糖尿病白内障术后黄斑水肿与房水细胞因子的关系
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摘要
为了探讨2型糖尿病白内障术后黄斑水肿与房水中细胞因子的关系,本研究选取2016年2月至2017年7月在我院治疗的2型糖尿病白内障患者117例117眼,均行超声乳化白内障摘除术,观察术后4周黄斑水肿发生情况以及房水中多种细胞因子水平。研究结果显示:术后4周,有37眼发生黄斑水肿(观察组),未发生黄斑水肿80眼(对照组);观察组术后4周黄斑区视网膜厚度为(247.28±18.37)μm,明显高于对照组(p<0.05),且明显高于术前水平(p<0.05);观察组术后4周干扰素诱导蛋白-10 (IP-10)、巨噬细胞趋化蛋白(MCP-1)、血管内皮生长因子(VEGF)和细胞因子转化生长因子-β2 (TGF-β2)水平分别为(6.01±0.89) pg/mL、(340.03±45.39) pg/mL、(812.28±40.06) pg/mL和(40.05±10.03) pg/mL,明显高于对照组(p<0.05),且高于术前水平(p<0.05);观察组和对照组手术前后粒细胞-巨噬细胞集落刺激因子(GM-CSF)和碱性成纤维细胞生长因子(b-FGF)比较差异无统计学意义(p>0.05);术后4周IP-10、MCP-1、VEGF和TGF-β2水平与黄斑区视网膜厚度呈正相关(r=0.452, 0.501, 0.466和0.470, p<0.05)。本研究的结果初步说明,房水中IP-10、MCP-1、VEGF和TGF-2水平与2型糖尿病白内障术后黄斑水肿有一定关系,有可能成为黄斑水肿的特异性评价指标,值得进一步研究。
In order to investigate the relationship between macular edema and cytokine in aqueous humor after cataract surgery in patients with type 2 diabetes, this study selected 117 eyes of 117 patients with type 2 diabetic cataract treated in our hospital from February 2016 to July 2017, performed phacoemulsification for cataract, and observed the occurrence of macular edema and the levels of various cytokines in aqueous humor 4 weeks after surgery. The results showed that there were 37 eyes with macular edema(observation group) and 80 eyes without macular edema(control group) 4 weeks after surgery. The macular retinal thickness of observation group was(247.28 ±18.37) m 4 weeks after operation, which was significantly higher than the control group(p<0.05) as well as significantly higher than the preoperative level(p<0.05). 4 weeks after operation, the interferon induced protein-10(IP-10), macrophage chemotactic protein(MCP-1), vascular endothelial growth factor(VEGF) and cytokine transforming growth factor-2(TGF-2) of observation group were(6.01±0.89) pg/mL,(340.03±45.39) pg/mL,(812.28 ±40.06) pg/mL and(40.05±10.03) pg/mL, respectively, which were significantly higher than the control group(p<0.05) as well as higher than the preoperative level(p<0.05). There were no significant difference in granulocyte macrophage colonystimulating factor(GM-CSF) and basic fibroblast growth factor(b-FGF) between the observation group and the control group before and after operation(p>0.05). 4 weeks after operation, the levels of IP-10, MCP-1, VEGF and TGF-β2 were positively correlated with macular retinal thickness(r=0.452, 0.501, 0.466 and 0.470, p<0.05). The study preliminarily concluded that the level of IP-10, MCP-1, VEGF and TGF-2 in aqueous humor had a certain relationship with macular edema after type 2 diabetic cataract surgery, which might be a specific evaluation index of macular edema and deserve further study.
In order to investigate the relationship between macular edema and cytokine in aqueous humor after cataract surgery in patients with type 2 diabetes, this study selected 117 eyes of 117 patients with type 2 diabetic cataract treated in our hospital from February 2016 to July 2017, performed phacoemulsification for cataract, and observed the occurrence of macular edema and the levels of various cytokines in aqueous humor 4 weeks after surgery. The results showed that there were 37 eyes with macular edema(observation group) and 80 eyes without macular edema(control group) 4 weeks after surgery. The macular retinal thickness of observation group was(247.28 ±18.37) m 4 weeks after operation, which was significantly higher than the control group(p<0.05) as well as significantly higher than the preoperative level(p<0.05). 4 weeks after operation, the interferon induced protein-10(IP-10), macrophage chemotactic protein(MCP-1), vascular endothelial growth factor(VEGF) and cytokine transforming growth factor-2(TGF-2) of observation group were(6.01±0.89) pg/mL,(340.03±45.39) pg/mL,(812.28 ±40.06) pg/mL and(40.05±10.03) pg/mL, respectively, which were significantly higher than the control group(p<0.05) as well as higher than the preoperative level(p<0.05). There were no significant difference in granulocyte macrophage colonystimulating factor(GM-CSF) and basic fibroblast growth factor(b-FGF) between the observation group and the control group before and after operation(p>0.05). 4 weeks after operation, the levels of IP-10, MCP-1, VEGF and TGF-β2 were positively correlated with macular retinal thickness(r=0.452, 0.501, 0.466 and 0.470, p<0.05). The study preliminarily concluded that the level of IP-10, MCP-1, VEGF and TGF-2 in aqueous humor had a certain relationship with macular edema after type 2 diabetic cataract surgery, which might be a specific evaluation index of macular edema and deserve further study.
引文
Bikbov M.M.,Zainullin R.M.,and Faizrakhmanov R.R.,2015,Macular pigment optical density alteration as an indicator of diabetic macular edema development,Sovremennye Tehnologii,7(3):73-76
Chen X.H.,Chen M.Z.,and Wang Y.P.,2015,Quantitative analysis of vascular endothelial growth factor and pigment epithelium-derived factor in aqueous humor before and after intravitreal injection of ranibizumab in proliferative diabetic retinopathy,Zhonghua Yandibing Zazhi(Chinese Journal of Ocular Fundus Diseases),31(6):560-563(陈小红,陈梅珠,王云鹏,2015,增生型糖尿病视网膜病变患眼玻璃体腔注射雷珠单抗治疗前后房水血管内皮生长因子和色素上皮衍生因子的浓度变化,中华眼底病杂志,31(6):560-563)
Ding G.L.,Xie A.M.,Lei J.Q.,Ding G.P.,and Hu Y.G.,2017,Changes of cytokines in aqueous humor of patients with proliferative diabetic retinopathy after intravitreal bevacizumab an d their correlation analysis,Yanke Xinjinzhan(Recent Advances in Ophthalmology),37(4):358-361(丁国龙,谢安明,雷剑琴,丁国鹏,胡亚光,2017,增生型糖尿病视网膜病变患者玻璃体内注射贝伐单抗后房水中细胞因子的变化及其相关性分析,眼科新进展,37(4):358-361)
Dong N.,Tang X.,Xiao L.,and Xu B.,2015,Association of multiple aqueous cytokines with postoperative macular edema in patients with type 2 diabetes following phacoemulsification cataract surgery,Zhonghua Shiyan Yanke Zazhi(Chinese Journal of Experimental Ophthalmology),33(4):356-361(董宁,汤欣,肖林,徐冰,2015,房水中多种细胞因子与2型糖尿病患者白内障术后黄斑水肿的关系,中华实验眼科杂志,33(4):356-361)
Dong N.,Xu B.,Wang B.,Chu L.,and Tang X.,2015,Aqueous cytokines as predictors of macular edema in patients with diabetes following uncomplicated phacoemulsification cataract surgery,Biomed.Res.Int.,(12):2418-2425
Jiang L.F.,Shi D.,and Yan Q.C.,2017,Quantitative detection and correlation analysis of Txnip,Trx in aqueous humor of cortical cataract patients with type 2 diabetes,Yanke Xinjinzhan(Recent Advances in Ophthalmology),37(8);736-738(姜凌峰,石栋,阎启昌,2017,2型糖尿病合并皮质性白内障患者房水中txnip、trx的定量检测及相关性分析,眼科新进展,37(8):736-738)
Jin-Woo K.,Choi J.A.,and Donghyun J.,2016,Matrix metalloproteinase-1 and matrix metalloproteinase-9 in the aqueous humor of diabetic macular edema patients,PLoS One,11(7):e0159720
Qian J.,Zhu W.M.,Xiao Y.Q.,Hu J.,Lu H.,and Tang J.M.,2016,Protective effects of huyumingmu decoction on maculararea after phacoemulsification in diabetic patients,Yanke Xinjinzhan(Recent Advances in Ophthalmology),36(2):165-168(钱锦,朱炜敏,肖燕倩,忽俊,陆豪,唐建明,2016,化瘀明目饮对糖尿病患者白内障术后黄斑区的保护作用,眼科新进展,36(2):165-168)
Song Y.F.,Cai H.Y.,Wang X.,Zhao L.,and Chen X.Y.,2016,Analysis of macular edema by OCT after phacoemulsification surgery in patients with diabetic retinopathy,Yanke Xinjinzhan(Recent Advances in Ophthalmology),36(7):658-661(宋一帆,蔡宏媛,王新,赵琳,陈晓勇,2016,糖尿病视网膜病变患者白内障超声乳化术后黄斑水肿的分析,眼科新进展,36(7):658-661)
Xiao J.A.,Bai Q.Y.,and Xie A.M.,2015,Changes of cytokines in the aqueous humor following Avastin intravitreous injection in early diabetic retinopathy rats,Zhongguo Zuzhi Gongcheng Yanjiu(Journal of Clinical Rehabilitative Tissue Engineering Research),19(18):2933-2939(肖津安,白清玉,谢安明,2015,早期糖尿病视网膜病变模型大鼠玻璃体腔注射安维汀后房水细胞因子变化,中国组织工程研究,19(18):2933-2939)
Xie C.,Fang F.,and Fang Y.,2017,Clinical analysis on T2DMand xerophthalmia after cataract surgery,Yanke Xinjinzhan(Recent Advances in Ophthalmology),37(8):773-775(谢驰,方芳,方严,2017,2型糖尿病与白内障术后干眼相关性的临床分析,眼科新进展,37(8):773-775)
Xu H.P.,Qiu X.W.,and Zhang Z.Y.,2016,The effects of Atorvastatin calcium on the incidence of macular edema after phacoemulsification in diabetic patients,Zhonghua Yandibing Zazhi(Chinese Journal of Ocular Fundus Diseases),32(2):149-153(徐海萍,邱新文,张志勇,2016,阿托伐他汀钙对糖尿病患者白内障手术后黄斑水肿发生率的影响,中华眼底病杂志,32(2):149-153)
Zheng Z.,Liu D.N.,Zhou X.Y.,Hu X.P.,and Wu M.X.,2016,Effect of intravitreal injection of lucentis for refractory macular edema after cataract surgery,Disan Junyi Daxue Xuebao(Acta Academiae Medicinae Militaris Tertiae),38(20):2287-2290(郑政,刘丹宁,周希瑗,胡晓鹏,武明星,2016,玻璃体腔注射lucentis治疗白内障术后顽固性黄斑水肿的疗效,第三军医大学学报,38(20):2287-2290)
Chen X.H.,Chen M.Z.,and Wang Y.P.,2015,Quantitative analysis of vascular endothelial growth factor and pigment epithelium-derived factor in aqueous humor before and after intravitreal injection of ranibizumab in proliferative diabetic retinopathy,Zhonghua Yandibing Zazhi(Chinese Journal of Ocular Fundus Diseases),31(6):560-563(陈小红,陈梅珠,王云鹏,2015,增生型糖尿病视网膜病变患眼玻璃体腔注射雷珠单抗治疗前后房水血管内皮生长因子和色素上皮衍生因子的浓度变化,中华眼底病杂志,31(6):560-563)
Ding G.L.,Xie A.M.,Lei J.Q.,Ding G.P.,and Hu Y.G.,2017,Changes of cytokines in aqueous humor of patients with proliferative diabetic retinopathy after intravitreal bevacizumab an d their correlation analysis,Yanke Xinjinzhan(Recent Advances in Ophthalmology),37(4):358-361(丁国龙,谢安明,雷剑琴,丁国鹏,胡亚光,2017,增生型糖尿病视网膜病变患者玻璃体内注射贝伐单抗后房水中细胞因子的变化及其相关性分析,眼科新进展,37(4):358-361)
Dong N.,Tang X.,Xiao L.,and Xu B.,2015,Association of multiple aqueous cytokines with postoperative macular edema in patients with type 2 diabetes following phacoemulsification cataract surgery,Zhonghua Shiyan Yanke Zazhi(Chinese Journal of Experimental Ophthalmology),33(4):356-361(董宁,汤欣,肖林,徐冰,2015,房水中多种细胞因子与2型糖尿病患者白内障术后黄斑水肿的关系,中华实验眼科杂志,33(4):356-361)
Dong N.,Xu B.,Wang B.,Chu L.,and Tang X.,2015,Aqueous cytokines as predictors of macular edema in patients with diabetes following uncomplicated phacoemulsification cataract surgery,Biomed.Res.Int.,(12):2418-2425
Jiang L.F.,Shi D.,and Yan Q.C.,2017,Quantitative detection and correlation analysis of Txnip,Trx in aqueous humor of cortical cataract patients with type 2 diabetes,Yanke Xinjinzhan(Recent Advances in Ophthalmology),37(8);736-738(姜凌峰,石栋,阎启昌,2017,2型糖尿病合并皮质性白内障患者房水中txnip、trx的定量检测及相关性分析,眼科新进展,37(8):736-738)
Jin-Woo K.,Choi J.A.,and Donghyun J.,2016,Matrix metalloproteinase-1 and matrix metalloproteinase-9 in the aqueous humor of diabetic macular edema patients,PLoS One,11(7):e0159720
Qian J.,Zhu W.M.,Xiao Y.Q.,Hu J.,Lu H.,and Tang J.M.,2016,Protective effects of huyumingmu decoction on maculararea after phacoemulsification in diabetic patients,Yanke Xinjinzhan(Recent Advances in Ophthalmology),36(2):165-168(钱锦,朱炜敏,肖燕倩,忽俊,陆豪,唐建明,2016,化瘀明目饮对糖尿病患者白内障术后黄斑区的保护作用,眼科新进展,36(2):165-168)
Song Y.F.,Cai H.Y.,Wang X.,Zhao L.,and Chen X.Y.,2016,Analysis of macular edema by OCT after phacoemulsification surgery in patients with diabetic retinopathy,Yanke Xinjinzhan(Recent Advances in Ophthalmology),36(7):658-661(宋一帆,蔡宏媛,王新,赵琳,陈晓勇,2016,糖尿病视网膜病变患者白内障超声乳化术后黄斑水肿的分析,眼科新进展,36(7):658-661)
Xiao J.A.,Bai Q.Y.,and Xie A.M.,2015,Changes of cytokines in the aqueous humor following Avastin intravitreous injection in early diabetic retinopathy rats,Zhongguo Zuzhi Gongcheng Yanjiu(Journal of Clinical Rehabilitative Tissue Engineering Research),19(18):2933-2939(肖津安,白清玉,谢安明,2015,早期糖尿病视网膜病变模型大鼠玻璃体腔注射安维汀后房水细胞因子变化,中国组织工程研究,19(18):2933-2939)
Xie C.,Fang F.,and Fang Y.,2017,Clinical analysis on T2DMand xerophthalmia after cataract surgery,Yanke Xinjinzhan(Recent Advances in Ophthalmology),37(8):773-775(谢驰,方芳,方严,2017,2型糖尿病与白内障术后干眼相关性的临床分析,眼科新进展,37(8):773-775)
Xu H.P.,Qiu X.W.,and Zhang Z.Y.,2016,The effects of Atorvastatin calcium on the incidence of macular edema after phacoemulsification in diabetic patients,Zhonghua Yandibing Zazhi(Chinese Journal of Ocular Fundus Diseases),32(2):149-153(徐海萍,邱新文,张志勇,2016,阿托伐他汀钙对糖尿病患者白内障手术后黄斑水肿发生率的影响,中华眼底病杂志,32(2):149-153)
Zheng Z.,Liu D.N.,Zhou X.Y.,Hu X.P.,and Wu M.X.,2016,Effect of intravitreal injection of lucentis for refractory macular edema after cataract surgery,Disan Junyi Daxue Xuebao(Acta Academiae Medicinae Militaris Tertiae),38(20):2287-2290(郑政,刘丹宁,周希瑗,胡晓鹏,武明星,2016,玻璃体腔注射lucentis治疗白内障术后顽固性黄斑水肿的疗效,第三军医大学学报,38(20):2287-2290)