胰岛素%受体,细胞因子%糖尿病视网膜病变%ROC曲线
胰島素%受體,細胞因子%糖尿病視網膜病變%ROC麯線
이도소%수체,세포인자%당뇨병시망막병변%ROC곡선
Insulin%Receptor,cytokine%Diabetic retinopathy%Receiver operating characteristic curve
目的 观察胰岛素降糖治疗下,2型糖尿病患者血管内环境中相关细胞增殖和抑制因子失衡状态以及视网膜病变(DR)发生的情况,以期为临床个体化监控提供参考.方法 选取2010年9月至2011年3月于上海交通大学附属第一人民医院眼科门诊就诊的90例2型糖尿病患者为研究对象,其中男46例、女44例,以眼底荧光血管造影结果作为眼底判断标准,分为非DR组(30例)和DR组(60例),其中DR组分为轻度非增殖期DR组(NPDR组,36例)和中重度NPDR组(24例).检测所有90例2型糖尿病患者外周血管增殖和抑制因子表达情况,包括血管内皮生长因子(VEGF)和CXC趋化因子[外周血基质细胞源因子-1(SDF-1)、白细胞介素-8(IL-8)、生长相关癌基因α(GROα)、干扰素诱导蛋白10(IP-10)、γ干扰素诱生单核因子(MIG)],应用受试者工作特征曲线(ROC曲线)分析筛选并制定3组促/抑血管增殖因子对,依照ROC曲线下面积进行比较.组间比较采用单因素方差分析,两两比较采用t检验.结果 非DR组与轻度NPDR组相比外周血中 SDF-1的变化有统计学意义[非 DR 组(0.010±0.000),轻度NPDR组(12.920±6 630),t=-2.977,P =0.005],ROC 曲线下面积(AUC)=0.643.在DR进展期(轻度NPDR组与中重度NPDR组相比)外周血中差异有统计学意义的因子为VEGF[轻度NPDR组(39±14),中重度NPDR组(120±102),t =3.333,P＜0.05,AUC =0.952]、IP-10[轻度NPDR组(338 ±96),中重度NPDR组(565±236),t=3.45,P ＜0.05,AUC =0.857]、IL-8[轻度NPDR组(18±5),中重度NPDR组(24±18),t＝-3.05,P ＜0.05,AUC=0.5].ROC分析比较3组促/抑血管增殖因子比率[SDF-1与IP-10的比率(S/I),IL-8与IP-10的比率(I/I),VEGF与IP-10的比率(V/I)]发现在初期I/I[AUC =0.561,灵敏度(Sen) =62.5％,特异度(Spe)=51.5％]、S/I(AUC=0.625,Sen=12.5％,Spe=100％)、V/I(AUC=0.655,Sen＝ 87.5％,Spe=57.6％)均有临床诊断参考价值(AUC均＞0.5),在进展期仅V/I(AUC=0.787,Sen=60.0％,Spe=87.5％)有临床诊断参考价值.结论 早期DR患者外周血促/抑血管增殖因子存在失衡现象,其中VEGF与IP-10的比率可能是明确糖尿病患者视网膜病变加速进展的较好指标.
目的 觀察胰島素降糖治療下,2型糖尿病患者血管內環境中相關細胞增殖和抑製因子失衡狀態以及視網膜病變(DR)髮生的情況,以期為臨床箇體化鑑控提供參攷.方法 選取2010年9月至2011年3月于上海交通大學附屬第一人民醫院眼科門診就診的90例2型糖尿病患者為研究對象,其中男46例、女44例,以眼底熒光血管造影結果作為眼底判斷標準,分為非DR組(30例)和DR組(60例),其中DR組分為輕度非增殖期DR組(NPDR組,36例)和中重度NPDR組(24例).檢測所有90例2型糖尿病患者外週血管增殖和抑製因子錶達情況,包括血管內皮生長因子(VEGF)和CXC趨化因子[外週血基質細胞源因子-1(SDF-1)、白細胞介素-8(IL-8)、生長相關癌基因α(GROα)、榦擾素誘導蛋白10(IP-10)、γ榦擾素誘生單覈因子(MIG)],應用受試者工作特徵麯線(ROC麯線)分析篩選併製定3組促/抑血管增殖因子對,依照ROC麯線下麵積進行比較.組間比較採用單因素方差分析,兩兩比較採用t檢驗.結果 非DR組與輕度NPDR組相比外週血中 SDF-1的變化有統計學意義[非 DR 組(0.010±0.000),輕度NPDR組(12.920±6 630),t=-2.977,P =0.005],ROC 麯線下麵積(AUC)=0.643.在DR進展期(輕度NPDR組與中重度NPDR組相比)外週血中差異有統計學意義的因子為VEGF[輕度NPDR組(39±14),中重度NPDR組(120±102),t =3.333,P＜0.05,AUC =0.952]、IP-10[輕度NPDR組(338 ±96),中重度NPDR組(565±236),t=3.45,P ＜0.05,AUC =0.857]、IL-8[輕度NPDR組(18±5),中重度NPDR組(24±18),t＝-3.05,P ＜0.05,AUC=0.5].ROC分析比較3組促/抑血管增殖因子比率[SDF-1與IP-10的比率(S/I),IL-8與IP-10的比率(I/I),VEGF與IP-10的比率(V/I)]髮現在初期I/I[AUC =0.561,靈敏度(Sen) =62.5％,特異度(Spe)=51.5％]、S/I(AUC=0.625,Sen=12.5％,Spe=100％)、V/I(AUC=0.655,Sen＝ 87.5％,Spe=57.6％)均有臨床診斷參攷價值(AUC均＞0.5),在進展期僅V/I(AUC=0.787,Sen=60.0％,Spe=87.5％)有臨床診斷參攷價值.結論 早期DR患者外週血促/抑血管增殖因子存在失衡現象,其中VEGF與IP-10的比率可能是明確糖尿病患者視網膜病變加速進展的較好指標.
목적 관찰이도소강당치료하,2형당뇨병환자혈관내배경중상관세포증식화억제인자실형상태이급시망막병변(DR)발생적정황,이기위림상개체화감공제공삼고.방법 선취2010년9월지2011년3월우상해교통대학부속제일인민의원안과문진취진적90례2형당뇨병환자위연구대상,기중남46례、녀44례,이안저형광혈관조영결과작위안저판단표준,분위비DR조(30례)화DR조(60례),기중DR조분위경도비증식기DR조(NPDR조,36례)화중중도NPDR조(24례).검측소유90례2형당뇨병환자외주혈관증식화억제인자표체정황,포괄혈관내피생장인자(VEGF)화CXC추화인자[외주혈기질세포원인자-1(SDF-1)、백세포개소-8(IL-8)、생장상관암기인α(GROα)、간우소유도단백10(IP-10)、γ간우소유생단핵인자(MIG)],응용수시자공작특정곡선(ROC곡선)분석사선병제정3조촉/억혈관증식인자대,의조ROC곡선하면적진행비교.조간비교채용단인소방차분석,량량비교채용t검험.결과 비DR조여경도NPDR조상비외주혈중 SDF-1적변화유통계학의의[비 DR 조(0.010±0.000),경도NPDR조(12.920±6 630),t=-2.977,P =0.005],ROC 곡선하면적(AUC)=0.643.재DR진전기(경도NPDR조여중중도NPDR조상비)외주혈중차이유통계학의의적인자위VEGF[경도NPDR조(39±14),중중도NPDR조(120±102),t =3.333,P＜0.05,AUC =0.952]、IP-10[경도NPDR조(338 ±96),중중도NPDR조(565±236),t=3.45,P ＜0.05,AUC =0.857]、IL-8[경도NPDR조(18±5),중중도NPDR조(24±18),t＝-3.05,P ＜0.05,AUC=0.5].ROC분석비교3조촉/억혈관증식인자비솔[SDF-1여IP-10적비솔(S/I),IL-8여IP-10적비솔(I/I),VEGF여IP-10적비솔(V/I)]발현재초기I/I[AUC =0.561,령민도(Sen) =62.5％,특이도(Spe)=51.5％]、S/I(AUC=0.625,Sen=12.5％,Spe=100％)、V/I(AUC=0.655,Sen＝ 87.5％,Spe=57.6％)균유림상진단삼고개치(AUC균＞0.5),재진전기부V/I(AUC=0.787,Sen=60.0％,Spe=87.5％)유림상진단삼고개치.결론 조기DR환자외주혈촉/억혈관증식인자존재실형현상,기중VEGF여IP-10적비솔가능시명학당뇨병환자시망막병변가속진전적교호지표.
Objective To observe the unbalanced statement of angiogenic growth factors and angiogenesis inhibitors with retinopathy development under insulin treatment in the type 2 diabetics,so as to provide reference for clinical monitoring.Methods Cross-sectional survey of 90 type 2 diabetic patients in the first people's hospital affiliated to Shanghai Jiaotong university from September of 2010 to March of 2011 (30 cases without retinopathy,36 cases with mild non-proliferative diabetic retinopathy (NPDR) and 24 cases with moderate and severe NPDR).The level of vascular endothelial growth factor(VEGF) and CXC chemotatic factors,including SDF-1,IL-8,GROα,IP-10 and MIG were measured in those patients.Oneway analysis of variance was used beteen groups compared,t test was used in pairwise comparison.Three ratio of angiogenic growth factors and angiogenesis inhibitors were selected using ROC curve and compared with the area under the curve.Result The expression of SDF-1 was significant higher in mild NPDR group than that in no retinal lesion group (t =-2.977,P ＜ 0.05,AUC =0.643).And compared with mild NPDR group,the expression of VEGF (t =3.333,P ＜ 0.05,AUC =0.952),IP-10 (t =-3.45,P ＜0.05,AUC =0.857) and IL-8 (t =-3.05,P ＜ 0.05,AUC =0.5) was significant higher in the moderate and severe NPDR group.At the early stasge,all the three type of ratio (SI:SDF-1/IP-10; Ⅱ:IL-8/IP-10;Ⅵ:VEGF/IP-10) had diagnostic value (Ⅱ:AUC =0.561,Sen =62.5％,Spe ＝ 51.5％ ; SI:AUC =0.625,Sen =12.5％,Spe =100％ ; Ⅵ:AUC =0.655,Sen ＝ 87.5％,Spe =57.6％).However,only Ⅵ had the diagnostic value in the group of moderate and severe NPDR.Conclusion There is an unbalance phenomenon of angiogenic growth factors and angiogenesis inhibitors in the type 2 diabetic,which is relative to the development of diabetic retinopathy.The ratio of VEGF/IP-10 may be a good index for the progressive of DR.
