新生血管性青光眼转化生长因子β_2含量及其相关影响因素

Levels of transforming growth factor-β_2 in neovascular glaucoma eyes and their associated diathesis

目的观察新生血管性青光眼(NVG)眼内房水和玻璃体液中转化生长因子(TGF)-β2总量和活化含量,并分析其相关影响因素。方法前瞻性研究NVG患者54例(54只眼)房水和玻璃体液中总TGF-β2(tTGF-β2)和活化TGF-β2(aTGF-β2)含量,其中视网膜中央静脉阻塞(CRVO)17只眼,糖尿病视网膜病变(DR)22只眼,视网膜血管炎(Eales)4只眼,视网膜脱离(RD)术后4只眼,未知原因(NA)7只眼。虹膜新生血管Ⅰ级17只眼,Ⅱ级12只眼,Ⅲ级13只眼,Ⅳ级12只眼。曾行视网膜光凝和/或冷凝治疗36只眼。10只新鲜健康角膜移植供体眼作为对照组。抽取房水和玻璃体液样本,采用酶联免疫吸附试验(ELISA)检测其中aTGF-β2含量,tTGF-β2酸化处理后进行检测。采用SPSS软件进行数据分析,NVG组和正常对照组TGF-β2总量和活化含量比较采用Mann-WhitneyU检验。不同原发病、不同等级虹膜新生血管、治疗视网膜光凝固法和/或冷冻视网膜固定术组与未治疗组之间tT-GF-β2和aTGF-β2含量分别比较采用方差分析、LSD-t检验和t检验。结果 NVG组房水中tTGF-β2和aTGF-β2含量分别为(3279.7±935.3)ng/L和(353.3±107.0)ng/L,玻璃体液中分别为(4386.9±1139.4)ng/L和(503.6±130.0)ng/L,均高于正常对照组细胞因子含量(P<0.01)。CRVO组在房水和玻璃体tTGF-β2含量高于NA(Z房水=-2.191,P=0.028;Z玻璃体=-2.509,P=0.012)。DR组房水和玻璃体液中tTGF-β2含量高于NA(Z房水=-2.293,P=0.022;Z玻璃体=-2.650,P=0.008)。Eales在玻璃体tTGF-β2含量高于NA(Z玻璃体=-2.079,P=0.038)。但在房水或玻璃体液中各组aTGF-β2含量差异没有统计学意义(P>0.05)。不同虹膜新生血管分级分组,房水和玻璃体液中aTGF-β2含量差异无统计学意义(P>0.05)。治疗组NVG眼房水tTGF-β2(3122.7±910.2 ng/L)和aTGF-β2(303.4±79.0 ng/L)以及玻璃体液tTGF-β2(4166.7±1157.3 ng/L)和aTGF-β2(444.0±93.4 ng/L)含量均低于未治疗组,差异具有统计学意义(P<0.05)。结论 NVG中tTGF-β2和aTGF-β2含量明显升高,tTGF-β2含量可能与原发病因有关,视网膜光凝和冷冻治疗可抑制NVG眼TGF-β2产生和活化。

Objective To determine the total and activated levels of transforming growth factor-β2（TGF-β2） in eye with neovascular glaucoma（NVG） and to evaluate the relation between probable clinical diathesis and the levels of TGF-β2.Methods Fifty-four NVG eyes of 54 patients and 10 fresh healthy donor eyes for corneal transplantation as control were prospectively studied and the levels of total TGF-β2（tTGF-β2） and activated TGF-β2（aTGF-β2） in aqueous humor and vitreous liquid aspirates were measured.These 54 eyes consisted of 17 central retinal vein occlusion（CRVO） eyes,22 diabetic retinopathy（DR） eyes,4 retinal vasculitis（Eales disease） eyes,4 retinal detachments（RD） and 7 unidentified NVG（NA）.Among them,the NVG number with iris neovascularization gradeⅠ,Ⅱ,Ⅲ and Ⅳ were 17,12,13 and 12,and 36 eyes,respectively,were treated with prophylactic retinal photocoagulation or/and cryotherapy.The level of aTGF-β2 was measured using an enzyme-linked immunosorbent assay（ELISA） method and the tTGF-β2 was pretreated with hydrochloric acid before ELISA test.All data were statically analyzed with SPSS software.The differences of tTGF-β2 and aTGF-β2 levels between NVG and control groups were analyzed with Man-Whitney U test.The differences of them among various primary causes,among iris neovascularization grades and between the prophylactic treated and the untreated groups were analyzed with ANOVA,LSD-t and t-test,respectively.Results The free tTGF-β2 and aTGF-β2 concentrations in aqueous humor from NVG patients were（3279.7±935.3） ng/L and（353.3±107.0） ng/L and these in vitreous liquid were（4386.9±1139.4） ng/L and（503.6±130.0） ng/L,which were higher than these in normal control eye（all P0.01）.The free tTGF-β2 concentrations in aqueous humor and vitreous liquid from NVG secondary with CRVO were higher than these in NA group（Zaqu=-2.191,P=0.028,Zvit=-2.509,P=0.012）.The free tTGF-β2 concentrations in aqueous humor and vitreous liquid from NVG secondary with DR were higher than these in NA group（Zaqu=-2.293,P=0.022,Zvit=-2.650,P=0.008）.The free tTGF-β2 concentrations in vitreous liquid from NVG secondary with Eales were higher than these in NA group Eales（Zvit=-2.079,P=0.038）.There were no differences of aTGF-β2 between CRVO,DR,Eales,and RD eyes（P0.05）.There was no statistical differences of aTGF-β2 levels in aqueous humor and vitreous liquid among various iris neovascularization grades（P0.05）.The tTGF-β2 and aTGF-β2 concentrations in aqueous humor（3122.7±910.2 ng/L and 303.4±79.0 ng/L） and vitreous liquid（4166.7±1157.3 ng/L and 444.0± 93.4 ng/L） among NVG with previous retinal photocoagulation or /and cryotherapy were lower than these in non-intervention NVG（all P0.05）.Conclusions The total and activated levels of TGF-β2 was related to primary causes of NVG and its release and activation might be inhibited after retinal photocoagulation or（/and） cryotherapy in NVG eyes.