摘要
目的探讨高分子量脂联素(HMW-ADP)、肿瘤坏死因子(TNF)-α及血管内皮生长因子(VEGF)与糖尿病性视网膜病变(DR)之间的关系。方法选取河北省老年病医院眼科2014年1月至2014年12月临床检查确诊为2型糖尿病的150例患者的临床资料。患者共分为无DR(NDR)组、非增殖性DR(NPDR)组及增殖性DR(PDR)组,每组均为50例。另选取同期健康体检者50例作为对照组。性别、高血压病史及糖尿病家族病史的比较采用χ~2检验。HMW-ADP、TNF-α、VEGF水平、生化指标及身体质量指数等临床资料均以均数±标准差(±s)表示,并采用单因素方差分析进行比较。HMW-ADP、TNF-α、VEGF及其他因素对NPDR和PDR患者的影响采用多元Logistic回归分析。HMW-ADP、TNF-α及VEGF与DR的相关性采用Pearson相关分析。结果与NDR组和对照组患者相比,NPDR组和PDR组的年龄较大(F=5.329,P<0.05);NDR组、NPDR组及PDR组患者的高血压病史显著长于对照组(χ~2=20.215,P<0.05);PDR组的患者病程最长,其次为NPDR组,NDR组最短(F=96.434,P<0.05);NDR组、NPDR组及PDR组患者的空腹血糖高于对照组(F=12.510,P<0.05);PDR组患者的空腹胰岛素水平最高,其次为NPDR组和NDR组,对照组最低(F=25.305,P<0.05);NDR组、NPDR组及PDR组患者的甘油三酯(TG)含量高于对照组(F=16.419,P<0.05),而高密度脂蛋白胆固醇(HDL-C)含量低于对照组(F=4.259,P<0.05);NPDR组和PDR组患者的肌氨酸酐高于对照组(F=47.158,P<0.05);组间比较,差异均有统计学意义。NPDR组与PDR组患者的HMW-ADP水平低于对照组与NDR组,NDR组又低于对照组,组间比较差异有统计学意义(F=362.480,P<0.05)。PDR组患者的TNF-α与VEGF水平最高,其次为NPDR组,而NDR组与对照组最低,组间比较差异均有统计学意义(F=239.200,641.970;P<0.05)。多因素分析结果显示,年龄、病程、TNF-α及VEGF是NPDR的独立危险因素(χ~2=7.621,18.331,5.532,5.618;P<0.05),也是PDR的独立危险因素(χ~2=6.962,11.542,5.615,5.331;P<0.05)。而HDL-C和HMW-ADP则是NPDR的保护因素(χ~2=6.694,10.671;P<0.05),也是PDR的保护因素(χ~2=5.674,7.671;P<0.05)。DR患者中的HMW-ADP水平与TNF-α、VEGF均呈显著负相关性(r=-0.328,-0.810;P<0.05)。结论 DR患者的HMW-ADP水平较低,但TNF-α和VEGF水平较高,HMW-ADP与TNF-α、VEGF呈显著负相关。说明HMW-ADP是DR的保护因素,而TNF-α、VEGF是独立危险因素。
Objective To discuss the relationship among high molecular weight adiponectin（ HMW-ADP）,tumor necrosis factor（ TNF）-α and vascular endothelial growth factor（ VEGF） with diabetic retinopathy（ DR）. Methods 150 cases with type 2 diabetes mellitus from January to December 2014 were selected as study objects,50 cases with NDR,50 cases with NPDR and 50 cases with PDR. 50 cases for physical examination were selected as control group. Compared with the gender,history of hypertension and diabetes family history of χ~2test. The clinical data such as HMW-ADP,TNF-α,VEGF,biochemical indexes and body mass index were all expressed by mean and standard deviation（ ±s）,and compared by single factor analysis of variance. The effects of HMW-ADP,TNF-α,VEGF and other factors on NPDR and PDR were analyzed by multiple Logistic regression. The correlation of HMW-ADP,TNF-α and VEGF with DR was analyzed by Pearson correlation. Results The age of the NPDR group and the PDR group were larger than that of the NDR group and the control group（ F = 5.329,P0.05）. The history of hypertension in group NDR,group NPDR and group PDR were significantly higher than that of control group（ χ~2= 20.215,P0.05）. The patients in group PDR had the longest course,followed by group NPDR,and the group NDR was the shortest（ F = 96.434,P0.05）. Fasting blood glucose in patients in group NDR,group NPDR and group PDR were significantly higher than that of control group（ F = 12. 510,P 0. 05）. The fasting insulin levels in group PDR were the highest,followed by group NPDR and group NDR,and lowest in the control group（ F = 25.305,P0.05）. The content of triglyceride（ TG） in patients in group NDR,group NPDR and group PDR were significantly higher than that of control group（ F = 16.419,P0.05）. The content of highdensity lipoprotein cholesterol（ HDL-C） was significantly lower than that of the control group（ F = 4.259,P 0.05）. The creatinine of group NPDR and group PDR was significantly higher than that of control group（ F= 47.158,P0.05）. The difference between the two groups was statistically significant. The level of HMWADP in the NPDR group and the PDR group were significantly lower than that in the control group and the NDR group,and the NDR group was significantly lower than that of the control group,the difference between the two groups was statistically significant（ F = 362.480,P0.05）. The levels of TNF-α and VEGF in group PDR were the highest,followed by NPDR group; NDR group and control group were lowest,the difference between the two groups were statistically significant（ F = 239.200,641.970; P0.05）. Multivariate analysis showed that age,duration of disease,TNF-α and VEGF were independent risk factors for NPDR（ χ~2=7.621,18.331,5.532,5.618; P0.05）,and they were also independent risk factors for PDR（ χ~2= 6.962,11.542,5.615,5.331; P0.05）. HDL-C and HMW-ADP were protective factors for NPDR（ χ~2= 6. 694,10.671; P0.05）,and they were also protective factors for PDR（ χ~2= 5.674,7.671; P0.05）. The levels of HMW-ADP in patients with DR were negatively correlated with TNF-α and VEGF（ r =-0.328,-0.810;P0.05）. Conclusion In patients with DR,the level of HMW-ADP decreases,and the levels of TNF-αand VEGF increase; Multivariate analysis shows that HMW-ADP is protective factor,and TNF-α and VEGF are risk factor; HMW-ADP is negatively correlated with TNF-α and VEGF.
作者
闫配
张莉
张晓红
张彦坤
Yan Pei Zhang Li Zhang Xiaohong Zhang Yankun(Department of Ophthalmology, Hebei provincial geriatric hospital, Shijiazhuang 050011, China Department of Ophthalnmlogy , Chest Hospital of Hebei Province, Shijiazhuang 050041, China)
出处
《中华眼科医学杂志（电子版）》
2017年第4期158-164,共7页
Chinese Journal of Ophthalmologic Medicine(Electronic Edition)
基金
河北省科技支撑计划项目(132777100D)
关键词
高分子量脂联素
肿瘤坏死因子
血管内皮生长因子
糖尿病性视网膜病变
High molecular weight adiponectin
Tumor necrosis thctor-α
Vascular endothelialgrowth factor
Diabetic retinopathy
作者简介
通信作者：张莉，Email：18911727297@163．com
