老年糖尿病视网膜病变患者血清ICAM-1、VEGF水平与微血管损伤的相关性分析

摘要

目的:研究老年糖尿病视网膜病变患者血清血管内皮生长因子(VEGF)及细胞间黏附分子(ICAM)-1水平与微血管损伤的相关性,为临床诊断及治疗提供参考.方法:选取我院收治的268例糖尿病患者,依据眼底荧光血管造影及直接眼底镜检查将患者分为增值型糖尿病视网膜病变组(PDR)、背景型糖尿病视网膜病变组(BDR)及无糖尿病视网膜病变组(NDR),并选择同期来我院参加体检的100名健康者作为对照组.对比4组受检者的ICAM-1、VEGF与一氧化氮(NO)、血管性假血友病因子(vWF)、内皮素-1(ET-1)及血栓调节蛋白(TM)等血管内皮功能指标变化.结果:4组受检者对比,NDR组、BDR组、PDR组ICAM-1、VEGF与NO、vWF(NDR组除外)、ET-1及TM 4项血管内皮功能指标均高于对照组,差异有统计学意义(P＜0.05),而NDR组vWF与对照组相比,差异无统计学意义(P＞0.05);NDR组、BDR组与PDR组3组间ICAM-1、VEGF与NO、vWF、ET-1及TM 4项血管内皮功能指标比较,差异均具有统计学意义(P＜0.05).两组受检者对比,视网膜病变组患者ICAM-1、VEGF与NO、vWF、ET-1及TM四项血管内皮功能指标均高于对照组,差异有统计学意义(P＜0.05).结论:老年糖尿病视网膜病变患者VEGF、ICAM-1水平与微血管损伤存在相关性,即病情发展越晚VEGF、ICAM-1表达升高,NO、vWF、ET-1及TM等血管内皮损伤指标同步升高,可较好的反映微循环血管内皮损伤的程度及血液流变、凝血机制改变,值得临床借鉴.%Objective:To study the correlation between serum vascular endothelial growth factor (VEGF) and intercellular adhesion molecule (ICAM)-1 level and microvascular injury in elderly diabetic retinopathy,and provide reference for clinical diagnosis and treatment.Methods:A total of 268 cases of diabetic patients in our hospital in October 2015-2017 year in October,on the basis of fundus fluorescein angiography and fundus examination were divided into proliferative diabetic retinopathy group (PDR),background diabetic retinopathy group (BDR) and diabetic retinopathy group (NDR),and 100 healthy at the same time to participate in the examination of our hospital as the control group.The changes of ICAM-1,VEGF and nitric oxide (NO),von Willebrand factor (vWF),endothelin-1 (ET-1) and thrombomodulin (TM) and other vascular endothelial function indexes in four groups were compared.Results:the four groups were compared,NDR group,BDR group,PDR group,ICAM-1,VEGF,NO and vWF (except NDR group),four ET-1 TM and vascular endothelial function index were higher than the control group,the difference was statistically significant (P＜0.05),while the NDR vWF group compared with the control group,the difference no statistical significance (P＞0.05);NDR group,BDR group and PDR group between the three groups ICAM-1,VEGF and NO,vWF,ET-1 and TM four vascular endothelial function index comparison,the differences were statistically significant (P ＜ 0.05).Compared with the two groups,four vascular endothelial function indexes of ICAM-1,VEGF and NO,vWF,ET-1 and TM in retinopathy group were higher than those in control group,the difference was statistically significant (P＜0.05).Conclusion:the correlation between senile diabetic retinopathy patients VEGF,ICAM1 level and microvascular injury,namely the progression of the disease more late VEGF,increase the expression of ICAM-1,NO,vWF,ET-1 and TM of vascular endothelial damage index increased,which can reflect the microcirculation better in lesions of the extent of injury and blood rheology,change of coagulation mechanism,worth clinical reference.