUMA in PDR patients were significantly higher than those in NPDR patients (all P <0.01), serum MCP-1 and 24UUMA were positively correlated with blood 8-iso-PGF2a (r = 0.915, 0.865, P <0.01). Serum 8-iso-PGF2a was an independent determinant of 24hUMA and serum MCP-1 (β = 0.865, 0.915; P = 0.000). The family history of diabetic retinopathy, 24hUMA, serum MCP-1,8-iso-PGF2a were independent risk factors for PDR (OR = 1.21,1.63,1.86,1.57). Conclusions Oxidative stress and inflammatory reaction may participate in the development of diabetic PDR. Serum MCP-1 and 8-iso-PGF2a may be used as markers to predict the progression of diabetic retinopathy. However, further studies in large sample clinical studies are needed.