目的：探讨2型糖尿病视网膜病变患者血清氧化水平与炎症因子的关系及其临床意义。

方法：临床选取54例糖尿病合并视网膜病变患者，其中包括31例糖尿病非增殖期视网膜病变患者(NPDR组)和23例糖尿病增殖期视网膜病变患者(PDR组)，另取30例确诊为糖尿病但尚无糖尿病视网膜疾病的患者(DM组)和30例体检正常人群(NC组)作为对照，检测患者空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)、血清丙二醛(MDA)、血红素加氧酶-1(HO-1)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)和C反应蛋白(CRP)的表达量，方差分析比较组间差异，SNK-q对组间进行两两比较，Pearson相关分析对氧化标志物水平(MDA和HO-1)与炎症因子水平(TNF-α、IL-6和CRP)进行相关性分析，COX多因素分析探讨糖尿病视网膜病变的危险因素和保护因素。

结果：DM组、PDR组和NPDR组的FPG、2hPG、HbA1c、MDA、TNF-α、IL-6和CRP均显著高于NC组，差异有统计学意义(P<0.05)； HO-1显著低于NC组，差异有统计学意义(P<0.05)。PDR组和NPDR组MDA、TNF-α、IL-6和CRP显著高于DM组，差异有统计学意义(P<0.05)； HO-1显著低于DM组，差异有统计学意义(P<0.05)； PDR组MDA和TNF-α显著高于NPDR组，差异有统计学意义(P<0.05)； HO-1显著低于NPDR组，差异有统计学意义(P<0.05)； MDA水平与TNF-α及CRP水平存在显著正相关性(P<0.05)； HO-1水平与TNF-α、IL-6及CRP水平存在显著负相关性(P<0.05)； COX多因素分析MDA、TNF-α均为视网膜病变的危险因素，HO-1为视网膜病变的保护因素。

结论：氧化应激与糖尿病患者血清中相关炎症因子的表达密切相关，是DR重要的危险因素，MDA、TNF-α和HO-1可作为DR诊断标志物。

METHODS: Totally 54 cases of patients with diabetic retinopathy was selected as subjects, including 31 patients with diabetes and non-proliferative retinopathy(NPDR group)and 23 patients with diabetes and proliferative retinopathy(PDR group). Another 30 cases of diabetes patients without DR(DM group)and 30 normal people(NC group)was selected as control. The level of fasting blood glucose(FPG), 2h postprandial blood glucose(2hPG), glycosylated hemoglobin(HbA1c), serum malondialdehyde(MDA)and heme oxygenase -1(HO-1), tumor necrosis factor α(TNF-α)and interleukin-6(IL-6)and C reactive protein(CRP)was detected, and variance test detect the difference between 4 groups, and SNK-Q was used to multiple comparison. Pearson correlation analysis was used to compare the correlation between oxidation markers(MDA and Ho-1)and the level of inflammatory factors(TNF-α, IL-6 and CRP). COX multivariate analysis was used to investigate the risk and protective factors of diabetic retinopathy.

RESULTS: The levels of FPG, 2hPG, HbA1c, MDA, TNF-α, IL-6 and CRP in DM group, PDR group and NPDR group were significantly higher than that in NC group(P<0.05), and HO-1 was lower than that in NC group(P<0.05). The levels of MDA, TNF-α, IL-6 and CRP in PDR group and NPDR group were significantly higher than that in DM group(P<0.05), and HO-1 was significantly lower than that of DM group(P<0.05). MDA and TNF-α in PDR group were significantly higher than that in NPDR group(P<0.05), and HO-1 was lower than that in NPDR group(P<0.05). The level of MDA was positively correlated with the level of TNF-α and CRP(P<0.05), and the level of HO-1 was negative correlated with the level of IL-6, TNF-α and CRP(P<0.05). COX multivariate analysis showed that both MDA and TNF-α were risk factors of retinopathy, and HO-1 was the protective factor of retinopathy.

CONCLUSION: Oxidative stress is closely related to the expression of inflammatory factors in serum of patients with diabetes mellitus, and is an important risk factor of DR, and related indicators can be used as markers for DR diagnosis.