Hernández Cristina, Fonollosa Alex, García-Ramírez Marta, Higuera Mónica, Catalán Roberto, Miralles Adela, García-Arumí José, Simó Rafael
Diabetes Research Unit, Endocrinology Division, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.
Diabetes Care. 2006 Sep;29(9):2028-33. doi: 10.2337/dc06-0556.
Erythropoietin has been recently found to be increased in the vitreous fluid from ischemic retinal diseases such as proliferative diabetic retinopathy (PDR). The aims of the present study were 1) to measure erythropoietin levels in the vitreous fluid from patients with diabetic macular edema (DME), a condition in which the ischemia is not a predominant event, and 2) to compare erythropoietin mRNA expression between human retinas from nondiabetic and diabetic donors without retinopathy.
Vitreous samples from 12 type 2 diabetic patients with DME without significant retinal ischemia and 12 PDR patients were prospectively analyzed. Ten nondiabetic patients with macular holes served as the control group. Erythropoietin was assessed by radioimmunoassay (milliunits per milliliter). Erythropoietin mRNA expression was measured by quantitative real-time RT-PCR analysis in the retina from eight nondiabetic and eight age-matched diabetic donors without diabetic retinopathy
Intravitreal erythropoietin concentration was higher in both PDR and DME patients than in nondiabetic control subjects (PDR vs. control subjects: median 302 [range 117-1,850] vs. 30 mU/ml [10-75], P < 0.01; DME vs. control subjects: 430 [41-3,000] vs. 30 mU/ml [10-75], P < 0.01). However, no significant differences were found between DME and PDR patients. Erythropoietin mRNA expression was detected in the human retina, and it was higher in the retina from diabetic than from nondiabetic donors.
As occurs in PDR, intravitreous erythropoietin concentrations are strikingly higher in DME. Erythropoietin is expressed in the human retina, and it is upregulated in diabetic patients even without retinopathy. These findings suggest that other factors apart from ischemia are involved in the overexpression of erythropoietin in diabetic retinopathy.
最近发现促红细胞生成素在诸如增殖性糖尿病视网膜病变（PDR）等缺血性视网膜疾病的玻璃体液中升高。本研究的目的是：1）测量糖尿病性黄斑水肿（DME）患者玻璃体液中的促红细胞生成素水平，DME这种疾病中缺血并非主要事件；2）比较无视网膜病变的非糖尿病和糖尿病供体的人视网膜之间促红细胞生成素mRNA的表达。
前瞻性分析了12例无明显视网膜缺血的2型糖尿病DME患者和12例PDR患者的玻璃体液样本。10例患有黄斑裂孔的非糖尿病患者作为对照组。通过放射免疫测定法（每毫升毫单位）评估促红细胞生成素。通过定量实时逆转录聚合酶链反应分析，测量了8例无糖尿病视网膜病变的非糖尿病和8例年龄匹配的糖尿病供体视网膜中促红细胞生成素mRNA的表达。
PDR和DME患者玻璃体内促红细胞生成素浓度均高于非糖尿病对照组（PDR与对照组：中位数302[范围117 - 1850]对30 mU/ml[10 - 75]，P < 0.01；DME与对照组：430[41 - 3000]对30 mU/ml[10 - 75]，P < 0.01）。然而，DME和PDR患者之间未发现显著差异。在人视网膜中检测到促红细胞生成素mRNA表达，糖尿病供体视网膜中的表达高于非糖尿病供体。
与PDR一样，DME患者玻璃体内促红细胞生成素浓度显著更高。促红细胞生成素在人视网膜中表达，即使在无视网膜病变的糖尿病患者中也会上调。这些发现表明，除缺血外，其他因素也参与糖尿病视网膜病变中促红细胞生成素的过表达。
