飞秒激光辅助的白内障手术对2型糖尿病患者术中房水细胞因子表达的影响

Effects of femtosecond laser assisted cataract surgery on the expression of aqueous cytokine in patients with type 2 diabetes mellitus

目的检测合并2型糖尿病的白内障患者行飞秒辅助的白内障手术时术中房水中前列腺素E_2(prostaglandin E_2,PGE_2)、白细胞介素6(interleukin 6,IL-6)、白细胞介素1β(interleukin 1β,IL-1β)、肿瘤坏死因子α(tumor necrosis factorα,TNF-α)及血管内皮生长因子(vascular endothelial growth factor,VEGF)的浓度,并探讨其和术后糖尿病黄斑水肿(diabetes macular edema,DME)的关系。方法前瞻性队列研究。将在武汉爱尔眼科医院接受飞秒激光辅助的白内障手术112例(112眼)患者纳入本研究,并按是否合并2型糖尿病分成两组:糖尿病组61例(61眼),对照组51例(51眼)。在飞秒激光步骤完成之后立即收集2组房水样本。采用酶联免疫吸附方法检测房水样本中PGE_2、IL-6、IL-1β、TNF-α及VEGF的浓度。术前及术后均使用OCT检测并比较2组患者的黄斑中央区厚度。结果糖尿病组房水样本中PGE_2浓度为(87.4±12.1)ng·L^(-1)、IL-6浓度为(39.7±6.6)ng·L^(-1)、IL-1β浓度为(59.2±7.2)ng·L^(-1)、TNF-α浓度(6.3±1.0)ng·L^(-1)、VEGF浓度为(274.1±40.4)ng·L^(-1);对照组房水样本中PGE_2浓度为(67.6±9.4)ng·L^(-1)、IL-6浓度为(24.8±5.7)ng·L^(-1)、IL-1β浓度为(27.1±5.3)ng·L^(-1)、TNF-α浓度(3.1±0.5)ng·L^(-1)、VEGF浓度为(189.7±17.6)ng·L^(-1)。糖尿病组房水样本中的PGE_2、IL-6、IL-1β、TNF-α及VEGF的浓度均明显高于对照组(均为P<0.01)。房水样本中PGE_2、IL-6、IL-1β、TNF-α及VEGF的浓度释放与年龄、性别、激光固定时间及激光作用时间均无相关性(均为P>0.05)。糖尿病组术前黄斑中央区厚度为(142.5±7.6)μm,术后为(166.5±13.6)μm,术前术后无明显差异(P>0.05)。对照组术前黄斑中央区厚度为(139.4±10.2)μm,术后为(156.2±7.0)μm,术前术后差异无统计学意义(P>0.05)。结论飞秒激光辅助的白内障手术中糖尿病患者术前术后黄斑中央区厚度均未发现明显差异,且所有患者均未出现术后黄斑水肿。

Objective To investigate aqueous humour concentrations of PGE2,IL-6,IL-1β,TNF-α,VEGF in patients with diabetes mellitus undergoing femtosecond laser-assisted cataract surgery and the potential relationship to postoperative diabetes macular edema （DME）.Methods Prospective consecutive nonrandomized comparative cohort study was conducted in 112 eyes of 112 patients undergoing femtosecond laser-assisted cataract surgery who were divided into 2 groups,and 61 eyes from 61 patients with diabetes mellitus were DM group,while 51 eyes from 51 non-diabetic patients were control group.And 100 μL aqueous humour was collected after laser treatment.Human PGE2,IL-6,IL-1β,TNF-α and VEGF ELISA kits were used to determine the concentrations of PGE2,IL-6,IL-1β,TNF-α and VEGF in the aqueous humour.Central foveal thickness was measured using OCT before and after surgery,and DME was defined as an 30% increase in foveal thickness after operation.All patients were treated with non-steroidal anti-inflammatory drugs prior to surgery.Results For PGE2,IL-6,IL-1β,TNF-α and VEGF,the mean concentration values in aqueous humour were （87.4±12.1）ng·L-1,（39.7±6.6）ng·L-1,（59.2±7.2）ng·L-1,（6.3±1.0）ng·L-1,（274.1±40.4）ng·L-1 in the DM group,and （67.6±9.4）ng·L-1,（24.8±5.7）ng·L-1,（27.1±5.3）ng·L-1,（3.1±0.5）ng·L-1,（189.7±17.6）ng·L-1in the control group,respectively.Concentrations of PGE2,IL-6,IL-1β,TNF-α and VEGF were significantly higher in the DM group than those in the control group （all P〈0.01）.There no significant correlations between concentrations of PGE2,IL-6,IL-1β,TNF-α or VEGF and age,sex,cataract densities,suction time or laser time （all P〉0.05）.In DM group,the mean fovea thickness was （142.5±7.6）μm preoperatively and （166.5±13.6）μm postoperatively,and difference was not significant （P〉0.05）.In control group,the mean fovea thickness was （139.4±10.2）μm preoperatively and （156.2±7.0）μm postoperatively,and difference was not significant （P〉0.05）.Conclusion Aqueous humour concentrations of PGE2,IL-6,IL-1β,TNF-α,VEGF were significantly higher in the DM group than those in the control group after femtosecond laser treatment,but there was no significant difference in the retinal thickness of the macular fovea before and after the operation and no cystoid macular edema was found in the two groups.