血清血小板内皮细胞黏附分子-1水平变化对糖尿病视网膜病变的影响

Influence of platelet endothelial cell adhesion molecule-1 on diabetic retinopathy in patients with type 2 diabetes

背景研究糖尿病视网膜病变（DR）发生发展的相关危险因素对DR的预防有重要意义，血小板内皮细胞黏附分子-1（PECAM-1）是介导糖尿病患者血管病变发生的重要介质，但其作用机制仍有待进一步研究。目的探讨2型糖尿病患者血清中PECAM-1水平变化对DR发生及发展的影响。方法收集在南通市第三人民医院内分泌科确诊的2型糖尿病患者共54例，根据检眼镜检查和荧光素眼底血管造影（FFA）结果，依据1987年中华医学会DR分期标准将患者分为无DR（NDR）组18例、非增生型糖尿病视网膜病变（NPDR）组20例和增生型糖尿病视网膜病变（PDR）组16例，并收集年龄和性别与患者相匹配的18名健康体检者作为正常对照组。收集患者外周血，用ELISA法检测患者血清中PECAM一1的质量浓度；用高效液相色谱法检测患者血清中糖化血红蛋白（HbAlC）含量；采用全自动生化分析仪检测患者的血糖水平；探讨DR患者PECAM—l质量浓度与HbAlC含量的关系，并将各组患者的检测结果进行比较。结果PDR组、NPDR组、NDR组和正常对照组患者血清中PECAM-1质量浓度分别为（10．907-4-2．792）、（7．024±2．377）、（5．231±1．816）和（3．817±1．045）μg／L，总体差异有统计学意义（F=12．630，P=0．002），PDR组患者血清PECAM—l质量浓度明显高于NPDR组、NDR组和正常对照组，差异均有统计学意义（P〈0．05）。PDR组、NPDR组、NDR组和正常对照组患者血清HbAlC水平分别为（12．596±3．148）％、（9．118±3．356）％、（5．491±1．017）％和（4．992＋-0．725）％，总体比较差异有统计学意义（F=7．130，P=0．015），PDR组、NPDR组患者血清HbAlc水平显著高于NDR组和正常对照组，PDR组PECAM一1和HbAlc水平明显高于NPDR组和正常对照组，差异均有统计学意义（P〈0．05）。PDR组、NPDR组、NDR组患者血清PECAM-1质量浓度与血清HbAlc水平间均呈显著正相关（r=0．799，P〈0．01；r=0．647，P〈0．01；r=0．685，P〈0．01）。病程≥10年的PDR组与NPDR组糖尿病病程比较差异有统计学意义（P=0．023）。结论PECAM一1高表达是促进DR发生和发展的重要因素，与患者的高血糖状态密切相关，预防DR应以治疗糖尿病、控制血糖为主。

Background To study diabetic retinopathy （DR） related risk factors is very important in the prevention of DR. Platelet endothelial cell adhesion molecule-1 （ PECAM-1 ） is an important mediator that mediates high blood glucose-induced vascular diseases in diabetic patients. However, its mechanism is still below understood. Objective This clinical study was to investigate the effect of serum level changes of PECAM-1 on DR in type 2 diabetic patients. Methods Fifty-four patients with type 2 diabetes were enrolled from the endocrinology department of the Third People＇ s Hospital of Nantong City. Fundus examination was performed using the ophthalmoscope and fundus fluorescence angiography （FFA） on all the patients, and these patients were grouped as the non-DR （NDR） group （ 18 cases） , non-proliferative DR （NPDR） group （20 cases） and proliferative DR group （PDR） （16 cases） based on the DR staging criterion of the Chinese Medical Association （1987 version）. Eighteen age- and gender-matched normal subjects served as the normal control group. Peripheral blood was collected, and serum PECAM-1 levels were assayed using ELISA. Serum HbAlc levels were detected using the high performance liquid colorimetric（HPLC） method. The correlation of serum PECAM-1 level with serum HbAlc level was analyzed. All results were compared among the groups. Results The serum PECAM-1 levels were （ 10. 907 ± 2. 792 ） , （ 7. 024 ＋2. 377 ） , （ 5.231 _＋ 1.816 ） and （ 3.817 ＋- 1. 045 ） Ixg/L, respectively, in the PDR group, NPDR group, NDR group and normal control group, showing a significant difference among the 4 groups （ F = 12. 630, P = 0.02 ）. Serum PECAM-1 content was significantly higher in the PDR group when compared with the NPDR group, NDR group and normal control group （ P〈0. 05 ）. The serum ItbA 1 c levels were （ 12. 596± 3. 148 ） %, （ 9. 118± 3. 356 ） %, （ 5.491 ± 1. 017）% and （4. 992± 0. 725 ）% in the PDR group, NPDR group, NDR group and normal control group, respectively, with a significant difference among these 4 groups （F= 7. 130, P = 0. 015 ） , and those in the PDR group and NPDR group were significantly elevated in comparison with the NDR group and normal control group （P〈0. 05）. Significantly positive correlations were seen between serum PECAM-1 level and HbAlc level in the PDR group, NPDR group and NDR group （ r=0. 799 ,P〈0.01 ;r=0. 647 ,P〈0.01 ;r=0. 685 ,P〈0.01 ）. Significantly more patients with a disease course of 〉I 10 years were in the NPDR group in comparison with the PDR group （P = 0. 023 ）, Conclusions Increase of serum PECAM-1 level is closely associated with blood glucose level,and it is an important factor in the pathogenesis and development of DR. These results imply that control of blood glucose is crucial for the prevention of DR in patient with type 2 diabetes.