【摘要】 目的：探讨2型糖尿病并发视网膜病变(diabetic retinopathy, DR)患者血清脂联素和超敏C反应蛋白(high sensitivity Creactive protein，hsCRP)浓度的变化。方法：病例对照研究。采用酶联免疫吸附法和速率散射比浊法检测49例非糖尿病视网膜病变(NDR)的糖尿病患者，46例非增生性糖尿病视网膜病变(NPDR)组患者，41例增生性糖尿病视网膜病变(PDR)组患者以及45例对照组受检者血清脂联素和超敏C反应蛋白(hsCRP)浓度的变化，采用单因素设计的定量资料的方差分析，多个均数之间两两比较采用q检验，相关分析采用直线相关分析。结果：NDR组患者血清脂联素浓度8.76±3.61mg/L，hsCRP浓度3.12±1.24mg/L;NPDR组患者血清脂联素浓度6.22±2.53mg/L，hsCRP浓度4.89±1.66mg/L;PDR组患者血清脂联素浓度3.98±1.86mg/L，hsCRP浓度6.95±2.59mg/L;对照组血清脂联素浓度13.55±5.87mg/L，hsCRP浓度2.01±0.85mg/L。正常对照组与NDR组、NDR组与NPDR组、NPDR组与PDR组的血清脂联素比较，差异有统计学意义(q=5.4401,P=0.000;q=3.1535,P=0.002;q=4.8756,P=0.000)。正常对照组与NDR组、NDR组与NPDR组、NPDR组与PDR组血清hsCRP浓度比较，差异具有统计学意义(q=2.4367,P=0.0017;q=2.0572,P=0.003;q=2.6184,P=0.001)。DR患者血清hsCRP与血清脂联素水平呈负相关(r=0.643,P<0.01)。结论：DR患者血清脂联素浓度水平与血清hsCRP浓度水平存在显著负相关，血清脂联素浓度水平下降，伴随着血清hsCRP浓度水平的升高，且与糖尿病视网膜病变的严重程度相关。
【关键词】 糖尿病视网膜病变;脂联素;超敏C反应蛋白
Changes of the concentration of serum adiponectin and high sensitivity Creactive protein in type 2 diabetes mellitus patients with retinopathy
XiaoLi Wang, Yan Dai, XiaoHu Chen
Foundation items:Science & Technology Department of Sichuan Province,China(No.2008sz0201);Mianyang Applied Technology Research and Development Fund,China(No.08s002)
Department of Ophthalmology, Mianyang Central Hospital, Mianyang 621000，Sichuan Province, China
Correspondence to:Yan Dai.Department of Ophthalmology, Mianyang Central Hospital, Mianyang 621000，Sichuan Province, [email protected]
Received:20100504 Accepted:20100809
Abstract
AIM: To explore the changes of the concentration of serum adiponectin(APN) and high sensitivity Creactive protein (hsCRP) in type 2 diabetes mellitus patients with diabetic retinopathy (DR).
METHODS: The concentration of serum APN and hsCRP in 49 noDR(NDR) patients were determined by ELISA and ratenephelometry and compared with those in 46 noPDR (NPDR) patients, 41 proliferative diabetic retinopathy(PDR) patients and 45 controls. Data were evaluated using analysis of SPSS version 11.0. Results were expressed as means standard deviation of the mean. Statistical comparisons were performed by Oneway analysis of variance and the means compared each other using q test.
RESULTS:The serum APN and hsCRP in NDR patients were 8.76±3.61mg/L, 3.12±1.24mg/L; in NPDR patients were 6.22±2.53mg/L, 4.89±1.66mg/L; in PDR patients were 3.98±1.86mg/L,6.95±2.59mg/L and in controls were 13.55±5.87mg/L, 2.01±0.85mg/L. There were significant differences in serum APN and hsCRP between controls and NDR patients, NDR and NPDR patients NPDR and PDR patients (q=5.4401, P=0.000; q=2.4367, P=0.0017. q=3.1535,P=0.002; q=2.0572, P=0.003. q=4.8756, P=0.000; q=2.6184, P=0.001). There was significant negative correlation between serum APN and hsCRP in DR patients(r=0.643, P<0.01).
CONCLUSION:There is significant negative correlation between serum APN and hsCRP in DR patients. The serum APN concentration decreases while the serum hsCRP concentration increases, which may contribute to the development of DR.
KEYWORDS: diabetic retinopathy; adiponectin; high sensitivity Creactive protein
Wang XL, Dai Y, Chen XH. Changes of the concentration of serum adiponectin and high sensitivity Creactive protein in type 2 diabetes mellitus patients with retinopathy. Int J Ophthalmol ( Guoji Yanke Zazhi) 2010;10(9):16991701
糖尿病视网膜病变(diabetic retinopathy, DR)是糖尿病最常见的微血管并发症之一，是成人首位致盲眼病，至今其发病机制尚未完全阐明。炎症反应与糖尿病视网膜病变的关系成了近年研究所关注的热点。超敏C反应蛋白(high sensitivity Creactive protein，hsCRP)是人体最敏感的非特异性炎性反应标志物之一，国外研究发现hsCRP与糖尿病微血管病变的发生有关[1,2]。脂联素(adiponectin，APN)是脂肪细胞特异性分泌的一种蛋白质，新近研究发现脂联素在DR中可能起调控作用。我们将探讨DR患者血清hsCRP和脂联素水平及关系，了解脂联素在DR中的作用机制，可能对DR患者提供一种新的临床检测指标和治疗手段。
1对象和方法
1.1对象
糖尿病组为我院200807/201002门诊及住院的女性2型糖尿病患者，共136例，纳入标准：(1)体质量指数≤24;(2)近期未服用过糖皮质激素及β肾上腺素激动剂等药物;(3)无心脑血管并发症。糖尿病的诊断符合1999年世界卫生组织糖尿病的标准。DR诊断依据中华医学会眼科学分会眼底病学组指定的标准，根据眼底镜检查及荧光素眼底血管造影将患者分为3组：(1)非视网膜病变组(NoDR, NDR)49例，年龄56.2±6.6岁，病程6mo～10a。(2)非增生性糖尿病视网膜病变组(noproliferative diabetic retinopathy, NPDR)46例，年龄61.1±5.2岁，病程3～15a。(3)增生性糖尿病视网膜病变组(proliferative diabetic retinopathy, PDR) 41例，年龄66.2±6.9岁，病程5～26a。选择健康女性为正常对照组，共45例，年龄56.6±7.6岁，无糖尿病、高血压及其他慢性病史。空腹血糖及口服葡萄糖耐量试验均正常，双眼散瞳检查眼底正常。
1.2方法
测定身高、体质量，计算体质量指数。受检者禁食8～10h后，晨起抽取空腹静脉血6mL，分成3份，1份血直接送检测空腹血糖 (FPG)、胰岛素浓度(INS)，其余血离心后，取血清置于20℃冰箱保存，待测血清脂联素及hsCRP浓度。空腹血糖(FPG)检测采用葡萄糖氧化酶法，胰岛素测定采用放免法测定。脂联素浓度测定：采用美国Linco公司生产的脂联素(adiponectin,APN )酶联免疫吸附法(ELISA)测定试剂盒及日本HTIR酶标仪，严格按照试剂盒说明书的要求步骤进行操作。血清hsCRP浓度检测：采用速率散射比浊法测定，试剂由美国利德曼生化技术有限公司提供。
统计学分析：计量数据采用±s表示，使用SPSS 11.0统计软件包进行数据分析，多组均数比较采用单因素设计的定量资料的方差分析，多个均数之间两两比较采用q检验;相关分析采用直线相关分析。P<0.05为差异有统计学意义。
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