房水中IL-6、TNF-α和VEGF的变化与糖尿病性黄斑水肿的相关性研究

The correlation analysis of IL-6,TNF-α and VEGF concentrate in aqueous humor with diabetic macular edema

目的观察糖尿病性黄斑水肿(DME)患者玻璃体腔内注射康柏西普(IVC)治疗前后房水中白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和血管内皮生长因子(VEGF)的浓度变化,并探讨其与DME的相关性。方法前瞻性病例研究。选择蚌埠医学院第一附属医院2020年7月至2021年7月收治的DME患者40例(40只眼),所有DME患者均为第1次接受治疗,同意行玻璃体腔内注射0.05 ml康柏西普,在首次及第2次IVC注射前采集患者房水,并使用Elisa试剂盒来检测房水中IL-6、TNF-α和VEGF浓度。在两次IVC术前,所有DME患者均进行最佳矫正视力(BCVA)和黄斑中心凹厚度(CMT)检查,分析两次IVC术前房水中IL-6、TNF-α和VEGF浓度与CMT、BCVA之间的联系。结果首次注药前DME患者房水中IL-6、TNF-α和VEGF的浓度分别为(27.18±15.99)pg/ml、(4.88±3.72)pg/ml和(224.77±114.46)pg/ml,其中IL-6和VEGF均与CMT呈正相关(r=0.652、0.847,均P<0.05)。IVC术后1个月后,DME患者眼内IL-6、VEGF浓度为(21.71±13.95)pg/mL、(128.53±75.51)pg/ml,明显低于基线水平均(均P<0.001),TNF-α浓度为(4.90±4.57)pg/ml,手术前后未见明显变化(P>0.05)。康柏西普治疗后BCVA较治疗前明显提高(P=0.001),CMT明显降低(P=0.002),由(479±116)μm降低至(375±84)μm。结论IL-6和VEGF浓度的变化与DME的发生发展密切相关,玻璃体腔内注射康柏西普后可使IL-6和VEGF的表达降低,CMT变薄,黄斑区水肿减轻,视力得到改善。

Objective To investigate the relationship between the levels of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and vascular endothelial growth factor(VEGF)and diabetic macular edema(DME)before and after intravitreal with injection of Conbercept(IVC)and to determine the correlation between them and disease activity.Methods A prospective analysis enrolled 40 patients(40 eyes)who were diagnosed with diabetic macular edema at the First Affiliated Hospital of Bengbu Medical College from July 2020 to July 2021.All patients received intravitreal injection 0.05ml of Conbercept.The aqueous humor was collected preoperatively.Elisa kit was used to detect the levels of IL-6,TNF-α and VEGF in aqueous humor.All patients received the best corrected visual acuity(BCVA)and macular fovea thickness(CMT)examination before the two IVC operations.The relationship between the concentrations of IL-6,TNF-αand VEGF in aqueous humor,and CMT and BCVA before the two IVC operations was analyzed.Results The concentrations of IL-6 and VEGF in the aqueous humor of DME patients before the first injection were(27.18±15.99)pg/ml、(4.88±3.72)pg/ml and(224.77±114.46)pg/ml,which were positively correlated with CMT(r=0.652,0.847,all P<0.05).IL-6 and VEGF concentrations(21.71±13.95 pg/mL and 128.53±75.51 pg/ml,both P<0.001)of DME patients were significantly lower than baseline at one month after IVC,while TNF-α concentration(4.90±4.57 pg/ml)had no significant difference before and after operation(P>0.05).BCVA was significantly increased after Compaxerib treatment(P=0.001).The thickness of macular fovea(CMT)decreased significantly(P=0.002),from(479±116)μm to(375±84)μm.Conclusions The levels of IL-6 and VEGF in aqueous humor were correlated with the occurrence and development of DME.IVC could bring down the expression of IL-6 and VEGF in aqueous humor,thinened CMT,alleviated macular edema,and improved visual acuity.