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糖尿病视网膜病变患者血清因子表达情况及其与病变分期的关系

Expression of serum factors in patients with diabetic retinopathy and its relationship with disease stages

    摘要
  • 摘要:
      目的  探讨血清细胞外超氧化物歧化酶（ecSOD）、脑源性神经营养因子（BDNF）及血管生成素-2（Ang-2）在糖尿病视网膜病变（DR）患者中的表达及其与病变分期的关系。
      方法  将126例糖尿病患者根据DR分期分为无糖尿病视网膜病变（NDR）组40例、单纯型糖尿病视网膜病变（BDR）组44例、增殖型糖尿病视网膜病变（PDR）组42例，另选取同期健康体检者40名作为对照组。比较4组受检者一般资料和空腹血糖（FBG）、糖化血红蛋白（HbA1c）、血清ecSOD、BDNF、Ang-2水平。分析DR病变分期与血清ecSOD、BDNF及Ang-2的相关性。评估血清ecSOD、BDNF、Ang-2单独及联合检测对DR的诊断价值。
      结果  NDR组、BDR组、PDR组FBG、HbA1c水平均高于对照组，差异有统计学意义（P < 0.05），但NDR组、BDR组、PDR组的FBG、HbA1c水平组间比较，差异无统计学意义（P>0.05）。DR患者血清ecSOD、BDNF、Ang-2水平随着病变分期加重而升高，差异有统计学意义（P < 0.05）。Spearman相关性分析发现，DR分期与血清ecSOD、BDNF、Ang-2水平呈正相关（P < 0.05）。ecSOD诊断DR的曲线下面积（AUC）为0.836，截断值为113.43 ng/mL，敏感度、特异度分别为73.02%、95.00%；BDNF诊断DR的AUC为0.774，截断值为1.66 ng/mL，敏感度、特异度分别为71.25%、94.55%；Ang-2诊断DR的AUC为0.862，截断值为1.69 μg/L，敏感度、特异度分别为80.16%、90.00%；联合检测诊断DR的AUC为0.904，敏感度、特异度分别为91.27%、98.03%。
      结论  DR患者的血清ecSOD、BDNF及Ang-2水平均显著升高，血清ecSOD、BDNF、Ang-2均与DR分期密切相关，有望成为DR诊治和预后评估的重要指标。

     

    Abstract:
      Objective  To investigate the expressions of extracellular superoxide dismutase (ecSOD), brain-derived neurotrophic factor(BDNF) and angiopoietin-2(Ang-2) in patients with diabetic retinopathy(DR) and their relationships with the stages of the disease.
      Methods  A total of 126 diabetic patients were divided into non-diabetic retinopathy group (NDR, 40 cases), background diabetic retinopathy group (BDR, 44 cases), and proliferative diabetic retinopathy group (PDR, 42 cases) according to diabetic retinopathy stages. At the same time, 40 healthy people in the same period were selected as control group. The general data, fasting blood glucose (FBG), glycosylated hemoglobin(HbA1c), serum ecSOD, BDNF and Ang-2 levels were compared among the four groups. The correlations between DR stages and serum ecSOD, BDNF as well as Ang-2 were analyzed. The clinical values of serum ecSOD, BDNF, Ang-2 alone and their combination in the diagnosis of DR were evaluated.
      Results  The levels of FBG and HbA1c in the NDR group, BDR group and PDR group were significantly higher than those in the control group (P < 0.05), but there were no significant between-group differences in NDR group, BDR group and PDR group (P>0.05). The levels of serum ecSOD, BDNF and Ang-2 in DR patients increased with the increase of pathological grading (P < 0.05). Spearman correlation analysis showed that there was a positive correlation between the stages of DR and the levels of serum ecSOD, BDNF as well as Ang-2 (P < 0.05). The area under the curve (AUC) of ecSOD in diagnosis of DR was 0.836, the cut-off value was 113.43 ng/mL, the sensitivity and specificity were 73.02% and 95.00%, respectively. The AUC of BDNF in the diagnosis of DR was 0.774, the cut-off value was 1.66 ng/mL, the sensitivity and specificity were 71.25% and 94.55%, respectively. The AUC of Ang-2 in the diagnosis of DR was 0.862, the cutoff value was 1.69 μg/L, the sensitivity and specificity were 80.16% and 90.00%, respectively. The AUC of combined detection was 0.904, sensitivity and specificity were 91.27% and 98.03%, respectively.
      Conclusion  The levels of serum ecSOD, BDNF and Ang-2 in DR patients are significantly increased, and they are closely related to the stages of retinopathy, which are expected to be important indexes for DR diagnosis, treatment and prognosis evaluation.

     

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