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增生型糖尿病视网膜病变玻璃体中微粒水平及其临床意义 被引量:1

Level and clinical significance of vitreous microparticles in proliferative diabetic retinopathy
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摘要 目的观察增生型糖尿病视网膜病变(PDR)患眼玻璃体中微粒水平,初步探讨微粒在PDR发病中的作用。方法病例对照研究。2018年1〜12月在天津医科大学总医院眼科确诊并接受玻璃体切割手术(PPV)治疗的PDR患者54例54只眼(PDR组)、非糖尿病视网膜病变患者20例20只眼(对照组)的玻璃体样本纳人研究。PDR组54只眼中,玻璃体积血(VH)、牵拉性视网膜脱离(TRD)、既往接受玻璃体腔注射药物治疗分别为42、21、17只眼。对照组20只眼中,特发性黄斑裂孔、特发性黄斑前膜、玻璃体黄斑牵拉综合征、晶状体完全脱位分别为6、6、2、6只眼。PDRI且依据PDR分期、是否发生TRD分为未合并TRD组、合并TRD组,分别为33、21只眼。依据有无VH分为伴VH组、不伴VH组,分别为42、12只眼。根据PPV前3d是否行玻璃体腔注射抗血管内皮生长因子(VEGF)药物治疗分为抗VEGF药物治疗组、未行抗VEGF药物治疗组,分别为17、37只眼。流式细胞仪检测玻璃体样本中视网膜光感受器细胞来源(RMP)、血小板来源(PMP)、内皮细胞来源(EMP)和膜表面表达磷脂酰丝氨酸(PS-MP)的水平。两组样本间比较采用t验,多组样本间比较采用单因素方差分析或Mann-Whitney检验。结果与对照组比较,PDR组患眼玻璃体中RMP水平显著降低,EMP、PMP水平显著升高,差异均有统计学意义(t=-2.361、5.064、3.531,P=0.018、<0.001、0.001)。两组患眼玻璃体中PS-MP水平比较,差异无统计学意义(t=-1.617,Р=0.110)。与未合并TRD组比较,合并TRD组患眼玻璃体中RMP、РМР水平显著升高,差异有统计学意义(t=-2.221、-2.098,Р=0.031、0.041)。抗VEGF药物治疗组患眼玻璃体中ЕМР水平显著低于未行抗VEGF药物治疗组,但仍高于对照组,差异有统计学意义(Z=-2.430、-2.499,P=0.015、0.012)。不伴VH组患眼玻璃体中PMP水平显著高于伴VH组,差异有统计学意义(Z=-3.097,>0.003)。结论PDR患者玻璃体中EMP、PMP水平升高,可能与视网膜微血管受损有关;手术前玻璃体腔注射抗VEGF药物可降低EМР水平;VH可能与PMP促凝作用有关。 Objective To observe the level of microparticles in the vitreous of patients with proliferative diabetic retinopathy(PDR),and preliminarily explore the role of microparticles in the pathogenesis of PDR.Methods A case control study.From January to December 2018,54 cases of 54 eyes of PDR patients(PDR group)and 20 cases of non-diabetic retinopathy patients(control group),who were diagnosed and treated with vitrectomy(PPV)in the Department of Ophthalmology,Tianjin Medical University General Hospital vitreous samples were included in the study.Among 54 eyes in the PDR group,there were 42,21,and 17 eyes with vitreous hemorrhage(VH),traction retinal detachment(TRD),and previous intravitreal injection of drugs,respectively.Among the 20 eyes of the control group,idiopathic macular hole,idiopathic anterior macular membrane,vitreous macular traction syndrome,and complete lens dislocation were 6,6,2,and 6 eyes,respectively.The PDR group was divided into uncombined TRD group and combined TRD group according to PDR stage and whether TRD occurred,with 33 and 21 eyes,respectively.According to the presence or absence of VH,they were divided into groups with VH and without VH,with 42 eyes and 12 eyes,respectively.According to whether anti-vascular endothelial growth factor(VEGF)drugs were injected into the intravitreal cavity 3 days before PPV,they were divided into anti-VEGF dmg group and no anti-VEGF drug group,with 17 eyes and 37 eyes respectively.The levels of retinal photoreceptor cells(RMP),platelets(PMP),endothelial cells(EMP)and phosphatidylserine(PS-MP)expressing on the membrane surface in the sample were detected by flow cytometry.The comparison between the two groups of samples was performed by t test,and the comparison between multiple groups of samples was performed by one-way analysis of variance or Mann-Whitney test.Results Compared with the control group,the vitreous RMP level of the PDR group was significantly decreased,and the EMP and PMP levels were significantly increased.The differences were statistically significant(t=-2.361,5.064,3.531;P=0.0183<0.001,0.001).There was no statistically significant difference in PS-MP levels between the two groups(t=-1.617,P=0.110).Compared with the TRD group,the levels of RMP and PMP in the vitreous of the TRD group were significantly increased,and the difference was statistically significant(t=-2.221,-2.098;P=0.031,0.041).The level of EMP in the vitreous body of the anti-VEGF drug group was significantly lower than that of the non-anti-VEGF drug group,however,it was still higher than the control group.The difference was statistically significant(Z=-2.430,-2.499;P=0.015,0.012).The level of PMP in the vitreous body of the eye without VH was significantly higher than that in the group with VH,and the difference was statistically significant(Z=-3.097,P=0.003).Conclusions The elevated levels of EMP and PMP in the vitreous of PDR patients may be related to the damage of retinal capillaries;intravitreal injection of anti-VEGF drugs before surgery can reduce the level of EMP.VH may be related to the procoagulant effect of PMP.
作者 廖梦宇 宋尹婷 颜华 Liao Mengyu;Song Yinting;Yan Hua(Department of Ophthalmology,Tianjin Medical University General Hospital,Tianjin Medical University Basic Medical Research Center,Laboratory of Molecular Ophthalmology,Tianjin 300052,China)
出处 《中华眼底病杂志》 CSCD 北大核心 2021年第8期610-616,共7页 Chinese Journal of Ocular Fundus Diseases
基金 国家自然科学基金[国际(地区)合作与交流项目](82020108007) 国家自然科学基金(重点项目)(81830026) 京津冀专项项目[19JCZDJC64300(Z)]。
关键词 糖尿病视网膜病变 玻璃体 细胞源性微粒 血管生成抑制剂 Diabetic retinopathy Vitreous body Cell-derived microparticles Angiogenesis inhibitors
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