增殖型2型糖尿病视网膜病变患者外周血ADAMTS13表达及对阿托伐他汀干预效果的评估价值

Expression of ADAMTS13 in peripheral blood of patients with proliferative type 2 diabetic retinopathy and its value in evaluating the effect of atorvastatin intervention

目的探究增殖型2型糖尿病视网膜病变患者外周血血管性血友病因子裂解蛋白酶(von Willebrand factor cleaving protease,ADAMTS13)表达及对阿托伐他汀干预效果的评估价值。方法选取江苏省海安市人民医院增殖型糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)患者118例为PDR组,所有患者均为2型糖尿病(type 2 diabetes mellitus,T2DM),均进行血浆ADAMTS13的活性检查。将所有PDR患者根据随机数字表法分为对照组及观察组,各59例,对照组进行常规的降糖治疗,观察组在基础降糖治疗的基础上加用阿托伐他汀。连续服用3个月后检测PDR患者血糖、血脂及血浆ADAMTS13及色素上皮衍生因子(pigment epithelium-derived factor,PEDF)活性。结果PDR组血浆ADAMTS13活性远远低于临床正常值。治疗后,2组血糖水平及糖化血红蛋白水平均低于治疗前(P<0.05),观察组糖化血红蛋白水平低于对照组(P<0.05)。治疗后,2组TG、TC及LDL-C水平均低于治疗前,观察组TG、TC及LDL-C水平均低于对照组(P<0.05)。治疗后,2组血浆ADAMTS13活性升高,血浆PEDF活性降低,观察组血浆ADAMTS13、PEDF活性高于对照组(P<0.05)。Pearson相关性分析结果显示,ADAMTS13与PEDF、血糖、糖化血红蛋白、TG、TC及LDL-C均呈负相关(r=-0.451、-0.573、-0.612、-0.548、-0.650、-0.504,P<0.001),基线ADAMTS13与治疗后改善程度呈正相关(r=0.572,P<0.001)。结论T2DM合并PDR患者血浆ADAMTS13活性降低,阿托伐他汀能够有效控制T2DM合并PDR患者血糖、血脂,并促进PDR患者的ADAMTS13表达,ADAMTS13表达能够反映阿托伐他汀的治疗效果。

Objective To investigate the expression of von Willebrand factor cleaving protease(ADAMTS13)in peripheral blood of patients with proliferative type 2 diabetic retinopathy and its value in evaluating the effect of atorvastatin intervention.Methods A total of 118 patients with proliferative diabetic retinopathy(PDR)in Haian People′s Hospital were selected as the PDR group,and all the patients had type 2 diabetes mellitus(T2DM).All of them were tested for the activity of plasma ADAMTS13.All PDR patients were divided into control group and observation group according to the random number table method,with 59 patients in each group.The control group was given conventional hypoglycemic therapy,while the observation group was given atorvastatin on the basis of basic hypoglycemic therapy.The blood glucose,blood lipid and plasma ADAMTS13 and pigment epithelium-derived factor(PEDF)activities of PDR patients were detected at 3 months after continuous administration.Results The plasma ADAMTS13 activity in the PDR group was significantly lower than clinical normal value.After treatment,the blood glucose levels and glycated hemoglobin levels in both groups were lower than those before treatment(P<0.05),while the glycated hemoglobin levels in the observation group were lower than those in the control group(P<0.05).After treatment,the levels of TG,TC,and LDL-C in both groups were lower than those before treatment,and lower in the observation group than in the control group(P<0.05).After treatment,the plasma ADAMTS13 activity increased and plasma PEDF activity decreased in both groups.The plasma ADAMTS13 and PEDF activities in the observation group were higher than those in the control group(P<0.05).Pearson correlation analysis results showed that ADAMTS13 was negatively correlated with PEDF,blood glucose,glycated hemoglobin,TG,TC,and LDL-C(r=-0.451,-0.573,-0.612,-0.548,-0.650,-0.504,P<0.001),while baseline ADAMTS13 was positively correlated with the degree of improvement after treatment(r=0.572,P<0.001).Conclusion Plasma ADAMTS13 expression in patients with T2DM and PDR is down-regulated.Atorvastatin can effectively control blood glucose and blood lipids in patients with T2DM and PDR,and promote the expression of ADAMTS13 in patients with PDR.ADAMTS13 expression can reflect the therapeutic effect of atorvastatin.