福辛普利、转化生长因子β1与糖尿病视网膜病变

Fosinopril and serum transforming growth factor-beta 1 and diabetic retinopathy

目的探讨血清转化生长因子β1（TGFβ1）在糖尿病视网膜病变（DR）发病中的意义以及血管紧张素转化酶抑制剂（ACEI）福辛普利对DR患者的治疗效果及对DR患者血清TGFβ1水平的影响。方法将80例2型糖尿病（2-DM）患者及20例健康人群分为5组，采用双抗体夹心酶联免疫吸附法（ELISA）检测其血清TGFβ1水平并进行比较。将45例背景型DR患者分为2组，25例福辛普利治疗组给予福辛普利治疗6个月，行眼底荧光造影（FFA）检查观察患者治疗前后眼底病变的变化并与药物对照组比较，同时检测患者治疗前后血清TGFβ1水平的改变。结果糖尿病组与正常对照组比较，血清TGFβ1水平升高，差异有显著性意义（P〈0．01）。糖尿病三组之间比较，PDR组血清TGFβ1水平高于背景型DR组；背景型DR组血清TGFβ1水平高于NoDR组，三组之间差异均有显著性意义（P〈0．05）。福辛普利治疗后背景型DR患者血清TGFβ1水平及UAER降低，与治疗前比较，差异均有显著性意义（P〈0．05）。福辛普利治疗组治疗前后DR眼底的变化与药物对照组比较，无显著性差异（P〉0．05）。结论DR患者血清TGFβ1水平显著升高，且随病变进展进一步升高，TGFβ1可能在DR发病及其进展中发挥重要作用。福辛普利通过抑制背景型DR患者产生TGFβ1，从而发挥可能对视网膜的保护作用，但短期内观察眼底的病变无明显改善。

Objective To discuss the effect of serum transforming growth factor-beta 1 （TGF β1） and angiotensin converting enzyme inhibitor （ACEI） （Fosinopril） to diabetic retinopathy （DR）. Methods 80 patients with type 2 diabetes and 20 health controls were divided into 5 groups and serum TGF β1 levels were detected with double-antibody enzyme-linked immunosersorbent assay （ELISA）. 45 patients with background DR were divided into 2 groups and investigated the effect of Fosinopril to treat the patients in 6 months with fundus fluorescein angiography （FFA）. Results Serum TGF β1 levels increased significantly in diabetic patients compared with those in health controls （P〈0.01）. When compared with each other, there were signifi- cant differences in serum TGF β1 levels in three diabetic groups （P〈0.05,respectively）. Serum TGFβ1 levels and urinary albumin excretion rate（UAER） decreased significantly in patients with background DR after Fosinopril treatment （P〈0.05）. However, there were no significant difference in fundus compared with medical controls. Conelusion Serum TGF β1 levels were elevated in the patients with DR and may play a role in pathogenesis of DR .Fosinopril may be protective effect on the patients with background DR by suppressing the production of TGF β1,but there was no significant progress in fundus in short periods.