ANGPTL4在增殖性糖尿病性視網(wǎng)膜病變患者血和玻璃體中的表達(dá)及相關(guān)研究
發(fā)布時間：2018-10-14 18:23
【摘要】：目的:定量檢測增殖性糖尿病性視網(wǎng)膜病變(Proliferative Diabetic Retinopathy,PDR)患者血清和玻璃體中血管生成素樣蛋白4(Angiopoietin-like 4,ANGPTL4)的表達(dá)水平并進(jìn)行分析,探討ANGPTL4水平與血脂、血糖和糖化血紅蛋白(glycosylated hemoglobin,Hb A1c)之間的相關(guān)性及PDR發(fā)生的可能危險因素,期望為PDR的預(yù)防及診治提供新的方法。方法:本研究納入PDR組及對照組共69例69眼,所有患者均采用經(jīng)睫狀體平坦部20G標(biāo)準(zhǔn)三通道玻璃體切割手術(shù)。其中PDR組共49例49眼,平均年齡53.49歲,男性17例17眼,女性32例32眼,玻璃體積血患者14眼,玻璃體積血同時伴牽拉性視網(wǎng)膜脫離患者30眼,不伴玻璃體積血的牽拉性視網(wǎng)膜脫離患者5眼;對照組20例20眼,均為非糖尿病患者,平均年齡57.95歲,男性7例7眼,女性13例13眼,全層黃斑裂孔16眼,孔源性視網(wǎng)膜脫離患者4眼。記錄所有患者的年齡、性別、身高、體重、糖尿病病程及降糖方案、高血壓病史、空腹血糖、甘油三酯、膽固醇、高密度脂蛋白、低密度脂蛋白、尿酸、眼壓等指標(biāo)及糖尿病患者的Hb A1c,收集并離心所有患者的血及玻璃體,酶聯(lián)免疫吸附試驗(Enzyme-linked Immunosorbent Assay,ELISA)定量檢測血清及玻璃體樣本中ANGPTL4水平。使用SPSS17.0統(tǒng)計學(xué)軟件對所有數(shù)據(jù)進(jìn)行正態(tài)分布檢驗、方差分析、Pearson相關(guān)分析和t檢驗等統(tǒng)計學(xué)分析。若P0.05表示差異具有統(tǒng)計學(xué)意義。結(jié)果:1、PDR組患者血清中ANGPTL4的水平(30.761±2.996ng/ml)顯著低于對照組患者(35.912±1.763ng/ml)(t=-8.851,P=0.000);PDR組患者玻璃體中ANGPTL4的水平(14.723±1.324ng/ml)明顯高于對照組患者(7.892±0.812ng/ml)(t=24.642,P=0.000)。兩組患者的血清與玻璃體中ANGPTL4濃度進(jìn)行比較,血清中濃度均高于玻璃體(PDR組t=58.401,P=0.000;對照組t=103.013,P=0.000),且患者血清及玻璃體中ANGPTL4濃度成正相關(guān)(PDR組r=0.881,P=0.000;對照組r=0.884,P=0.000);2、PDR組患者的體重指數(shù)、眼壓、總膽固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、血壓與對照組患者比較,差異均無統(tǒng)計學(xué)意義(P0.05)。PDR組患者空腹靜脈血糖、肌酐、尿酸水平均高于對照組(P0.05)。3、在PDR組中,血清ANGPTL4濃度與甘油三脂、高密度脂蛋白進(jìn)行相關(guān)性分析,血清ANGPTL4濃度與甘油三脂呈正相關(guān)關(guān)系(r=0.735,P=0.000),與高密度脂蛋白呈負(fù)相關(guān)關(guān)系(r=-0.597,P=0.000)。而血清和玻璃體中ANGPTL4濃度與患者的年齡、糖尿病病程、空腹靜脈血糖、肌酐、總膽固醇、低密度脂蛋白、體重指數(shù)、Hb A1c等指標(biāo)均無相關(guān)性(P0.05);4、在PDR組患者中,有玻璃體積血者空腹靜脈血糖明顯高于無玻璃體積血者(P=0.006);合并玻璃體積血的PDR組患者的總膽固醇明顯增高(P=0.022);5、在PDR組患者中,以是否合并玻璃體積血、是否合并視網(wǎng)膜脫離、是否合并肥胖、術(shù)前是否行玻璃體腔雷珠單抗注射術(shù)及視網(wǎng)膜激光光凝治療分組進(jìn)行比較,僅合并肥胖的PDR患者血清ANGPTL4明顯高于非肥胖者(t=1.178,P=0.041),其余血清與玻璃體中ANGPTL4水平均無統(tǒng)計學(xué)差異。結(jié)論:PDR患者玻璃體ANGPTL4水平較正常人群升高,其可能參與了PDR的發(fā)生發(fā)展過程,玻璃體中ANGPTL4水平有可能作為PDR是否存在的參考指標(biāo)之一,為預(yù)防和治療PDR提供依據(jù);糖尿病患者血ANGPTL4濃度較正常人群低,且與甘油三脂水平呈正相關(guān),其可能在肥胖及糖脂代謝的病理生理過程中發(fā)揮了一定的作用;空腹靜脈血糖升高、血糖控制不佳可能是PDR發(fā)生的危險因素。
[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.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R587.2;R774.1
本文編號：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.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R587.2;R774.1
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