补体、炎症因子与2型糖尿病视网膜病变关系的研究

Association of complements,inflammatory factors and type 2 of diabetic retinopathy

目的研究糖尿病视网膜病变(diabetic retinopathy,DR)的严重程度与血浆炎症因子、补体的水平关系,为糖尿病视网膜病变的发病机制提供理论依据。方法选取2型糖尿病无DR患者30例,2型糖尿病有DR患者68例(轻度NPDR组23例、中度NPDR组15例,重度NPDR15组例,增生期PDR15组例)。检测血浆白介素6(interleukin-6,IL-6)、白介素8(interleukin-8,IL-8)、补体C3、C4、C1q、血沉(erythrocyte sedimentation rate,ESR)、空腹血糖(fasting plasma glucose,FPG)、餐后2小时血糖(postprandial blood glucose,PBG)、糖化血红蛋白(glycosylated hemoglobin,HbA1c)等指标。结果IL-8在中度NPDR(22.92±12.16 pg/mL)、重度NPDR(25.28±11.31 pg/mL)均高于DM无DR组(19.06±9.48 pg/mL)、轻度NPDR组(16.76±10.32 pg/mL)、PDR组(14.51±3.94 pg/mL)(P<0.05)。补体C1q在重度NPDR组(195.12±33.58 mg/L)显著高于DM无DR组(166.8±28.37 mg/L)、轻度NPDR组(163.4±31.36 mg/L)、中度NPDR(166.5±28.10 mg/L)、PDR组(160.7±36.39 mg/L)(P<0.05)。5组之间补体C3、ESR、FPG、PBG、HbA1c差异具有统计学意义(P<0.05)。结论糖尿病视网膜病变患者的补体激活、炎症反应程度在NPDR期重于PDR期,且与非增殖期视网膜严重程度成正比。积极干预糖尿病患者早期补体激活及阻断炎症反应可能有助于预防糖尿病视网膜病变的发展。

Objective To study the relationship between the severity of diabetic retinopathy(DR)and the levels of plasma inflammatory factors,and complement,and to provide a theoretical basis for the pathogenesis of DR.Methods 30 patients with type 2 diabetes without DR(DM-free DR group)and 68 patients with type 2 diabetes with DR were selected(23 cases in mild NPDR group,15 cases in moderate NPDR group,15 cases in severe NPDR group and 15 cases in proliferative pDRstage).Among these,plasma interleukin-6(IL-6),interleukin-8(IL-8),complement C3,C4,C1q,erythrocyte sedimentation rate(ESR),postprandial blood glucose(PBG),glycosylated hemoglobin(HbA1c)and other indexes were detected.Results IL-8 was higher in the moderate NPDR(22.92±12.16 pg/mL)and severe NPDR(25.28±11.31 pg/mL)than in the DM-free DR group(19.06±9.48 pg/mL),mild NPDR group(16.76±10.32 pg/mL),PDR group(14.51±3.94 pg/mL)(P<0.05).Complement C1q was significantly higher in the severe NPDR group(195.12±33.58 mg/L)than in the DM-free DR group(166.8±28.37 mg/L),mild NPDR group(163.4±31.36 mg/L),moderate NPDR(166.5±28.10 mg/L),PDR group(160.7±36.39 mg/L)(P<0.05).The differences in complement C3,ESR,FPG,PBG,HbA1c between the 5 groups were also statistically significant(P<0.05).Conclusion The degree of complement activation and inflammatory response in patients with diabetic retinopathy is heavier in the NPDR stage than in the PDR stage,and is directly proportional to the severity of retinal in the non-proliferative stage.Active intervention in early complement activation and blocking of the inflammatory response in diabetic patients may help prevent the development of diabetic retinopathy.