增殖性糖尿病视网膜病变患者玻璃体中的AngⅡ、VEGF的研究

Study of Angiotensin Ⅱ and Vascular Endothelial Growth Factor inthe Vitreous of Patients with Proliferative Diabetic Retinopathy

目的本文通过测定增殖性糖尿病视网膜病变(PDR)患者及非PDR对照组患者玻璃体中AngⅡ、VEGF水平,旨在探讨AngⅡ、VEGF在PDR发病中的作用,并分析其间的相关关系。为探讨PDR的发病机制提供实验依据和理论基础。方法测定15例PDR患者和15例非PDR患者玻璃体及血液中AngⅡ、VEGF和血管紧张素转换酶(angiotensin converting enzyme,ACE)的水平。用放免法(radioimmunoassay)测定玻璃体及血浆中AngⅡ的水平。用酶联免疫吸附测定法(enzyme linked immunosorbent assay,ELISA),测定玻璃体及血浆中VEGF的水平。用紫外分光光度法(ultraviolet-spectrophotometry),测定玻璃体及血清中ACE的水平。结果(1)PDR患者玻璃体中,AngⅡ、VEGF和ACE的水平显著高于非PDR对照组患者(P<0.001),PDR患者玻璃体中,AngⅡ、VEGF和ACE的水平显著高于血液(P<0.01);非PDR患者玻璃体中,AngⅡ、VEGF和ACE的水平与血液中的比较无显著性差异(P>0.05);(2)PDR患者玻璃体中,AngⅡ与VEGF之间呈正相关性(P<0.01),PDR患者玻璃体中,AngⅡ与ACE之间具正相关性(P<0.05)。结论(1)PDR患者玻璃体中,AngⅡ、VEGF的水平明显升高,推测AngⅡ、VEGF在PDR的病理过程中起一定作用;(2)PDR患者玻璃体中,AngⅡ、ACE和VEGF的水平分别高于血液中AngⅡ、ACE和VEGF的水平;非PDR患者玻璃体中,AngⅡ、VEGF和ACE的水平与血液中的比较无显著性差异,推测眼内肾素-血管紧张素(RAS)系统可能是独立的,PDR患者玻璃体中,VEGF可能来源于眼内组织;(3)PDR患者玻璃体中,AngⅡ与AGE、VEGF呈正相关关系,PDR患者玻璃体中,ACE的水平明显升高,提示高水平的AngⅡ可能由高水平的ACE引起的,AngⅡ、VEGF在PDR的发生、发展中,具有相辅相承、互相促进的作用。

Objeetive Proliferative diabetic retionopathy is the later period of diabetic retinopathy, which is characterized by neovascularization and fibroplasias. It has a catastrophic effect on vision and seriously influences the patients＇ living quatities, the pathogensis is extremely complex, thebasic pathology is retinal microvessel disorder, and is a kind of disease of cell proliferation by out control of cell proliferation. Recent years, the study showed that varied factors play a role in the pathology course of PDR, in which angiotensin Ⅱ （Ang Ⅱ ） and vascular endothelial growth factor （VEGF） gradually have been brought to people＇s attention. By detecting the levels of VEGF and Ang Ⅱ in vitreous in patiens with diabetic and in patiens with nondibetic, this experiment tries to explore the value of VEGF and Ang Ⅱ in PDR, and to determine the relation between them. Then provide experimental basis and theoretical foundation for determining the pathogenesis of PDR. Methods The levels of Ang Ⅱ ,VEGF and ACE in the vitreous and blood were quantiffed in 15 PDR patients and 15 non PDR patients. The levels of AngⅡ in the vitreous and plasma are quantified by the radiommunoassayand. The levels of VEGF in the vitrous and plasma are quantified by the enzyme linked immunosorbent assay. The levels of ACE in the vitrous and serum are quantified by the ultraviolet - spectrophotometry. Results （ 1 ） The levels of Ang Ⅱ ,VEGF and ACE of PDR patients in the vitreous are significantly higher than non PDR patients （ P 〈 0.001） ; The levels of Ang Ⅱ ,VEGF and ACE of PDR patients in the vitreous are significantly higher than the levels in the blood （ P 〈 0.01）. There is no significantly differenc between the levels of AngⅡ ,VEGF and ACE of non PDR patients in the vitreous and the levels in the blood statistically. （2） There is positive correlation between AngⅡ and VEGF in PDR patients in the vitreous. There is positive correlation between Ang Ⅱ and ACE in PDR patients in the vitreous. Conclusion （1） Elevated levels of Ang Ⅱ and VEGF in PDR patients is considered that AngⅡ and VEGF play a role in the pathology course of PDR. （2）The levels of AngⅡ,ACE and VEGF in PDR patients in the vitreous are separately higher than the levels in the blood, and there is no significantly difference between the levels of Ang Ⅱ, VEGF and ACE of non PDR patients in the vitreous and the levels in the blood statistically, which is considered that intraocular RAS system may be independent and VEGF may originate from intraocular organization. （3）The levels of Ang Ⅱ positively correIate with that of ACE and VEGF in the vitreous of PDR patients, and the levels of ACE in the vitreous of PDR patients are significantly elevated, which indicates that high levels of AngⅡ are caused by high levels of ACE, ACE and VEGF play interpendant roles in the onset and development of PDR.