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目的探讨血清转化生长因子β1(TGFβ1)在糖尿病视网膜病变(DR)发病中的意义以及血管紧张素转化酶抑制剂(ACET)福辛普利对DR患者的治疗效果及对DR患者血清TGFβ1水平的影响。方法将80例2型糖尿病(2-DM)患者及20例健康人群分为5组,采用双抗体夹心酶联免疫吸附法(ELISA)检测其血清TGFβ1水平并进行比较。将45例背景型DR患者分为2组,25例福辛普利治疗组给予福辛普利治疗6个月,行眼底荧光造影(FFA)检查观察患者治疗前后眼底病变的变化并与药物对照组比较,同时检测患者治疗前后血清TGFβ1水平的改变。结果糖尿病组与正常对照组比较,血清TGFβ1水平升高,差异有显著性意义(P<0．01)。糖尿病三组之间比较,PDR组血清TGFβ1水平高于背景型DR组;背景型DR组血清TGFβ1水平高于NODR组,三组之间差异均有显著性意义(P<0．05)。苯那普利治疗后背景型DR患者血清TGFβ1水平及UAER降低,与治疗前比较,差异均有显著性意义(P<0．05)。福辛普利治疗前后DR眼底的变化与药物对照组比较,无显著性差异(P>0．05)。结论DR患者血清TGFβ1水平显著升高,且随病变进展进一步升高,TGFβ1可能在DR发病及其进展中发挥重要作用。福辛普利通过抑制背景型DR患者产生TGFβ1,从而发挥对视网膜可能的保护用,但短期内观察眼底的病变无明显改善。
Objective To investigate the significance of serum transforming growth factor-β1 (TGFβ1) in the pathogenesis of diabetic retinopathy (DR) and the therapeutic effect of acitretin (ACET) on patients with DR and the serum levels of TGFβ1 influences. Methods Eighty patients with type 2 diabetes mellitus (DM) and 20 healthy people were divided into five groups. Serum TGFβ1 levels were measured by ELISA and the levels of TGFβ1 were compared. Forty-five patients with background DR were divided into two groups. Fosinopril was given to 25 patients in the fosinopril treatment group for 6 months. Fundus fluorescein angiography (FFA) was performed to observe the changes of fundus lesions before and after treatment. Group, at the same time detect the change of serum TGFβ1 level before and after treatment. Results Compared with the normal control group, the level of serum TGFβ1 in diabetic group was significantly increased (P <0.01). The level of serum TGFβ1 in PDR group was higher than that in background DR group. The level of serum TGFβ1 in background DR group was higher than that in NODR group. The difference among the three groups was significant (P <0.05). The levels of TGFβ1 and UAER in background DR patients after benazepril treatment were significantly lower than those before treatment (P <0.05). There was no significant difference in DR fundus changes between before and after fosinopril treatment (P> 0.05). Conclusion Serum levels of TGFβ1 are significantly increased in patients with DR and further increase with the progression of the disease. TGFβ1 may play an important role in the pathogenesis and progression of DR. Fosinopril exerted a protective effect on the retina by inhibiting the production of TGFβ1 in patients with background DR, but no significant improvement was observed in the fundus in the short term.