探讨不同分期糖尿病视网膜病变患者多焦视网膜电图及超敏血清C反应蛋白水平变化及意义

Clinical significance of serum level of hypersensitive C-reaction protein and multifocal electroretinogram changes in patients with different stages of diabetic retinopathy

目的探讨不同分期糖尿病视网膜病变(DR)患者多焦视网膜电图(mf ERG)及超敏血清C反应蛋白(hs-CRP)水平变化及意义。方法选择2型糖尿病患者102例,无糖尿病视网膜病变(NDR)12例,非增生性糖尿病视网膜病变(NPDR)39例,增生性糖尿病视网膜病变(PDR)51例。另选健康体检者38例作为健康对照组。采用酶联免疫吸附(ELISA)检测CRP水平,同时行眼科mf ERG检查。结果随着DR病程分级的进展,hs-CRP逐渐增高,PDR组hs-CRP显著高于NPDR和NDR组(P<0.05),NPDR组hs-CRP显著高于NDR组(P<0.05)。PDR组N1波和P1波反应密度在环1、2、3、4、5上均比对照组、NDR组和NPDR组显著性降低(P<0.05);而NPDR组N1波和P1波反应密度在环1、2、3上与NDR相比均显著性降低(P<0.05),NDR组N1波和P1波反应密度在环1、2、3上比对照组显著性降低(P<0.05)。hs-CRP的水平与DR分级呈正相关(r=0.782,P<0.05);mf ERG的N1波及P1波反应密度与DR分级呈负相关(r=-0.734,P<0.05)。结论不同程度的DR的C反应蛋白和多焦视网膜电图有变化,而且有相关性。DR患者mf ERG功能与hs-CRP水平与DR的发生发展密切相关,mf ERG检测联合hs-CRP检测在DR疾病的早期诊断、随访中具有临床应用价值。

Objective To explore clinical significance of serum level of hypersensitive C-reaction protein （ hs- CRP ） and muhifocal electroretinogram change in patients with different stages of diabetic retinopathy （ DR ）. Methods We selected 102 patients with type 2 diabetes me｜litus in this study. Among them, 12 were NDR, 39 were NPDR and 51 were PDR. Another 38 healthy subjects were enrolled as control. The hs-CRP level was detected by enzyme linked immunosor- bent assay （ ELISA）. Muhifoeal ERG （ mfERG） was performed. Results With the progression of DR hs-CRP level grad- ually increased, hs-CRP was significantly higher in PDR group than in NPDR and NDR patients （ P 〈 0. 05 ） , and was significantly higher in NPDR than in NDR patients （ P 〈0.05 I- In PDR patients, N1 and P1 wave response density in rings 1,2, 3, 4 and 5 were significantly lower than all other patients （ P 〈 O. 05 ）. The N1 and P1 wave response density in rings 1,2, and 3 were significantly lower in NPDR than in NDR patients （ P 〈 0. 05 ） and lower in NDR than in control （ P 〈 0. 05 ）. hs-CRP level was positively correlated with DR classification （ r = 0. 782, P 〈 0. 05 ）. N1 and P1 wave re- sponse density were negatively correlated with DR grading （ r = - O. 734, P 〈 0.05 ）. Conclusions DR is closely related to the occurrence and progression of functional changes in mfERG and the level of hs-CRP, mfERG combined with hs-CRP showed high sensitivity in the diagnosis of early DR and therefore the two examination methods have clinical value in early diagnosis and follow-up of DR disease.