CAJ | 학술논문

目的：了解石家庄市社区居民中老年糖尿病患者糖尿病视网膜病变（ DR）严重程度与血清糖化血红蛋白（ HbA1c ）水平及血清、泪液肿瘤坏死因子α（ TNF-α）水平之间的关系。方法于2011年4—10月，分层随机抽样选择石家庄市9个社区的居民（居住≥5年，年龄≥45岁），进行流行病学调查及血液、泪液检测。根据诊断标准确诊DM患者及不同分期 DR 患者。抽取受试者静脉血，测定空腹血糖（ FPG ）、餐后2 h 血糖（2 hPG ）、血脂、TNF-α、HbA1c。泪液标本以毛细玻璃管法采集，采用酶联免疫吸附试验（ ELISA）测定TNF-α水平。结果共纳入1447例，对其中的正常糖耐量（NGT）467例，DM 593例进行研究；上述人群中接受眼底检查并留取泪液标本者， NGT 105例（210眼，NGT组），糖尿病无视网膜病变（NDR）184例（368眼，NDR组），非增殖性糖尿病视网膜病变（NPDR）149例（298眼，NPDR组），增殖性糖尿病视网膜病变（PDR）63例（126眼，PDR组）。4组体质指数（ BMI）、腰臀比（ WHR）、收缩压（ SBP）、舒张压（ DBP）、FPG、总胆固醇（ TC）、三酰甘油（ TG）、高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）比较，差异均有统计学意义（P﹤0.01）。NGT组、NDR组、NPDR组和PDR组泪液、血清TNF-α及血清HbA1c比较，差异均有统计学意义（ P﹤0.05）。其中NDR组、NPDR组和PDR组泪液、血清TNF-α及血清 HbA1c均高于 NGT组，NPDR 组和 PDR 组泪液、血清TNF-α及血清 HbA1c均高于NDR组，PDR组泪液、血清TNF-α及血清HbA1c均高于NPDR组，差异均有统计学意义（ P﹤0.05）。泪液TNF-α与血清TNF-α呈正相关（b＝0.291，t＝29.28，P﹤0.01）。泪液TNF-α与血清HbA1c呈正相关（b＝1.480，t＝7.58，P﹤0.01）。多因素 Logistic 回归分析结果显示，年龄、性别、糖尿病家族史、BMI、WHR、TG、FPG、2 hPG、泪液TNF-α、血清TNF-α、HbA1c是影响人群发生DR的因素（P﹤0.05）。结论石家庄市社区中老年2型糖尿病患者泪液TNF-α水平较正常中老年人增高，随视网膜病变加重，其泪液TNF-α水平逐渐增高。泪液、血清TNF-α水平以及血清HbA1c水平可一定程度上反映DR严重程度。目的：瞭解石傢莊市社區居民中老年糖尿病患者糖尿病視網膜病變（ DR）嚴重程度與血清糖化血紅蛋白（ HbA1c ）水平及血清、淚液腫瘤壞死因子α（ TNF-α）水平之間的關繫。方法于2011年4—10月，分層隨機抽樣選擇石傢莊市9箇社區的居民（居住≥5年，年齡≥45歲），進行流行病學調查及血液、淚液檢測。根據診斷標準確診DM患者及不同分期 DR 患者。抽取受試者靜脈血，測定空腹血糖（ FPG ）、餐後2 h 血糖（2 hPG ）、血脂、TNF-α、HbA1c。淚液標本以毛細玻璃管法採集，採用酶聯免疫吸附試驗（ ELISA）測定TNF-α水平。結果共納入1447例，對其中的正常糖耐量（NGT）467例，DM 593例進行研究；上述人群中接受眼底檢查併留取淚液標本者， NGT 105例（210眼，NGT組），糖尿病無視網膜病變（NDR）184例（368眼，NDR組），非增殖性糖尿病視網膜病變（NPDR）149例（298眼，NPDR組），增殖性糖尿病視網膜病變（PDR）63例（126眼，PDR組）。4組體質指數（ BMI）、腰臀比（ WHR）、收縮壓（ SBP）、舒張壓（ DBP）、FPG、總膽固醇（ TC）、三酰甘油（ TG）、高密度脂蛋白膽固醇（HDL-C）和低密度脂蛋白膽固醇（LDL-C）比較，差異均有統計學意義（P﹤0.01）。NGT組、NDR組、NPDR組和PDR組淚液、血清TNF-α及血清HbA1c比較，差異均有統計學意義（ P﹤0.05）。其中NDR組、NPDR組和PDR組淚液、血清TNF-α及血清 HbA1c均高于 NGT組，NPDR 組和 PDR 組淚液、血清TNF-α及血清 HbA1c均高于NDR組，PDR組淚液、血清TNF-α及血清HbA1c均高于NPDR組，差異均有統計學意義（ P﹤0.05）。淚液TNF-α與血清TNF-α呈正相關（b＝0.291，t＝29.28，P﹤0.01）。淚液TNF-α與血清HbA1c呈正相關（b＝1.480，t＝7.58，P﹤0.01）。多因素 Logistic 迴歸分析結果顯示，年齡、性彆、糖尿病傢族史、BMI、WHR、TG、FPG、2 hPG、淚液TNF-α、血清TNF-α、HbA1c是影響人群髮生DR的因素（P﹤0.05）。結論石傢莊市社區中老年2型糖尿病患者淚液TNF-α水平較正常中老年人增高，隨視網膜病變加重，其淚液TNF-α水平逐漸增高。淚液、血清TNF-α水平以及血清HbA1c水平可一定程度上反映DR嚴重程度。
목적：료해석가장시사구거민중노년당뇨병환자당뇨병시망막병변（ DR）엄중정도여혈청당화혈홍단백（ HbA1c ）수평급혈청、루액종류배사인자α（ TNF-α）수평지간적관계。방법우2011년4—10월，분층수궤추양선택석가장시9개사구적거민（거주≥5년，년령≥45세），진행류행병학조사급혈액、루액검측。근거진단표준학진DM환자급불동분기 DR 환자。추취수시자정맥혈，측정공복혈당（ FPG ）、찬후2 h 혈당（2 hPG ）、혈지、TNF-α、HbA1c。루액표본이모세파리관법채집，채용매련면역흡부시험（ ELISA）측정TNF-α수평。결과공납입1447례，대기중적정상당내량（NGT）467례，DM 593례진행연구；상술인군중접수안저검사병류취루액표본자， NGT 105례（210안，NGT조），당뇨병무시망막병변（NDR）184례（368안，NDR조），비증식성당뇨병시망막병변（NPDR）149례（298안，NPDR조），증식성당뇨병시망막병변（PDR）63례（126안，PDR조）。4조체질지수（ BMI）、요둔비（ WHR）、수축압（ SBP）、서장압（ DBP）、FPG、총담고순（ TC）、삼선감유（ TG）、고밀도지단백담고순（HDL-C）화저밀도지단백담고순（LDL-C）비교，차이균유통계학의의（P﹤0.01）。NGT조、NDR조、NPDR조화PDR조루액、혈청TNF-α급혈청HbA1c비교，차이균유통계학의의（ P﹤0.05）。기중NDR조、NPDR조화PDR조루액、혈청TNF-α급혈청 HbA1c균고우 NGT조，NPDR 조화 PDR 조루액、혈청TNF-α급혈청 HbA1c균고우NDR조，PDR조루액、혈청TNF-α급혈청HbA1c균고우NPDR조，차이균유통계학의의（ P﹤0.05）。루액TNF-α여혈청TNF-α정정상관（b＝0.291，t＝29.28，P﹤0.01）。루액TNF-α여혈청HbA1c정정상관（b＝1.480，t＝7.58，P﹤0.01）。다인소 Logistic 회귀분석결과현시，년령、성별、당뇨병가족사、BMI、WHR、TG、FPG、2 hPG、루액TNF-α、혈청TNF-α、HbA1c시영향인군발생DR적인소（P﹤0.05）。결론석가장시사구중노년2형당뇨병환자루액TNF-α수평교정상중노년인증고，수시망막병변가중，기루액TNF-α수평축점증고。루액、혈청TNF-α수평이급혈청HbA1c수평가일정정도상반영DR엄중정도。
Objective To investigate the relationship between the severity of diabetic retinopathy( DR)in middle-aged and elderly diabetes patients and the levels of tear fluid TNF-α, serum TNF-α and serum HbA1c in Shijiazhuang. Methods From April to October in 2011,we selected 9 community residents(resident years≥5,age≥45)in Shijiazhuang using stratified random sampling. According to diagnostic criteria,the patients were definitely diagnosed and determined with different phrases. Venous blood was sampled,and FPG,2 hPG,blood lipid,TNF-α and HbA1c were determined. Capillary glass tube method was employed,and ELISA was employed to determine TNF-αlevel. Results A total of 1 447 patients were included,among which 467 had normal glucose tolerance ( NGT ) and 593 had DM;among subjects who received fundus examination and offered tear samples,105 subjects had NGT(210 eyes,NGT group),184 subjects had diabetes without retinopathy(368 eyes,NDR group),149 had non-proliferating diabetic retinopathy(298 eyes,NPDR group),and 63 had proliferative diabetic retinopathy(126 eyes,PDR group). The 4 groups were significantly different in BMI,WHR,SBP, DBP,FPG,TC,TG,HDL-C and LDL-C( P ﹤0. 01 for all). NGT group,NDR group,NPDR group and PDR group were significantly different in the levels of tear fluid TNF-α,serum TNF-α and serum HbA1c ( P ﹤0. 05 for all). NDR group,NPDR group and PDR group were higher than NGT group in the levels of tear fluid TNF-α,serum TNF-αand serum HbA1c ( P﹤0. 05 for all);NPDR group and PDR group were higher than NDR group in the levels of tear fluid TNF-α,serum TNF-α and serum HbA1c ( P﹤0. 05 for all);PDR group was higher than NPDR group in the levels of tear fluid TNF-α, serum TNF-α and serum HbA1c ( P﹤0. 05 for all). The level of tear fluid TNF-α was positively correlated with the level of serum TNF-α(b =0. 291,t =29. 28,P ﹤0. 01). Tear fluid TNF-α was positively correlated with serum HbA1c(b =1. 480,t=7. 58,P ﹤0. 01). Multivariate Logistic regression analysis showed that age,gender,history of diabetes,BMI, WHR,TG,FPG,2 hPG, tear fluid TNF-α, serum TNF-α and HbA1c were influencing factors for DR ( P ﹤0. 05 ). Conclusion Middle-aged and elderly residents with type 2 diabetes have higher tear fluid TNF-αlevel than healthy middle-aged and elderly residents. With the exacerbation of retinopathy,the tear fluid TNF-α level increases. The levels of tear fluid TNF-α,serum TNF-α and serum HbA1c may reflect the severity of DR to some extent.