摘要
背景 多种炎性细胞和细胞因子参与2型糖尿病患者白内障术后黄斑水肿（ME）的发生和发展,一些因子已证实可作为2型糖尿病患者白内障术后ME的预测指标,对房水中多种相关细胞因子的同时检测具有重要意义.目的 探讨房水中多种细胞因子与2型糖尿病患者白内障术后ME发生的关系.方法 纳入2010年1月至2012年4月于天津市眼科医院行超声乳化白内障摘出术的2型糖尿病患者136例136眼,术中抽取房水0.lml,采用人磁性微球的多重免疫检测平板同时对房水中27种细胞因子的质量浓度进行测定.所有患者术前和术后4周进行黄斑区OCT检查,比较和分析房水中多种细胞因子与黄斑区视网膜厚度的关系.结果 纳入的136眼中均成功实施了超声乳化白内障摘出术,共116眼完成了4周的随访,占85.29％.术后第4周,34眼发生ME,占29.31％,为ME（＋）组,未发生ME者82眼,占70.69％,为ME（-）组,2个组间患者的基线资料匹配,差异均无统计学意义（均P＞0.05）.ME（＋）组术眼术后黄斑区视网膜厚度值为（237.24±24.16） μm,明显高于术前的（162.41±21.33） μm和ME（-）组术后4周的（185.53±18.35） μm,差异均有统计学意义（均P＜0.01）.ME（＋）组患者房水中白细胞介素-1β （IL-1β）、IL-6、IL-8、干扰素诱导蛋白-10（IP-10）、单核细胞趋化蛋白-1（MCP-1）和血管内皮生长因子（VEGF）的质量浓度明显高于ME（-）组,差异均有统计学意义（均P＜0.01）,术后4周黄斑区视网膜厚度值与术前房水中IL-1β、IL-6、IL-8、IP-10、MCP-1和VEGF质量浓度均呈正相关（r=0.288,P=0.005;r=0.345,P=0.008;r=0.256,P=0.016;r=0.377,P=0.007;r=0.423,P=0.001;r=0.279,P=0.012）.ME（＋）组术眼房水中IL-10和IL-12的质量浓度明显低于ME（-）组,差异均有统计学意义（P=0.003、0.017）.术后4周,黄斑区视网膜厚度与术前房水中IL-10和IL-12的质量浓度均呈负相关（r=-0.327,P=0.013;r=-0.264,P=0.036）.患者糖化血红蛋白水平及上述房水中高表达因子均为糖尿病患者白内障术后ME发生的危险因素（OR=1.25,P=0.026;OR=1.31,P=0.006;OR=3.62,P＜0.001;OR=1.82,P=0.007;OR=1.58,P＜0.001;OR =4.21,P＜0.001;OR=5.36,P＜0.001;OR=0.19,P=0.011;OR =0.31,P=0.013）.结论 2型糖尿病患者房水中细胞因子IL-1β、IL-6、IL-8、IL-10、IL-12、IP-10、MCP-1和VEGF质量浓度与白内障术后ME的发生密切相关.
Background Multiple inflammatory factors in aqueous humor are indicated to be correlated with postoperative macular edema （ME） in type 2 diabetic patients who received phacoemulsification （Phcao） cataract surgery.To analyze the correlation of aqueous inflammatory factors and cytokines with postoperative ME in these patients is significant for the treatment.Objective This study was to ascertain whether cytokines in the aqueous humor can predict ME in type 2 diabetic patients following Phaco cataract surgery.Methods One hundred and thirty-six eyes of 136 consecutive patients with type 2 diabetes were included from January 2010 to April 2012 in Tianjin Eye Hospital.All the patients received Phaco cataract surgery and 0.1 ml aqueous fluid was collected from each eye during the surgery under the informed consent.Twenty-seven cytokines in aqueous humor samples were simultaneously assayed using multiplex bead immunoassay.Central foveal thickness was measured using OCT before and after surgery,and ME was defined as an 30％ increase in foveal thickness after operation.The correlations of 27 aqueous cytokines with ME were analyzed.Results Phaco surgery was successfully performed in all the eyes,and 116 eyes completed the follow-up with the finishing rate 85.29％.ME occurred in 29.31％ eyes （34/116） 4 weeks after surgery and were assigned to the ME （＋） group ;while 70.69％ eyes （82/116） did not appear ME as the ME （-） group.The patients showed the matched demography between the two groups （all at P＞ 0.05）.The mean macular thickness value was （237.24± 24.16） μm in the ME （＋） group 4 weeks after operation,which was significantly higher than （162.41±21.33） μm before operation and （185.53± 18.35）um in the ME （-） group （both at P＜0.001）.Compared to the ME （-） group,the concentrations of interleukin-lβ （IL-1β）,IL-6,IL-8,interferon-induced protein-10 （IP-10）,monocyte chemotactic protein-1 （MCP-1） and vascular endothelial growth factor （VEGF） in aqueous of the ME （＋） patients were significantly elevated （all at P＜0.01）.In addition,these factors showed positive correlation with the postoperative central foveal thickness （r =0.288,P =0.005 ;r =0.345,P =0.008 ;r=0.256,P=0.016;r=0.377,P=0.007 ;r=0.423,P=0.001 ;r=0.279,P=0.012）.However,the aqueous levels of IL-10 and IL-12 before operation were significantly lower in the ME （＋） group compared with the ME （-）group （P =0.003,0.017）,and showed negatively correlated with the postoperative central foveal thickness （r =-0.327,P=0.013 ;r =-0.264,P =0.036）.Logistic regression analysis showed that higher glycosylated hemoglobin and above mentioned factors were risk factors of ME following Phaco cataract surgery （OR =1.25,P =0.026 ; OR =1.31,P=0.006;OR=3.62,P＜0.001 ;OR=1.82,P=0.007 ;OR=1.58,P＜0.001 ;OR=4.21,P＜0.001 ;OR=5.36,P＜0.001;OR=O.19,P=0.011;OR=0.31,P=0.013）.Conclusions The increases of aqueous IL-1β3,IL-6,IL-8,IP-10,MCP-1,VEGF and decreases of IL-10,IL-12 are associated with postoperative ME in type 2 diabetic patients following Phaco cataract surgery.
出处
《中华实验眼科杂志》
CAS
CSCD
北大核心
2015年第4期356-361,共6页
Chinese Journal Of Experimental Ophthalmology
作者简介
董宁（在职研究生，现在首都医科大学附属北京世纪坛医院眼科）
通信作者：汤欣，Email：eye_tangxin@163．com
