糖尿病视网膜病变患者血清转化生长因子-β水平变化及其在监测抗VEGF药物治疗效果中的作用  

Changes in serum transforming growth factor beta level in patients with diabetic retinopathy and its role in monitoring the therapeutic effect of anti-vascular endothelial growth factor drugs

作　　者：杨洁[1] 朱晓敏 胡子毅 张会民 冯子龙 YANG Jie;ZHU Xiaomin;HU Ziyi;ZHANG Huimin;FENG Zilong(Department of Ophthalmology,the First Affiliated Hospital of Hubei University of Science and Technology,Xianning 437100,Hubei Province,China;Department of Ophthalmology,the Third People’s Hospital of Dalian,Dalian 116000,Liaoning Province,China)

机构地区：[1]湖北科技学院附属第一医院眼科,湖北省咸宁市437100 [2]大连市第三人民医院眼科,辽宁省大连市116000

出　　处：《眼科新进展》2021年第12期1158-1163,共6页Recent Advances in Ophthalmology

摘　　要：目的探究糖尿病视网膜病变(DR)患者血清转化生长因子-β(TGF-β)水平变化及其在监测抗血管内皮生长因子(VEGF)药物治疗效果中的作用。方法本研究纳入2020年1至2020年12月本院收治的增生型DR(PDR)患者40例(PDR组)、非PDR(NPDR)患者40例(NPDR组)、无DR症状的糖尿病患者40例(糖尿病组)以及40位年龄、性别匹配的健康对照者(对照组)。检测所有受试者血清VEGF-A和TGF-β水平。所有DR患者均接受玻璃体内注射雷珠单抗,1个月后检测受试者黄斑中心凹厚度(FMT)和血清TGF-β水平,采用受试者工作特征(ROC)曲线分析血清TGF-β诊断各组患者的曲线下面积(AUC),采用Spearman秩相关分析血清VEGF-A、TGF-β水平与FMT、糖化血红蛋白(HbAlc)和糖尿病病程等指标之间的相关性。结果治疗前糖尿病组、NPDR组、PDR组患者血清VEGF-A、TGF-β水平均高于对照组(均为P<0.05)。NPDR组和PDR组患者血清TGF-β水平和FMT较对照组和糖尿病组均升高(均为P<0.05),且PDR组升高更明显,与对照组、糖尿病组、NPDR组患者相比,差异均有统计学意义(均为P<0.05)。ROC曲线分析结果显示,血清TGF-β水平可以诊断糖尿病患者(AUC=0.860,P<0.001)、糖尿病人群中的DR患者(AUC=0.756,P<0.001)以及鉴别诊断NPDR和PDR患者(AUC=0.734,P<0.001)。DR患者血清TGF-β水平与HbAlc、糖尿病病程均呈正相关性(r=0.703、0.656,均为P<0.001)。治疗后1个月NPDR组患者血清TGF-β水平和FMT值均显著低于治疗前基线值(均为P<0.001),而PDR组患者治疗前后血清TGF-β水平和FMT值差异均无统计学意义(均为P>0.05)。治疗后1个月,DR患者血清TGF-β水平与FMT值呈正相关性(r=0.808,P<0.001);而血清VEGF-A水平与FMT值则无相关性(r=0.013,P=0.907)。结论血清TGF-β水平可以被认为是预测从NPDR到PDR疾病进展的一个生物标志物,它也可能是抗VEGF药物临床疗效的次要终点。Objective To explore the changes in serum transforming growth factor beta(TGF-β)level in patients with diabetic retinopathy(DR)and its role in monitoring the therapeutic effects of anti-vascular endothelial growth factor(VEGF)drugs.Methods This study included 40 patients with proliferative diabetic retinopathy(PDR)in the PDR group,40 patients with non-PDR in the NPDR group,and 40 patients with non-DR in the diabetes mellitus(DM)group,all patients being treated in our hospital from January to December 2020.In addition,40 age-and sex-matched healthy individuals were selected in the control group.Serum VEGF-A and TGF-βlevels were measured.All DR patients received intravitreal injection of ranibizumab.The foveal macular thickness(FMT)and serum TGF-βlevel were measured one month later.The receiver operating characteristic(ROC)curve was used to analyze the area under curve(AUC)for serum TGF-β,and Spearman rank correlation was used to analyze the correlation between serum VEGF-A,TGF-β,FMT,glycated hemoglobin(HbAlc),and the course of diabetes.Results The levels of VEGF-A and TGF-βin the DM group,NPDR group,and PDR group were higher than those in the control group(all P<0.05).Serum TGF-βlevel and FMT in the NPDR group and PDR group were higher than those in the control group and DM group(all P<0.05),especially in the PDR group,it increased more significantly,and the difference was statistically significant compared with the control group,DM group,NPDR group(all P<0.05).The ROC curve showed that serum TGF-βlevel could be used for diagnosis of diabetic patients(AUC=0.860,P<0.001),DR patients(AUC=0.756,P<0.001)and differential diagnosis of NPDR and PDR patients(AUC=0.734,P<0.001).The serum TGF-βlevel in DR patients was positively correlated with HbAlc and the course of diabetes(r=0.703,0.656,both P<0.001).The postoperative serum TGF-βlevel and FMT in the NPDR group were significantly lower than the preoperative baselines(all P<0.001),but in the PDR group,there were no significant differences in the serum TGF-βleve

关 键 词：糖尿病视网膜病变 转化生长因子-Β 抗血管内皮生长因子 黄斑中心凹厚度 

分 类 号：R774.1[医药卫生—眼科]