2型糖尿病患者DR不同时期血浆钙卫蛋白水平的检测和比较

Detection and comparison of plasma calprotectin in different stages of diabetic retinopathy in patients with type 2 diabetes mellitus

背景糖尿病视网膜病变（DR）时视网膜血管的中性粒细胞浸润，造成血管内皮损伤。钙卫蛋白主要存在于中性粒细胞溶酶体外的细胞质中，通过促进中性粒细胞的聚集参与血管损伤的生物学行为，是一种潜在的临床炎症标志物。钙卫蛋白在DR进展过程中的作用尚不清楚。目的探讨钙卫蛋白在2型糖尿病患者DR不同时期的表达差异及其在DR发生发展过程中的可能作用。方法本研究为病例对照研究。临床确诊为2型糖尿病的患者60例纳入研究，根据检眼镜下眼底表现和荧光素眼底血管造影（FFA）检查结果将患者分为无DR组（20例）、非增生型糖尿病视网膜病变（NPDR）组（20例）和PDR组（20例），并纳入门诊体检的20例健康者为对照组，对照组与2型糖尿病组受检者的年龄、性别及血液生化检测指标结果相匹配。于清晨抽取受试者空腹静脉血2ml，ELISA法测定各组受检者血浆钙卫蛋白的质量浓度。结果对照组、无DR组、NPDR组和PDR组受检者外周血浆中钙卫蛋白的质量浓度分别为（57．70±12．29）、（72．074-10．14）、（87．704．-10．37）、（94．36±9．40）ng／L，4个组间的总体差异有统计学意义（F=73．09，P〈0．01）。PDR组受检者外周血钙卫蛋白的质量浓度最高，与其他3个组间的两两比较差异均有统计学意义（q=20．157、10．648、4．497，P〈0．01）；NPDR组受检者外周血钙卫蛋白的质量浓度高于无DR组，差异有统计学意义（q=6．216，P〈0．01）。结论血浆钙卫蛋白质量浓度的变化可能在2型糖尿病患者DR的发生发展过程中起一定作用。

Background The neutrophils infiltration and vascular endothelium damage are found in the patients with diabetic retinopathy （ DR）. Calprotectin existes in the cytosol outside lysoome. It is thought to be a marker of inflammation. The effect of calprotectin in the development of DR is still in the study. Objective This study was to investigate the contents of plasma ealprotectin in different stages of DR in patients with type 2 diabetes mellitus. Methods This was a case-control study. Sixty consecutive patients with type 2 diabetes mellitus were enrolled in this study. The patients were assigned to non-DR （NDR） group, non-proliferative DR （NPDR） group and proliferative DR（PDR） group according to fundus appearance and fundus fluorescein angiography（FFA） manifestation and 20 patients for each group. Twenty healthy subjects matched in gender, age and blood biochemical indicators were collected as the normal control group. The periphery blood samples were collected from the subjects for the detection of plasma calprotectin by ELISA. The plasma calprotectin levels were compared among different stages of DR and normal subjects. All subjects had signed informed consents. Results The contents of plasma calprotectin were （ 57.70± 12.29 ）, （72.07 ± 10. 14 ）, （ 87.70 ± 10.37 ）, （ 94.36 ± 9.40 ） ng/L in the normal control group, NDR group, NPDR group, PDR group respectively, with a statistically significant difference among 4 groups （ F = 73.09, P〈0. 001 ）. The content of calprotectin in PDR group showed a highest value in comparison with normal control group, NDR group and PDR group（ q = 20. 157, 10. 648,4. 497, P 〈 0.01 ）. The content of calproteetin in NPDR group was significantly higher than that in NDR group（q=6. 216,P〈0.01 ）. Conclusions Plasma calprotectin may play a role during the development of DR in type 2 diabetes mellitus patient.