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目的 探讨糖尿病视网膜病变不同时期细胞外间质、血管基膜成分以及血管内皮细胞粘附分子在血循环中的变化,了解他们与血管基膜和血管内皮细胞损伤的相关性。方法 85例(男40例、女45例)2型糖尿病患者分无视网膜病变(NDR)组31例、背景期视网膜病变(BDR)组24例和增殖期视网膜病变(PDR)组30例,采用放射免疫法和ELISA法测其血清Ⅳ型胶原(ⅣC)、层粘蛋白(LN)和血管内皮细胞粘附分子(sVCAM-1)含量,同时设健康体检者20人为对照组。结果 三组糖尿病患者血清LN、ⅣC、sVCAM-1水平均高于对照组。PDR组的血清LN、ⅣC和sVCAM-1水平与对照组比较,差异有非常显著意义(P<0.01),与NDR组比较,差异也有非常显著意义(P<0.01);BDR组血清LN、ⅣC和sVCAM-1水平与对照组比较,差异有非常显著意义(P<0.01);NDR组血清ⅣC、sVCAM-1水平与对照组比较,差异有非常显著意义(P<0.01);PDR组与BDR组比较,仅LN、ⅣC差异有非常显著意义(P<0.01);BDR组与NDR组比较,仅sVCAM-1差异有显著意义(P<0.05)。三组糖尿病患者血清三项指标之间无相关性(分别为r=0.119,r=0.167和r=-0.210;P>0.05)。 结论 血清ⅣC、LN和sVCAM-1用于联合检测,能较好地反映糖尿病微血管病变的发展过程,为其早期诊断和治疗提供依据,也可作为糖尿病视网膜病变严重程度的估计和预
Objective To investigate the changes of extracellular matrix, vascular basement membrane and vascular endothelial cell adhesion molecules in the blood circulation in diabetic retinopathy at different stages and to investigate their correlation with vascular basement membrane and vascular endothelial cell injury. Methods Totally 85 patients (40 males and 45 females) with type 2 diabetes were divided into three groups: 31 patients with no retinopathy (NDR), 24 patients with background retinopathy (BDR) and 30 patients with proliferative retinopathy (PDR) The serum levels of type Ⅳ collagen, laminin and sVCAM-1 were measured by radioimmunoassay and ELISA. Twenty healthy subjects were selected as the control group. Results The serum levels of LN, Ⅳ C and sVCAM-1 in three groups of diabetic patients were higher than those in the control group. The serum levels of LN, ⅣC and sVCAM-1 in PDR group were significantly different from those in control group (P <0.01), and there was also significant difference between NDR group and PDR group (P <0.01) (P <0.01). There was significant difference between the NDR group and the control group (P <0.01). The level of serum sVCAM-1 and IVC in the NDR group was significantly higher than that in the control group (P <0.01). Only the difference of sVCAM-1 between BDR group and NDR group was significant (P <0.05). There was no correlation between the three indicators of serum in three groups of diabetic patients (r = 0.119, r = 0.167 and r = -0.210, respectively; P> 0.05). Conclusions Serum levels of IVC, LN and sVCAM-1 are useful for combined detection, which can better reflect the development of diabetic microangiopathy and provide a basis for their early diagnosis and treatment. They can also be used as an assessment and prediction of the severity of diabetic retinopathy