血清中胰岛素样生长因子Ⅰ、肿瘤坏死因子α、血管内皮生长因子165在糖尿病视网膜病变中的诊断价值

Clinical significance of serum insulin-like growth factor-Ⅰ, tumor necrosis factor-α, and vascular endothelial growth factor 165 in patients with diabetic retinopathy

探讨血清中胰岛素样生长因子Ⅰ(insulin-like growth factor-Ⅰ,IGF-Ⅰ)、肿瘤坏死因子 α(tumor necrosis factor-α,TNF-α)和血管内皮生长因子165(vascular endothelial growth factor,VEGF)的表达水平与糖尿病视网膜病变(diabetic retinopathy,DR)发生发展的相关性.选择2015年9月至2017年9月在本院住院已确诊为糖尿病患者129例(病例组),其中糖尿病不伴有视网膜病变组58例(NDR)、糖尿病伴有非增殖期视网膜病变组45例(NPDR)、糖尿病伴增殖期视网膜病变组26例(PDR),同时选择同期体检的健康人110名作为正常对照组.根据眼底照相和眼底荧光造影判断视网膜病变的严重程度.检测所有受试者的血糖、BMI、HbA1C、TC、TG、HDL-C、LDL-C和VLDL-C.再采用酶联免疫吸附测定法分别检测血清中IGF-Ⅰ、TNF-α 及VEGF165的浓度.病例组患者的血清中IGF-Ⅰ、TNF-α、VEGF165的表达量均明显高于正常对照组(均P<0.05).随着糖尿病视网膜病变患者的病情加重,血清中IGF-Ⅰ、TNF-α、VEGF165的表达水平也随之增加.Pearson相关分析显示,血清IGF-Ⅰ与TNF-α、TNF-α 和VEGF165、IGF-Ⅰ和VEGF165均呈正相关(P<0.05).Logistic回归分析显示,IGF-Ⅰ和VEGF165是DR的危险因素(OR值为1.059、1.165,均P<0.05).IGF-Ⅰ、TNF-α 和VEGF165联合检测诊断的敏感性、特异性和诊断准确率均高于IGF-Ⅰ、TNF-α 和VEGF165单独诊断效果(曲线下面积分别为0.968、0.928、0.792、0.893,均P<0.05).血清中IGF-Ⅰ、TNF-α 和VEGF165的表达水平与糖尿病视网膜病变病情严重程度有关,IGF-Ⅰ、TNF-α 和VEGF165联合检测对糖尿病视网膜病变的诊断优于IGF-Ⅰ、TNF-α 和VEGF165单一指标的检测.

To determine the associations between expressions of insulin-like growth factor-Ⅰ( IGF-Ⅰ), tumor necrosis factor-α (TNF-α), and vascular endothelial growth factor (VEGF) 165 in serum, and the occurrence and development of diabetic retinopathy ( DR). A total of 129 patients diagnosed as DM in our hospital between September 2015 and September 2017 were randomly selected in the study, including 58 cases single DM, diabetes with non-proliferative retinopathy group ( 45 cases) and diabetic proliferative retinopathy group ( 26 cases). Meanwhile, 110 healthy examinees during the same period were collected as a normal control group. The severity of retinopathy was judged by fundus photography and fundus fluorescein angiography. Blood glucose, BMI, HbA1C , TC, TG, HDL-C, LDL-C, and VLDL-C were detected in all subjects. Enzyme-linked immunosorbent assay (ELISA) was adopted to detect the serum concentrations of IGF-Ⅰ, TNF-α, and VEGF165. The expressions of serum IGF-Ⅰ, TNF-α, and VEGF in DM patients were significantly higher than those in the control group (all P<0.05). As diabetic retinopathy worsened, the expressions of serum IGF-Ⅰ, TNF-α, and VEGF increased. Pearson correlation analysis showed that serum IGF-Ⅰ was positively correlated with TNF-α, TNF-α, and VEGF165, IGF-Ⅰ, and VEGF165(P<0.05). Logistic regression analysis showed that IGF-Ⅰ and VEGF165 were risk factors for DR (OR = 1.059, 1.165, all P<0.05). The sensitivity, specificity and diagnostic accuracy of IGF-Ⅰ, TNF-α, and VEGF165 were higher than IGF-Ⅰ, TNF-α, and VEGF165 alone(AUC = 0.968, 0.928, 0.792, 0.893, all P<0.05). The expression level of IGF-Ⅰ, TNF-α, and VEGF165 in serum was related to the severity of diabetic retinopathy. The diagnosis of diabetic retinopathy with combined IGF-Ⅰ, TNF-α, and VEGF165 measurements was better than the single index of IGF-Ⅰ, TNF-α, and VEGF165.