摘要
目的探讨miR-126和血管内皮生长因子(VEGF)在增生性糖尿病视网膜病变(PDR中的表达情况及临床意义。方法选取本院收治的糖尿病视网膜病变(DR)患者226例进行研究,其中PDR患者110例(PDR组),非增生性糖尿病视网膜病变(NPDR)患者116例(NPDR组),选取同期住院治疗的糖尿病不伴视网膜病变(NDR)患者80例(NDR组),选取正常的健康体检者80例(对照组),采用实时荧光定量PCR(qRT-PCR)方法检测所有受试者血浆miR-126水平,酶联免疫吸附法(ELISA)检测血浆VEGF水平,进一步分析miR-126和VEGF对PDR患者的临床诊断价值。结果 PDR组、NPDR组、NDR组患者血浆miR-126水平低于对照组(P <0. 05),PDR组低于NPDR组、NDR组(P <0. 05); PDR组、NPDR组、NDR组患者血浆VEGF水平高于对照组(P <0. 05),且PDR组高于NPDR组、NDR组(P <0. 05); PDR组、NPDR组、NDR组患者总胆固醇(TC)、甘油三酯(TG)、糖化血红蛋白(HbA1c)均高于对照组(P <0. 05),PDR组高于NPDR组、NDR组(P <0. 05); PDR组、NPDR组、NDR组患者低密度脂蛋白胆固醇(LDL-C)高于对照组(P <0. 05),PDR组高于NPDR组、NDR组(P <0. 05); PDR组、NPDR组、NDR组患者高密度脂蛋白胆固醇(HDL-C)低于对照组(P <0. 05); PDR组、NPDR组、NDR组患者C反应蛋白(CRP)高于对照组(P <0. 05); PDR患者血浆miR-126水平与TC、LDL-C、CRP、HbA1c呈负相关(P <0. 05),与HDL-C呈正相关(P <0. 05),与TG无相关性; PDR患者血浆VEGF水平与TC、TG、LDL-C、CRP、HbA1c呈正相关(P <0. 05); miR-126和VEGF表达呈明显负相关(r=-0. 573,P=0. 000); miR-126诊断PDR的AUC为0. 861,截断值≤0. 64时,诊断灵敏度为83. 64%,特异度为82. 50%; VEGF诊断PDR的AUC为0. 889,截断值≥72. 56 pg/ml时,诊断灵敏度为82. 73%,特异度为86. 25%; HbA1c诊断PDR的AUC为0. 847,截断值≥10. 42%时,诊断灵敏度为81. 82%,特异度为87. 50%。结论 PDR患者血浆miR-126低表达,VEGF高表达,二者呈负相关性,可能通过血脂代谢异常及炎症反应参与PDR病程,可能成为PDR早期诊断的潜在生物标记物。
Objective To investigate the expression and clinical significance of miR-126 and vascular endothelial growth factor （VEGF） in proliferative diabetic retinopathy （PDR）. Methods 226 cases of diabetic retinopathy （DR） patients admitted in our hospital were studied, including 1 l0 cases of PDR （group PDR）, 116 non proliferative diabetic retinopathy （NPDR） （group NPDR）. 80 patients with diabe- tes mellitus without retinopathy （NDR） were enrolled in DR group at the same period, another 80 healthy subjects （control group） were selected as control group. The plasma miR-126 level of all subjects was detected by real-time fluorescence quantitative polymerase chain reaction （qRT-PCR）. The enzyme linked iramunosorbent assay （ELISA） method was used to detect plasma VEGF level. The clinical diagnostic value of miR-126 and VEGF in PDR patients was further analyzed. Results Plasma levels of miR-126 in PDR group, NPDR group and NDR group were lower than those in control group （ P 〈 0.05 ） , PDR group was lower than NPDR group and NDR group （ P 〈0. 05 ） ; plasma levels of VEGF in PDR group, NPDR group and NDR group were higher than those in control group （ P 〈 0. 05 ）, PDR group was higher than NPDR group and NDR group （ P 〈 0. 05 ）. Total cholesterol （ TC ）, triglyceride （TG） and glycated hemoglobin （HbAle） in PDR group were higher than those in NPDR group and NDR group （P 〈 0. 05）, low density lipoprotein cholesterol （LDL-C） in PDR group, NPDR group and NDR group were higher than those in con- trol group （ P 〈 0. 05 ）, and LDL-C in PDR group was higher than that in NPDR group and NDR group （P 〈 0. 05 ）. High density lipoprotein cholesterol （HDL-C） in PDR group and NDR group was lower than that in control group （ P 〈 0.05 ）, C-reactive protein （CRP） in PDR group, NPDR group and NDR group was higher than that in control group （ P 〈 0.05 ） ; plasma miR-126 levels in PDR group were negatively correlated with TC, LDL-C, CRP and HbAlc （ P 〈 O. 05 ） , but positively correlated with HDL-C （ P 〈 O. 05 ） , and no correlation with TG ; the plasma levels of VEGF in PDR patients were positively correlated with TC, TG, LDL-C, CRP and HbA1 c （P 〈 0. 05）, but negatively correlated with the expressions of miR- 126 （r = -0. 573, P =0. 000） ; the AUC of miR-126 was 0. 861, and when the cut-off value was 〈0. 64, the diagnostic sensitivity and specificity were 82. 50% ,83.64% ; the area under curve （AUC） of VEGF was 0. 889, and when the cut-off value was 〈 7. 000, the sensitivity and specificity of diagnosis were 82.73% , 86. 25% ; 0. 847 for the AUC of HbAlc ,and the sensitivity and specificity 81.82% , 87.50% respectively. Conclusions Plasma miR-126 is low-expressed and VEGF is high-expressed in PDR patients, there is a negative con＇elation between the two indexes. They may be involved in the course of PDR through abnormal lipid metabolism and inflammatory reaction and may be a potential biomarker for early diagnosis of PDR.
作者
郑华东
于俊霞
田宁艳
吴家楣
Zheng Huadong;Yu Junxia;Tian Ningyan;Wu Jiamei(Department of Geriatrics,the Second Affiliated Hospital of Xi＇an Jiaotong University,Xi＇an 710004,China;Department of Ophthalmology,Yaozhou District Hospital,Tongchuan 727100,China)
出处
《中国医师杂志》
CAS
2018年第10期1477-1481,共5页
Journal of Chinese Physician
基金
2010年陕西省卫生厅科研基金(2010A03)~~
作者简介
通信作者：吴家楣，Email：zlsxwn@yeah．net
