Ocular complications of diabetes mellitus

Diabetes mellitus(DM) is a important health problem that induces ernestful complications and it causes significant morbidity owing to specific microvascular complications such as, retinopathy, nephropathy and neuropathy, and macrovascular complications such as, ischaemic heart disease, and peripheral vasculopathy. It can affect children, young people and adults and isbecoming more common. Ocular complications associated with DM are progressive and rapidly becoming the world's most significant cause of morbidity and are preventable with early detection and timely treatment. This review provides an overview of five main ocular complications associated with DM, diabetic retinopathy and papillopathy, cataract, glaucoma, and ocular surface diseases.

Variations and Clinical Significance of Coagulation and Fibrinolysis Parameters in Patients with Diabetes Mellitus

We observed the changes of parameters of coagulation and fibrinolytic system in order to understand the clinical implication of these variations in type Ⅱ diabetic patients. Subjects consisted of 22 patients with type Ⅱ diabetes mellitus and 25 healthy controls. Compared with the control, activated partial thrombo-plastin time, prothrombin time were shortened in the patients. The diabetic subjects also displayed higher levels of D-dimer, serum fibrin degradation products, median concentrations of fibrinogen (3. 99 vs 2. 96 g/L, P<0. 01) and von Wille-brand factor (149 % vs 87 %, P<0. 01). Levels of anfithrombin Ⅲ activity or antigen were not different from control values. Simple linear regression analysis revealed a negative correlation between antithrombin Ⅲ activity and fast blood glucose. Diabetic patients with vascular complications had significantly higher levels of fibrinogen and D-dimer than those without diabetic angiopathy. Our data demonstrated that patients with type Ⅱ diabetes mellitus had a hypercoagulable state. We believed the activation of coagulation might contribute to the vascular complications in diabetics.

Optical angiography for diabetes-induced pathological changes in microvascular structure and function:An overview

Diabetes mellitus(DM)is a kind of metabolic disorder characterized by chronic hyperglycemia and glucose intolerance due to absolute or relative lack of insulin,leading to chronic damage of vasculature within various organ systems.These detrimental e®ects on the vascular networks will result in the development of various diseases associated with microvascular injury.Modern optical imaging techniques provide essential tools for accurate evaluation of the structural and functional changes of blood vessels down to capillaries level,which can o®er valuable insight on understanding the development of DM-associated complications and design of targeted therapy.This review will brie°y introduce the DM-induced structural and functional alterations of vasculature within di®erent organs such as skin,cerebrum and kidneys,as well as how novel optical imaging techniques facilitate the studies focusing on exploration of these pathological changes of vasculature caused by DM both in-vivo and ex-vivo.

Real role of growth factor receptor-binding protein 10:Linking lipid metabolism to diabetes cardiovascular complications

Cardiovascular complications of patients with type 2 diabetes mellitus(T2DM)threaten the health and life of numerous individuals.Recently,growth factor receptor-binding protein 10(GRB10)was found to play a pivotal role in vascular complications of T2DM,which participates in the regulation of lipid metabolism of T2DM patients.The genetic variation of GRB10 rs1800504 is closely related to the risk of coronary heart disease in patients with T2DM.The development of GRB10 as a key mediator in the association of lipid metabolism with cardiovascular complications in T2DM is detailed in and may provide new potential concerns for the study of cardiovascular complications in T2DM patients.

Lipoprotein(a) in type 2 diabetic subjects and its relationship to diabetic microvascular complications

AIM: To estimate the level of serum lipoprotein (a) [Lp (a)] in type 2 diabetes mellitus patients and to determine the relationship between Lp(a) in type 2 diabetes mellitus patients and micro-vascular complications. METHODS: A cross sectional study was performed that enrolled 144 subjects with type 2 diabetes mellitus above the age of 25 years attending outpatient clinic of Government Medical College, Kozhikode. Lp(a) levels were measured quantitatively in venous samples using Turbidimetric Immunoassay in all subjects. Each patient was evaluated for micro vascular complications, namely diabetic retinopathy, nephropathy and neuropathy. The relationship between Lp(a) levels and the micro vascular complications was assessed by univariate analysis. RESULTS: Mean age of cases was 53.93 ± 10.74 years with a male to female ratio of 1.3:1. Mean duration of diabetes was 9.53 ± 7.3 years. Abnormal Lp(a) levels (≥ 30 mg/dL) were observed in 38 (26.4%) diabetic subjects. Seventy-eight (54.16%) cases had diabetic nephropathy and significantly higher Lp(a) levels were found among these cases [Median 28.2 mg/dL (Interquartile range; IQR 24.4-33.5) vs 19.3 mg/dL (IQR 14.7-23.5); P < 0.05]. Retinopathy was present among 66 (45.13%) cases and peripheral neuropathy was detected among 54 (37.5%) cases. However, Lp(a) levels were not significantly different among those with or without retinopathy and neuropathy. Positive correlation was found between higher Lp(a) levels and duration of diabetes (r = 0.165, P < 0.05) but not with HbA1c values (r = - 0.083). CONCLUSION: Abnormal Lp(a) levels were found among 26.4% of diabetic subjects. Patients with diabetic nephropathy had higher Lp(a) levels. No association was found between Lp(a) levels and diabetic retinopathy or neuropathy. Longer duration of diabetes correlated with higher Lp(a) levels.

Morbidity Profile and Causes of Mortality in Type 2 Diabetes Patients: Data from a Tertiary Teaching Hospital from Eastern India

Background: Data regarding the prevalence of morbidity and mortality in patients of Type 2 Diabetes Mellitus (T2DM) is scanty in India. Objectives: To determine the prevalence of micro and macro vascular complications, acute metabolic complications, infections, Non Alcoholic Fatty Liver Disease (NAFLD) and cause of mortality in T2DM patients admitted to a tertiary care teaching hospital in Eastern India. Material and Methods: This was a hospital-based prospective study evaluating 150 T2DM patients admitted to a tertiary care institution in Eastern India. Diagnosis of micro and macro vascular complications, infections and NAFLD was made using standard protocols. In case of death, the most probable cause was noted. Results: Out of 150 patients, 14.7% of patients were newly diagnosed T2DM and out of them 41% of patients had vascular complications and 54.5% had infections. Of the total patients, 56% had nephropathy, 20% neuropathy, 17.3% retinopathy, 31.3% CVD, 11.3% CAD, 4.6% acute metabolic complications, 44% infections and 16.6% had NAFLD respectively. Macrovascular events occured earlier than microvascular complications. Multiple logistic regression analysis showed strong association of age, duration of diabetes, serum cholesterol, triglyceride, LDL-C with retinopathy (Regression coefficient β: -0.1086807, 0.4127152, -0.0513393, 0.0146429, 0.0587475;p < 0.05, < 0.001, < 0.05, < 0.05, < 0.05 respectively), while only duration of diabetes was strongly associated with nephropathy and neuropathy (Regression coefficient β: 0.2538751, 0.2261636;p < 0.001 for each). Increasing age was associated with CAD (Regression coefficient β: 0.055392;p β: 0.0055014;p 18.6% patients died due to diabetes related complications. Cardiovascular (CV)-related deaths (CVD+CAD) were most common cause (51.5%: CVD 36.4%, CAD 15.1%) to be followed by infections (27.3%) and then chronic kidney disease (12.1%). Conclusions: This study highlights the high prevalence of vascular complications and infections in T2DM patients of Eastern India. CV-related deaths were principal causes of death, similar to that in developed world.

Pathogenesis of diabetic cerebral vascular disease complication

Diabetes mellitus is one of the most potent independent risk factors for the development of diabetic cerebral vascular disease(CVD). Many evidences suggested that hyperglycemia caused excess free fatty acids, the loss of endothelium-derived nitric oxide, insulin resistance, the prothrombotic state, endothelial dysfunction, the abnormal release of endothelial vasoactivators,vascular smooth muscle dysfunction, oxidative stress, and the downregulation of mi Rs participated in vessel generation and recovery as well as the balance of endotheliocytes. In turn, these abnormalities, mainly via phosphatidylinositol 3 kinase, mitogen-activated protein kinase, polyol, hexosamine, protein kinase C activation, and increased generation of advanced glycosylation end products pathway, play an important role in inducing diabetic CVD complication. A deeper comprehension of pathogenesis producing diabetic CVD could offer base for developing new therapeutic ways preventing diabetic CVD complications, therefore, in the paper we mainly reviewed present information about the possible pathogenesis of diabetic CVD complication.

术前注射雷珠单抗对糖尿病视网膜病变伴血管性青光眼患者的治疗效果观察

目的 探究在糖尿病视网膜病变伴血管性青光眼患者治疗中术前注射雷珠单抗所取得的应用效果。方法 选取2021年4月—2023年4月在本院接受治疗的70例糖尿病视网膜病变伴血管性青光眼患者为研究对象,并按照随机分组法分为对照组和观察组,每组35例。其中,对照组采用玻璃体切割术治疗,观察组采用玻璃体切割术联合术前注射雷珠单抗治疗,观察两组手术前后BCVA和眼压指标、并发症发生率、VEGF、IGF-1、SDF-1指标。结果 观察组术后1周和1个月BCVA和眼压指标低于对照组,并发症发生率低于对照组(P<0.05)。治疗前,两组VEGF、IGF-1、SDF-1指标对比,差异无统计学意义(P>0.05);治疗后,观察组VEGF、IGF-1、SDF-1指标低于对照组,差异有统计学意义(P<0.05)。结论 在糖尿病视网膜病变伴血管性青光眼治疗中术前为患者注射雷珠单抗,有助于提升视力矫正效果,降低眼压,并发症发生率明显下降,疾病临床治疗效果显著。

Serum galectin-3： a risk factor for vascular complications in type 2 diabetes mellitus

Background Plasma galectin-3, a mediator of fibrogenesis and inflammation, its potential to associate with type 2 diabetes （T2DM） is poorly investigated. Here, we explored its interaction with the serum galectin-3 and vascular complications. Methods We conducted a population-based cross-sectional survey in Zhejiang, China involving 165 men and 119 women （age range, 43-84 years）, investigating the relationship between serum galectin-3 and vascular disease in patients with T2DM. Results Serum galectin-3 was higher in subjects with T2DM than that in control participants （27.4 vs. 17.6 ng/ml, P 〈0.001）. Compared with subjects with galectin-3 values in the lowest quartile, those with values in the highest quartile had an increased likelihood of vascular complications （4th quartile odds ratio （OR） 2.52, 95% confidence interval （CI）, 1.25- 4.07）. Increased risk of micro- or macrovascular complications corrrelated with serum galectin-3 concentration （ORs 11.4 and 8.5, respectively）. An increased number of vascular complications was associated with high serum galectin-3 levels （P 〈0.05）. Patients with serum galectin-3 levels 〉25 ng/ml had an elevated risk of diabetes relative to patients with levels 〈10 ng/ml （OR for any vascular complication 2.64, for heart failure 3.97, for nephropathy 4.09, for peripheral arterial disease （PAD） 4.18; all P 〈0.05）. Complication risk was higher in patients with neurogenic, stroke, or retinopathy complications, but this difference was not significant after risk factor adjustment. Serum galectin-3 levels correlated with diabetes duration, C-reactive protein （CRP） levels, and albuminuria. Conclusion High galectin-3 values were associated with increased odds of developing heart failure, nephropathy, and peripheral arterial disease in patients with T2DM.

miRNA-27、FGF21及AGE在2型糖尿病血清中的表达及其与微血管并发症的相关性

目的 探讨2型糖尿病(T2DM)患者血清中miRNA-27、纤维细胞生长因子21(FGF21)及糖化终末产物(AGE)的表达,并分析它们与微血管并发症的相关性。方法 回顾性选取2020年2月至2022年2月在沧州市人民医院进行诊疗的89例2型糖尿病患者纳入研究组,根据患者是否合并微血管并发症(包括糖尿病所致的周围神经病变、肾脏病变和视网膜病变)将其分为合并组(n=41)和未合并组(n=48)。另选50例在本院进行健康体检的志愿者纳入对照组。比较研究组和对照组的miRNA-27、FGF21及AGE水平;比较合并组和未合并组患者的miRNA-27、FGF21、AGE水平、生化指标[总胆固醇、甘油三酯、甘油三酯、高密度脂蛋白(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、尿酸、血肌酐及尿素氮]水平,并探究影响患者合并微血管并发症的影响因素。结果 研究组的miRNA-27、FGF21、AGE水平分别为2.31±0.42、(388.27±23.09) ng/mL、(89.29±4.98) UA,均高于对照组[0.89±0.31、(268.56±26.18) ng/mL、(70.22±5.16) UA],差异均有统计学意义(P<0.05)。合并组患者的miRNA-27、FGF21、AGE水平分别为2.45±0.44、(399.26±25.49) ng/mL、(92.34±4.28) UA,均高于未合并组[1.98±0.36、(316.44±23.91) ng/mL、(76.28±3.92) UA],差异均有统计学意义(P<0.05)。两组间总胆固醇、LDL-C水平比较,差异均无统计学意义(P>0.05);合并组患者的HDL-C水平为(1.12±0.33) mmo/L,低于未合并组[(1.28±0.36) mmo/L],甘油三酯、尿酸、血肌酐、尿素氮水平分别为(2.33±0.51) mmo/L、(355.26±41.08)μmol/L、(92.08±9.04)μmol/L、(7.99±2.15) mmol/L,均高于未合并组[(1.98±0.46) mmo/L、(336.11±45.26)μmol/L、(72.45±9.87)μmol/L、(5.06±1.03) mmol/L],差异均有统计学意义(P<0.05)。多因素Logistic回归分析,可知FGF21、AGE、miRNA-27均为2型糖尿病合并微血管并发症产生的影响因素(P<0.05)。结论 2型糖尿病患者的血清中miRNA-27、FGF21和AGE水平较高,且在合并微血管并发症的2型糖尿病患者中表达更高,与2型糖尿病的微血管并发症的发生具有一定的相关性。

Effects of Puerarin on Plasma Endothelin and Serum Tumor Necrosis Factor-α in Type 2 Diabetes Mellitus Patients with Vascular Complications

Objective: To study the changes of endothelin (ET), tumor necrosis factor-α (TNF-α) before and after puerarin treatment in patients with diabetes mellitus vascular complications (DMVC). Methods: Ninety-eight DMVC patients were divided into 2 groups, they were given puerarin (n=68) and normal saline (n=30) respectively, 20 diabetic patients without vascular complications (NDMVC) were taken as control, who were also given puerarin. All the patients were treated on the basis of controlling blood glucose. Plasma ET and serum TNF-α were determined by radioimmunoassay (RIA) before and after treatment. Results: Plasma ET and serum TNF-α in DMVC got higher than that of NDMVC patients (P<0.05), and ET level was correlated with TNF-α (r=0.69, r=0.73, P<0.01). After treatment, the levels of ET and TNF-α were significantly lower than those before treatment of DMVC patients with puerarin (P<0.05). Conclusion: Puerarin could regulate the levels of plasma ET and serum TNF-α of DMVC patients, suggesting that it has the function of regulating endothelial cells.

视网膜中央静脉阻塞与糖尿病视网膜病变所致新生血管性青光眼的临床特点分析

背景 新生血管性青光眼（NVG）是一种可迅速致盲的难治性疾病,而引起NVG的主要病理机制是不同原发病导致的缺血性视网膜病变,以视网膜中央静脉阻塞（CRVO）和糖尿病视网膜病变（DR）居多,二者引起的NVG的临床特点不同,目前这方面的研究报道较少.目的 探讨和比较CRVO与DR引起NVG的临床特点及发展规律,为NVG的有效防治提供依据.方法 采用系列病例观察的方法,收集2009年1月至2012年6月在青岛大学医学院附属海慈医院眼科治疗的由CRVO和DR引起的NVG患者27例29眼,其中由CRVO引起者10例10眼,由DR引起者17例19眼.对两种NVG患者的原发病病程、NVG病程、眼压、眼底表现及治疗后的并发症进行分析和对比.所有患者均接受全视网膜光凝术、改善微循环治疗、抗青光眼（药物和手术）及原发病治疗,部分患者接受了玻璃体切割或/和白内障摘出术,每组患者中均有2眼接受雷珠单抗玻璃体腔内注射.两组患者随访时间分别为（14.00±10.13）个月和（17.89±12.52）个月,差异无统计学意义（t=-0.83,P＞0.05）. 结果 CRVO和DR所致的NVG患者原发病病程的中位数分别为3.3个月（2周～6个月）和11.1个月（4～36个月）,两组间差异有统计学意义（Z=-2.40,P＜O.05）.CRVO所致NVG患者的病情进展快,而DR所致NVG患者的病情进展稍慢.CRVO所致10例10眼NVG者中,治疗后视力升高者2眼,视力不变或下降者8眼；而DR所致NVG的17例19眼中,治疗后视力升高者15眼,视力不变或下降者4眼,二者比较,差异有统计学意义（x2=9.38,P＜0.01）.两组患者治疗前的眼压分别为（48.40±7.96） mmHg（1 mmHg=0.133 kPa）和（25.34±10.51）mmHg,治疗后分别为（11.40±5.15） mmHg和（16.42±3.63） mmHg,两组患者治疗前后的眼压差比较差异有统计学意义（t=6.30,P＜0.01）.CRVO所致NVG患者治疗前6眼可见视盘水肿、视网膜出血水肿和静脉扩张,4眼可见轻度视盘水肿及视网膜出血；治疗后4眼眼底窥不见,2眼隐约见视盘苍白,视网膜陈旧性激光斑,2眼视盘苍白,视网膜血管闭塞,2眼视网膜动脉呈银丝状.DR所致NVG患者中治疗前8眼眼底窥不见,11眼眼底呈DRⅢ～Ⅳ期改变；治疗后16眼眼底病变稳定,3眼眼底病变发展到V～Ⅵ期.两组患者治疗后并发症的发生率分别为100.0％和21.1％,两组比较,差异有统计学意义（x2 =5.18,P＜O.05）. 结论 CRVO与DR引起NVG的临床特点有所不同,可以依据两种NVG患者不同的临床表现来指导NVG的防治.

2型糖尿病患者餐后甘油三酯水平与血管并发症关系的研究

目的 研究 2型糖尿病患者餐后甘油三酯水平与血管并发症的关系。方法 44例 2型糖尿病患者以空腹和餐后 4小时甘油三酯 (TG和 TG4h)水平分组 :空腹及餐后 TG正常组 (19例 )、空腹正常餐后增高组 (14例 )、空腹增高组 (10例 ) ,分析其血管并发症的发生情况。结果 按上述分组次序 ,微血管并发症发生率分别为 2 1.0 5 %、42 .85 %和70 % ,大血管并发症分别为 10 .5 2 %、5 7.14%和 80 %。前两组微血管并发症比较 P<0 .0 5 ,大血管并发症比较 P>0 .0 5 ;后两组无论微血管或大血管并发症比较均为 P>0 .0 5。结论 空腹 TG水平正常的部分 2型糖尿病患者血管并发症 ,尤其是大血管并发症的发生情况与空腹高 TG血症者基本相当。

健康管理对糖尿病血管并发症的影响效果评价研究

目的探讨健康管理对糖尿病慢性血管并发症的影响。方法将入选的2型糖尿病患者分为干预组82例及对照组98例,对干预组进行信息化管理,建立健康档案,评估危险因素,制定个体化的健康计划,实施针对性的健康教育、合理膳食、适量运动、戒烟限酒、心理调适与循证药物治疗等规范化管理,并跟踪随访3年。结果通过3年的健康管理,干预组患者的体质指数(BM I)、血压、血脂等危险因素指标及糖化血红蛋白水平均较干预前明显降低,差异有统计学意义(P<0.05);干预组血管并发症的发生率较对照组减少,差异有统计学意义(P<0.05)。结论健康管理能有效提高2型糖尿病患者各项危险因素控制达标率,延缓糖尿病慢性血管并发症的发生,从而改善患者的生活质量。

当归注射液对2型糖尿病患者血液流变学及凝血功能的影响

目的 :观察 2型糖尿病 (DM)患者应用 2 5 %当归注射液治疗后血液流变学及凝血功能的变化 ,并探讨该药在DM并发症中的防治作用。方法 :4 6名 2型糖尿病患者经眼科检查无眼底出血 ,血糖控制稳定后 ,给予 2 5 %当归注射液治疗。另选 15名正常对照 ,检测糖尿病组患者当归治疗前后及正常对照组血液流变学及凝血功能等指标。结果 :糖尿病患者血液流变学及凝血功能部分指标 ,如全血粘度、红细胞聚集指数、血沉、血沉K值方程、血小板聚集率与对照组比较有显著性增高 (P <0 .0 1或P <0 .0 5 ) ,用当归注射液治疗后上述指标显著性降低 (P <0 .0 1或P <0 .0 5 ) ,且接近正常对照水平。结论

可溶性内皮细胞蛋白C受体和高敏C反应蛋白水平预测糖尿病患者血管并发症的价值

目的探讨可溶性内皮细胞蛋白C受体(sEPCR)和高敏C反应蛋白(hsCRP)预测糖尿病(DM)患者血管并发症的价值。方法 20例1型DM患者、30例2型DM患者及30例健康志愿者纳入该次研究。酶联免疫吸附法(ELISA)来测定受试者血清s EPCR和hs CRP含量。结果与对照组相比,两种类型糖尿病患者中sEPCR和hsCRP水平都升高。sEPCR能够预测1型糖尿病患者大血管并发症和血栓形成,P值分别为0.016和0.015。而hsCRP可以明显预测2型糖尿病患者的大血管并发症,P=0.042。结论 1型和2型糖尿病患者sEPCR和hsCRP水平高于健康志愿者,提示其血管内皮功能损伤。sEPCR对1型糖尿病患者大血管并发症和血栓形成有一定预测作用,而hsCRP对2型糖尿病患者大血管并发症有一定预测作用。

糖尿病患者血小板高活性状态研究进展

糖尿病与肿瘤、心血管疾病被并称为世界三大非传染性疾病,是由遗传和环境因素共同作用而引起的一类以代谢紊乱为特征的临床综合症。其血管并发症包括微血管病变和大血管病变,是目前导致糖尿病患者致残、致死的主要原因。在导致糖尿病血栓前状态的因素中,血小板高活性发挥了重要作用。文章对糖尿病导致血小板高活性的机制进行综述。

2型糖尿病合并亚临床甲减与糖尿病血管并发症相关性的研究

目的探讨2型糖尿病合并亚临床甲状腺功能减退症与糖尿病血管并发症的相关性。方法选择安徽省立医院内分泌科121例2型糖尿病患者,根据甲状腺功能结果分为两组:2型糖尿病合并亚临床甲减组和2型糖尿病甲状腺功能正常组。记录所有患者的年龄、糖尿病病程、身高、体重、冠心病和脑梗死的发病情况,眼底检查了解眼底病变,检测其血脂、高敏C反应蛋白(hsCRP)、糖化血红蛋白(HbA1c)及24 h尿白蛋白(UALB)水平,同时测定患者颈动脉内膜中层厚度(IMT)和踝臂指数(ABI),比较两组的差异。结果两组在年龄、病程、体重指数(BMI)、总胆固醇(TC)、甘油三脂(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、极低密度脂蛋白(VLDL)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)、脂蛋白a(LPa)、hsCRP、HbA1c、ABI、颈动脉IMT、糖尿病视网膜病变以及冠心病和脑梗死的发病率上均无明显差异。与2型糖尿病甲状腺功能正常组相比,2型糖尿病合并亚临床甲减组的女性比例和UALB明显升高(P<0.01),糖尿病肾病发病率也升高,差异有显著性(P<0.05)。结论亚临床甲减对2型糖尿病患者的大血管并发症无明显影响,但可能增加糖尿病肾病的发病风险。

脂联素、直接胆红素及甘油三酯对2型糖尿病患者大血管病变的诊断价值

目的探讨脂联素(APN)、直接胆红素(DB)、甘油三酯(TG)及三者联合对2型糖尿病(T2DM)患者大血管病变的诊断价值。方法选取120例T2DM患者,根据是否合并大血管病变将其分为T2DM组(62例)和T2DM+大血管病变组(58例)。比较两组的临床资料;采用非条件多因素逐步Logistic回归分析T2DM患者合并大血管病变的风险因素;绘制受试者工作特征(ROC)曲线评估APN、DB、TG及三者联合对T2DM患者合并大血管病变的诊断效能。结果非条件多因素逐步Logistic回归分析结果显示,HbA1c[OR=24.096(95%CI:6.419,90.453)]、LDL-C[OR=13.118(95%CI:2.202,78.134)]和TG[OR=7.019(95%CI:2.414,20.407)]是T2DM患者合并大血管病变的危险因素(P<0.05);HDL-C[OR=0.000(95%CI:0.000,0.011)]、APN[OR=0.504(95%CI:0.313,0.809)]和DB[OR=0.694(95%CI:0.581,0.829)]是T2DM患者合并大血管病变的保护因素(P<0.05)。ROC曲线分析结果显示,当APN≤5.870 nmol/mL时,诊断T2DM患者合并大血管病变的曲线下面积(AUC)为0.718,敏感性为70.7%(95%CI:0.571,0.815),特异性为61.3%(95%CI:0.480,0.713);当DB≤14.205 mol/L时,AUC为0.772,敏感性为74.1%(95%CI:0.607,0.844),特异性为71.0%(95%CI:0.579,0.814);当TG≥1.955 mol/L时,AUC为0.735,敏感性为72.4%(95%CI:0.589,0.830),特异性为69.4%(95%CI:0.562,0.801);三者联合诊断的AUC为0.881,敏感性为84.5%(95%CI:0.721,0.922),特异性为77.4%(95%CI:0.647,0.867)。结论APN、DB、TG可用于T2DM患者合并大血管病变的辅助诊断,且三者联合可进一步提升诊断效能。

血管内皮生长抑制因子在糖尿病视网膜病变患者血清及玻璃体中的变化

背景糖尿病视网膜病变（DR）患者因视网膜缺血导致新生血管的形成，从而严重威胁患者视力。血管内皮生长抑制因子（VEGI／TLlA）作为一种血管生成抑制剂，具有强大的抗血管生成作用。目的检测VEGI／TLlA及其相关因子在DR患者血清及玻璃体中的变化。方法采用非随机对照研究方法，收集2012年11月至2013年3月在天津医科大学总医院眼科确诊为DR的患者55例，按照中国眼底病学组制定的DR分期标准分为非增生性糖尿病视网膜病变（NPDR）组20例，PDR组35例；另纳入无全身疾病的白内障患者11例作为正常对照组，取单纯糖尿病（DM）患者15例作为DM组，各组患者人口基线特征相匹配，但PDR组和DM组患者的病程值及血糖水平值明显高于DR组，差异均有统计学意义（均P〈0．05）。收集4个组所有受试者静脉血清以备ELISA检测。另收集2012年11月至2013年3月在天津医科大学总医院眼科确诊为PDR的患者23例25眼作为PDR组，健康成人尸体供眼7例7眼作为对照组，并根据PDR组患者的治疗方法分为视网膜光凝组、手术治疗组和视网膜光凝＋手术组，在手术过程中收集玻璃体待检。采用ELISA法检测血清及玻璃体中肿瘤坏死因子样配体1／血管内皮生长抑制因子251（TLlA／VEGI251）、血管内皮生长因子（VEGF）、肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）和核因子-KBp65（NF—KBp65）的质量浓度。应用单因素方差分析和独立样本t检验比较并分析各组血清及玻璃体中TLlA／VEGI251、VEGF、TNF-α、IL-1β和NF—KBp65的差异，应用Pearson积矩线性相关分析法分析TLlA／VEGI251与VEGF、TNF-α、IL-1β和NF—KBp65的相关性。结果DM组、NPDR组、PDR组患者血清中TLlA／VEGI251质量浓度均明显高于正常对照组，4个组间总体差异有统计学意义（F=27．431，P=0．009）；PDR组患者血清中TLlA／VEGI251质量浓度明显高于DM组和NPDR组（P〈0．05）；PDR组患者血清中VEGF、TNF—α、IL-1β和NF—KBp65质量浓度均明显高于DM组、NPDR组和正常对照组，差异均有统计学意义（P〈0．05），而正常对照组、DM组和NPDR组之间比较差异均无统计学意义（P〉0．05）。患者血清中TLlA／VEGI251质量浓度与VEGF、TNF-α、IL-1β和NF—KBp65质量浓度间均呈明显正相关（r=0．951、0．951、0．851、0．944，均P〈0．01）。PDR组玻璃体中TLlA／VEGI251、VEGF、TNF-α、IL-1β质量浓度均明显高于正常对照组（P=0．024、0．001、0．000、0．037），但两组间玻璃体中NF—KBp65浓度比较差异无统计学意义（P=0．073）。视网膜光凝组及手术组患者玻璃体中TLlA／VEGI251质量浓度低于对照组（P〈0．05），玻璃体中TLlA／VEGI251质量浓度与VEGF和TNF-α质量浓度间均呈明显正相关（r=0．675、0．950，P〈0．01），与玻璃体中IL-1β和NF—KBp65质量浓度均无明显相关性（r=0．233、0．318，P〉0．05）。结论VEGI参与DR的发病，并通过与VEGF、TNF-α、IL-1β、NF—KB等因子的相互作用共同影响疾病的进展，为DR的进一步研究提供了新的思路。