糖尿病视网膜病变患者血清S100A8／A9变化与视网膜炎症反应的关系

Relationship of serum SI00A8/A9 complex and retinal inflammation in patients with diabetic retinopathy

背景 炎症－免疫机制是目前糖尿病视网膜病变（DR）机制研究的热点之一，研究表明，S100A8/A9蛋白复合物与炎症相关，但S100A8/A9蛋白是否参与DR的发生和发展有待探讨。目的 测定糖尿病（DM）及DR患者血清S100A8/A9蛋白质量浓度，探讨其在疾病发生和发展中的作用。方法 采用病例对照研究设计，选取2014年1-6月在上海市徐汇区中心医院诊治的DR患者（DR组）和无视网膜病变的2型DM患者（DM组）30例，以及健康体检者（正常对照组）30人，依据DR的病变程度将DR组亚分为非增生性DR（NPDR）组和增生性DR（PDR）组。采集受检者空腹静脉血并分离血清，采用ELISA法测定受检者血清S100A8/A9蛋白质量浓度，分别采用免疫透射比浊法和免疫凝集法测定受检者血清超敏C反应蛋白（hsCRP）质量浓度和糖化血红蛋白（HbAlc）含量。结果 DR组、DM组和正常对照组受检者血清S100A8/A9质量浓度分别为（9.74±0.59）、（11.41±0.64）和（6.46±0.62）μg/L，其中DM组和DR组患者血清S100A8/A9质量浓度均明显高于正常对照组，DM组患者血清S100A8/A9质量浓度明显高于DR组，差异具有统计学意义（均P＝0.00）；DR组、DM组和正常对照组受检者血清hsCRP质量浓度分别为（1.40±0.34）、（1.27±0.13）和（1.11±0.12）mg/L，其中DR组、DM组患者血清hsCRP质量浓度均明显高于正常对照组，差异均有统计学意义（均P＝0.00）；DR组和DM组患者血清HbAlc含量明显高于正常对照组，差异均有统计学意义（均P＝0.00），而DR组与DM组差异无统计学意义（P＝0.12）。NPDR组与PDR组间患者血清S100A8/A9和hsCRP质量浓度及血清HbAlc含量的差异均无统计学差异（t＝－0.10，P＝0.92；t＝－0.17，P＝0.87；t＝0.66，P＝0.51）。血清S100A8/A9蛋白质量浓度与血清hsCRP质量浓度间呈弱正相关（r＝0.36，P＝0.00）。结论 S100A8/A9蛋白是炎症标志物分子之一，可能参与DM相关微血管病变的发生及发展，控制血糖浓度能够减缓DM患者的炎症反应。

Background Inflammation is one of the most popular aspects in the studies of diabetic retinopathy （DR） mechanisms.Researches showed that S100A8/A9 participate in the inflammatory procedure of many diseases, however, the relationship between S100A8/A9 complex and retinal inflammation of DR needs to be researched. Objective This study was to detect the serum S100A8/A9 level of diabetes mellitus （DM） and DR patients, and explore its role in DM an DR development.Methods A cases-controlled study was carried out.The DR patients, type 2 DM patients without retinal change and heathy controls were enrolled in Shanghai Xuhui Central Hospital from January to June 2014, and 30 patients for each group.The DR patients were subgrouped to non-proliferative DR （NPDR） group and proliferative DR （PDR） group.The periphery blood was collected to isolate the serum, and serum S100A8/A9 complex level was detected by ELISA.Serum high-sensitivity C-reactive protein （hsCRP） and glycosylated hemoglobin A1C （HbAlc） level was assayed by immunity turbidimetry and immune agglutination respectively.Results Serum S100A8/A9 complex levels in the DR group, DM group and normal control group were （9.74±0.59）, （11.41±0.64） and （6.46±0.62）μg/L, respectively, and the serum S100A8/A9 complex level in the DM group and DR group was significantly higher than that in the normal control group, and the serum S100A8/A9 complex level in the DM group raised in compared with the DR group （all at P〈0.01）. Serum hsCRP levels in the DR group, DM group and normal control group were （1.40±0.34）, （1.27±0.13） and （1.11±0.12）mg/L, respectively, with the highest value in the DR group and the lowest value in the normal control group （ all at P=0.00）. The serum HbAlc levels were higher in the DR group and DM group than those in the normal control group （both at P=0.00）, while no significant difference was found in the serum HbAlc level between DR group and DM group （P=0.12）. There was no significant differece in the serum S100A8/A9, hsCRP and HbAlc levels between NPDR group and PDR group （t=-0.10, P=0.92; t=-0.17, P=0.87; t=0.66, P=0.51）. A weak positive correlation was seen between serum S100A8/A9 level and serum hsCRP level （r=0.36, P=0.00）.Conclusions As an inflammatory marker, S100A8/A9 complex might play an important role in the pathogenesis and development of DR.Intensive control of glycemia can alleviate retinal inflammation in DM patients.