Adamiec-Mroczek Joanna, Oficjalska-Młyńczak Jolanta
Department of Ophthalmology, Wroclaw Medical University, ul. Chałubińskiego 2a, 50-368, Wrocław, Poland.
Graefes Arch Clin Exp Ophthalmol. 2008 Dec;246(12):1665-70. doi: 10.1007/s00417-008-0868-6. Epub 2008 Aug 6.
The aim of the study is to demonstrate the participation of the inflammatory-immune process in the pathogenesis of proliferative diabetic retinopathy (PDR).
Twenty four women and 22 men with type 2 diabetes (mean age 63.97 +/- 9.00 years, mean duration of diabetes 12.56 +/- 6.87 years) were enrolled in the study. Serum concentrations of soluble forms of ICAM-1, VCAM-1 as well as IL-6 and TNF-alpha were evaluated in all study subjects. In 19 patients, simultaneous assessment of selected parameter levels in both serum and vitreous samples was performed. Vitrectomy was performed due to intravitreal hemorrhage, accompanied in some patients by traction retinal detachment. The control group consisted of 15 patients having undergone vitrectomy for reasons other than PDR. Tests were performed using the ELISA method.
Serum and intraocular concentrations of sICAM-1, sVCAM-1, IL-6, TNF-alpha were considerably higher in study subjects with PDR than in controls. Simultaneously, a positive correlation was found between intraocular sVCAM-1 (r = 0.590, p = 0.007), TNF-alpha (r = 0.822, p < 0.001) concentrations and HbA(1)c levels. The above-mentioned dependence was not shown for sICAM-1 and IL-6 vitreous concentration. Local vitreous VCAM-1 level increase was also dependent on vitreous TNF-alpha concentration growth (r = 0.470, p = 0.043). No significant correlation was found between serum and vitreous levels of the selected parameters in the group of 19 patients with PDR.
Increase in sICAM-1 and sVCAM-1 levels, as well as their correlation with high vitreous IL-6 and TNF-alpha concentrations in patients with PDR, seem to confirm the inflammatory-immune nature of this process. In diabetes, inadequate metabolic control remains an important risk factor in the development of PDR.
本研究旨在证明炎症免疫过程在增殖性糖尿病视网膜病变（PDR）发病机制中的作用。
本研究纳入了24名女性和22名男性2型糖尿病患者（平均年龄63.97±9.00岁，平均糖尿病病程12.56±6.87年）。对所有研究对象的血清中可溶性细胞间黏附分子-1（ICAM-1）、血管细胞黏附分子-1（VCAM-1）以及白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）的浓度进行了评估。对19例患者同时进行了血清和玻璃体样本中选定参数水平的评估。因玻璃体积血进行了玻璃体切除术，部分患者伴有牵拉性视网膜脱离。对照组由15例因PDR以外原因接受玻璃体切除术的患者组成。采用酶联免疫吸附测定（ELISA）法进行检测。
PDR研究对象的血清和眼内sICAM-1、sVCAM-1、IL-6、TNF-α浓度明显高于对照组。同时，眼内sVCAM-1（r = 0.590，p = 0.007）、TNF-α（r = 0.822，p < 0.001）浓度与糖化血红蛋白（HbA1c）水平之间存在正相关。上述相关性在sICAM-1和玻璃体IL-6浓度方面未表现出来。局部玻璃体VCAM-1水平升高也依赖于玻璃体TNF-α浓度升高（r = 0.470，p = 0.043）。在19例PDR患者组中，所选参数的血清和玻璃体水平之间未发现显著相关性。
PDR患者sICAM-1和sVCAM-1水平升高，以及它们与高玻璃体IL-6和TNF-α浓度的相关性，似乎证实了这一过程的炎症免疫性质。在糖尿病中，代谢控制不佳仍然是PDR发生发展的重要危险因素。
