ANGPTL4在增殖性糖尿病性视网膜病变患者血和玻璃体中的表达及相关研究
发布时间：2018-10-14 18:23
【摘要】：目的:定量检测增殖性糖尿病性视网膜病变(Proliferative Diabetic Retinopathy,PDR)患者血清和玻璃体中血管生成素样蛋白4(Angiopoietin-like 4,ANGPTL4)的表达水平并进行分析,探讨ANGPTL4水平与血脂、血糖和糖化血红蛋白(glycosylated hemoglobin,Hb A1c)之间的相关性及PDR发生的可能危险因素,期望为PDR的预防及诊治提供新的方法。方法:本研究纳入PDR组及对照组共69例69眼,所有患者均采用经睫状体平坦部20G标准三通道玻璃体切割手术。其中PDR组共49例49眼,平均年龄53.49岁,男性17例17眼,女性32例32眼,玻璃体积血患者14眼,玻璃体积血同时伴牵拉性视网膜脱离患者30眼,不伴玻璃体积血的牵拉性视网膜脱离患者5眼;对照组20例20眼,均为非糖尿病患者,平均年龄57.95岁,男性7例7眼,女性13例13眼,全层黄斑裂孔16眼,孔源性视网膜脱离患者4眼。记录所有患者的年龄、性别、身高、体重、糖尿病病程及降糖方案、高血压病史、空腹血糖、甘油三酯、胆固醇、高密度脂蛋白、低密度脂蛋白、尿酸、眼压等指标及糖尿病患者的Hb A1c,收集并离心所有患者的血及玻璃体,酶联免疫吸附试验(Enzyme-linked Immunosorbent Assay,ELISA)定量检测血清及玻璃体样本中ANGPTL4水平。使用SPSS17.0统计学软件对所有数据进行正态分布检验、方差分析、Pearson相关分析和t检验等统计学分析。若P0.05表示差异具有统计学意义。结果:1、PDR组患者血清中ANGPTL4的水平(30.761±2.996ng/ml)显著低于对照组患者(35.912±1.763ng/ml)(t=-8.851,P=0.000);PDR组患者玻璃体中ANGPTL4的水平(14.723±1.324ng/ml)明显高于对照组患者(7.892±0.812ng/ml)(t=24.642,P=0.000)。两组患者的血清与玻璃体中ANGPTL4浓度进行比较,血清中浓度均高于玻璃体(PDR组t=58.401,P=0.000;对照组t=103.013,P=0.000),且患者血清及玻璃体中ANGPTL4浓度成正相关(PDR组r=0.881,P=0.000;对照组r=0.884,P=0.000);2、PDR组患者的体重指数、眼压、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、血压与对照组患者比较,差异均无统计学意义(P0.05)。PDR组患者空腹静脉血糖、肌酐、尿酸水平均高于对照组(P0.05)。3、在PDR组中,血清ANGPTL4浓度与甘油三脂、高密度脂蛋白进行相关性分析,血清ANGPTL4浓度与甘油三脂呈正相关关系(r=0.735,P=0.000),与高密度脂蛋白呈负相关关系(r=-0.597,P=0.000)。而血清和玻璃体中ANGPTL4浓度与患者的年龄、糖尿病病程、空腹静脉血糖、肌酐、总胆固醇、低密度脂蛋白、体重指数、Hb A1c等指标均无相关性(P0.05);4、在PDR组患者中,有玻璃体积血者空腹静脉血糖明显高于无玻璃体积血者(P=0.006);合并玻璃体积血的PDR组患者的总胆固醇明显增高(P=0.022);5、在PDR组患者中,以是否合并玻璃体积血、是否合并视网膜脱离、是否合并肥胖、术前是否行玻璃体腔雷珠单抗注射术及视网膜激光光凝治疗分组进行比较,仅合并肥胖的PDR患者血清ANGPTL4明显高于非肥胖者(t=1.178,P=0.041),其余血清与玻璃体中ANGPTL4水平均无统计学差异。结论:PDR患者玻璃体ANGPTL4水平较正常人群升高,其可能参与了PDR的发生发展过程,玻璃体中ANGPTL4水平有可能作为PDR是否存在的参考指标之一,为预防和治疗PDR提供依据;糖尿病患者血ANGPTL4浓度较正常人群低,且与甘油三脂水平呈正相关,其可能在肥胖及糖脂代谢的病理生理过程中发挥了一定的作用;空腹静脉血糖升高、血糖控制不佳可能是PDR发生的危险因素。
[Abstract]:Objective: To quantitatively detect the expression level of angiopoietin-like protein 4 (ANGPTL4) in serum and vitreous of patients with proliferative diabetic retinopathy (PDR) and to investigate the level of ANGPTL4 and blood lipid, blood glucose and glycosylated hemoglobin. It is expected to provide new methods for the prevention and treatment of PDR. Methods: 69 cases of 69 eyes were included in PDR group and control group. There were 49 eyes in PDR group, with an average age of 53. 49 years, 17 eyes in 17 eyes, 32 eyes in 32 eyes, 14 eyes in vitreous humor, 30 eyes of vitreous hemorrhage with traction retinal detachment, and 5 eyes without vitreous detachment. In the control group, 20 eyes were non-diabetic, with mean age of 57. 95 years old, 7 eyes in 7 eyes, 13 eyes in 13 eyes, 16 eyes of all-layer macular holes and 4 eyes of source retinal detachment. recording age, sex, height, body weight, diabetes course and blood sugar reducing scheme, hypertension history, fasting blood glucose, triglyceride, cholesterol, high density lipoprotein, low density lipoprotein, uric acid, intraocular pressure and other indexes of diabetes patients, Blood and vitreous, enzyme-linked immunosorbent assay (ELISA) of all patients were collected and centrifuged to quantitatively detect ANGPTL4 levels in serum and vitreous samples. Statistical analysis of normal distribution test, analysis of variance, Pearson correlation analysis and t-test were performed on all data using SPSS 17. 0 statistical software. The difference was statistically significant if P0.05. Results: The level of ANGPTL4 in patients with PDR group was significantly lower than that in the control group (35.912% 1.763ng/ ml) (t =-8.851, P = 0.000). The level of ANGPTL4 in vitreous of PDR group was significantly higher than that in the control group (7.892. 0. 812ng/ ml) (t = 24.642, P = 0.000). The concentrations of ANGPTL4 in serum and vitreous were higher in both groups than in vitreous body (PDR group t = 58. 401, P = 0.000; control t = 103. 013, P = 0.000), and the concentration of ANGPTL4 in serum and vitreous was positively correlated (r = 0. 881, P = 0.000; control r = 0.884, P = 0.000); 2. The body mass index of patients with PDR group, There was no significant difference in intraocular pressure, total cholesterol, triglyceride, high density lipoprotein, low density lipoprotein, blood pressure and control group (P0.05). Serum ANGPTL4 concentration was correlated with triglyceride and high density lipoprotein. Serum ANGPTL4 concentration was positively correlated with triglyceride (r = 0. 735, P = 0.000), negatively correlated with high density lipoprotein (r =-0.597, P = 0.000). The concentrations of ANGPTL4 in serum and vitreous were not correlated with the age of patients, diabetes course, fasting venous blood glucose, total cholesterol, total cholesterol, low density lipoprotein, body mass index and Hb, etc. (P0.05); 4. In patients with PDR group, There was a significant increase in fasting venous blood glucose in patients with vitreous hemorrhage (P = 0. 006); the total cholesterol of patients with PDR group combined with vitreoretinopathy was significantly higher (P = 0.022); 5. In PDR group patients, whether combined vitreoretinal detachment, whether combined with retinal detachment, whether to combine obesity, The levels of ANGPTL4 in patients with PDR were significantly higher than those of non-obese patients (t = 1.178, P = 0. 034), and there was no statistical difference between the rest serum and ANGPTL4 levels in vitreous body. Conclusion: The level of ANGPTL4 in PDR patients is higher than that of normal population, which may participate in the development of PDR, and the level of ANGPTL4 in vitreous body may be one of the reference indexes in PDR, which can provide evidence for the prevention and treatment of PDR. The concentration of ANGPTL4 in diabetic patients is lower than that in normal population. and is positively related to triglyceride level, which may play a certain role in the pathophysiological process of obesity and urinary glucose metabolism; the fasting venous blood glucose is increased, and the control of blood sugar is not good; and the risk factors of PDR can be avoided.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R587.2;R774.1
本文编号：2271257
[Abstract]:Objective: To quantitatively detect the expression level of angiopoietin-like protein 4 (ANGPTL4) in serum and vitreous of patients with proliferative diabetic retinopathy (PDR) and to investigate the level of ANGPTL4 and blood lipid, blood glucose and glycosylated hemoglobin. It is expected to provide new methods for the prevention and treatment of PDR. Methods: 69 cases of 69 eyes were included in PDR group and control group. There were 49 eyes in PDR group, with an average age of 53. 49 years, 17 eyes in 17 eyes, 32 eyes in 32 eyes, 14 eyes in vitreous humor, 30 eyes of vitreous hemorrhage with traction retinal detachment, and 5 eyes without vitreous detachment. In the control group, 20 eyes were non-diabetic, with mean age of 57. 95 years old, 7 eyes in 7 eyes, 13 eyes in 13 eyes, 16 eyes of all-layer macular holes and 4 eyes of source retinal detachment. recording age, sex, height, body weight, diabetes course and blood sugar reducing scheme, hypertension history, fasting blood glucose, triglyceride, cholesterol, high density lipoprotein, low density lipoprotein, uric acid, intraocular pressure and other indexes of diabetes patients, Blood and vitreous, enzyme-linked immunosorbent assay (ELISA) of all patients were collected and centrifuged to quantitatively detect ANGPTL4 levels in serum and vitreous samples. Statistical analysis of normal distribution test, analysis of variance, Pearson correlation analysis and t-test were performed on all data using SPSS 17. 0 statistical software. The difference was statistically significant if P0.05. Results: The level of ANGPTL4 in patients with PDR group was significantly lower than that in the control group (35.912% 1.763ng/ ml) (t =-8.851, P = 0.000). The level of ANGPTL4 in vitreous of PDR group was significantly higher than that in the control group (7.892. 0. 812ng/ ml) (t = 24.642, P = 0.000). The concentrations of ANGPTL4 in serum and vitreous were higher in both groups than in vitreous body (PDR group t = 58. 401, P = 0.000; control t = 103. 013, P = 0.000), and the concentration of ANGPTL4 in serum and vitreous was positively correlated (r = 0. 881, P = 0.000; control r = 0.884, P = 0.000); 2. The body mass index of patients with PDR group, There was no significant difference in intraocular pressure, total cholesterol, triglyceride, high density lipoprotein, low density lipoprotein, blood pressure and control group (P0.05). Serum ANGPTL4 concentration was correlated with triglyceride and high density lipoprotein. Serum ANGPTL4 concentration was positively correlated with triglyceride (r = 0. 735, P = 0.000), negatively correlated with high density lipoprotein (r =-0.597, P = 0.000). The concentrations of ANGPTL4 in serum and vitreous were not correlated with the age of patients, diabetes course, fasting venous blood glucose, total cholesterol, total cholesterol, low density lipoprotein, body mass index and Hb, etc. (P0.05); 4. In patients with PDR group, There was a significant increase in fasting venous blood glucose in patients with vitreous hemorrhage (P = 0. 006); the total cholesterol of patients with PDR group combined with vitreoretinopathy was significantly higher (P = 0.022); 5. In PDR group patients, whether combined vitreoretinal detachment, whether combined with retinal detachment, whether to combine obesity, The levels of ANGPTL4 in patients with PDR were significantly higher than those of non-obese patients (t = 1.178, P = 0. 034), and there was no statistical difference between the rest serum and ANGPTL4 levels in vitreous body. Conclusion: The level of ANGPTL4 in PDR patients is higher than that of normal population, which may participate in the development of PDR, and the level of ANGPTL4 in vitreous body may be one of the reference indexes in PDR, which can provide evidence for the prevention and treatment of PDR. The concentration of ANGPTL4 in diabetic patients is lower than that in normal population. and is positively related to triglyceride level, which may play a certain role in the pathophysiological process of obesity and urinary glucose metabolism; the fasting venous blood glucose is increased, and the control of blood sugar is not good; and the risk factors of PDR can be avoided.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R587.2;R774.1
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