摘要
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(Hb A1c)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 h PG)、血脂、TNF-α、Hb A1c。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1 447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Hb A1c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Hb A1c均高于NGT组,NPDR组和PDR组泪液、血清TNF-α及血清Hb A1c均高于NDR组,PDR组泪液、血清TNF-α及血清Hb A1c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Hb A1c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 h PG、泪液TNF-α、血清TNF-α、Hb A1c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Hb A1c水平可一定程度上反映DR严重程度。
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 h PG, blood lipid, TNF-α and HbA1c were determined. Capillary glass tube method was employed,and ELISA was employed to determine TNF-α level. 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-α and serum Hb A1c（ 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 Hb A1c（ 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 Hb A1c（ 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 h PG, 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-α level 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.
出处
《中国全科医学》
CAS
CSCD
北大核心
2015年第35期4288-4292,共5页
Chinese General Practice
基金
石家庄市科学技术研究与发展指导计划项目(121461173)
关键词
糖尿病
糖尿病视网膜病变
泪液
血清
肿瘤坏死因子Α
Diabetes mellitus
Diabetic retinopathy
Tear fluid
Serum
Tumor necrosis factor-alpha
