目的：探讨中老年糖尿病视网膜病变(diabetic retinopathy，DR)患者DR严重程度与血清HbA1c、TNF-α水平的相关性。

方法：选取200例糖尿病患者，其中单纯糖尿病患者(DM组)60例，糖尿病伴非增殖期视网膜病变组(NPDR组)80例和糖尿病伴增殖期视网膜病变组(PDR组)60例，并选取80例健康者作为正常对照组(NC组)。观察患者的体检指标，并检测患者的空腹血糖(fasting plasma glucose，FPG)、餐后2h血糖(2hPG)、血脂、血清糖化血红蛋白(HbA1c)、血清肿瘤坏死因子-α(tumor necrosis factor，TNF-α)及泪液TNF-α。

结果：(1)四组受试者的体质量指数(body mass index，BMI)、FPG、2hPG、总胆固醇(total cholesterol ，TC)、甘油三酯(trilycerides，TG)、高密度脂蛋白(high density lipoprotein，HDL-C)、低密度脂蛋白(low-density lipoprotein，LDL-C)等指标比较，差异均具有统计学意义(F=37.211、395.421、42.515、7.385、121.764、121.568、34.567，均P<0.05)。DM、NPDR、PDR三组患者的BMI、FPG、2hPG、TC、TG、HDL-C、LDL-C等指标水平均高于NC组，差异有统计学意义(P<0.05)； NPDR组患者的BMI、FPG、2hPG、TC、TG、HDL-C、LDL-C等指标水平均高于PDR组，差异有统计学意义(P<0.05)。(2)四组受试者血清TNF-α、泪液TNF-α及血清HbA1c水平比较，差异均具有统计学意义(F=337.256、215.471、40.522，均P<0.05)； DM、NPDR、PDR三组患者的血清TNF-α、泪液TNF-α和血清HbA1c水平均高于NC组，差异有统计学意义(P<0.05)； NPDR、PDR两组患者的血清TNF-α、泪液TNF-α和血清HbA1c水平均高于DM组，差异有统计学意义(P<0.05)； PDR组患者的血清TNF-α、泪液TNF-α及血清HbA1c水平均高于NPDR组，差异有统计学意义(P<0.05)。(3)泪液TNF - α与血清TNF - α呈正相关(r=0.289，P<0.01)； 泪液TNF-α与血清 HbA1c呈正相关(r=0.375，P<0.01)。

结论：中老年DR患者泪液TNF-α水平高于正常人，且随着视网膜病变的加重，泪液TNF-α水平升高。泪液TNF-α与血清TNF-α、HbA1c呈正相关。

METHODS: Totally 200 patients with diabetes mellitus was selected, 60 patients with diabetes mellitus(DM group), 80 patients with non-proliferative diabetic retinopathy(NPDR)and 60 patients with diabetic retinopathy(PDR), and 80 healthy subjects were selected as normal control group(NC group). Patient's physical examination index was observed, the levels of fasting plasma glucose(FPG), 2h postprandial blood glucose(2hPG), serum lipids, serum HbA1c, serum tumor necrosis factor-α(TNF-α)and tear TNF-α of patients were measured.

RESULTS:There were significant differences in body mass index(BMI), FPG, 2hPG, total cholesterol(TC), trilycerides(TG), high density lipoprotein(HDL-C)and low-density lipoprotein(LDL-C)among the four groups(F=37.211, 395.421, 42.515, 7.385, 121.764, 121.568, 34.567, P<0.05). The levels of BMI, FPG, 2hPG, TC, TG, HDL-C and LDL-C of DM, NPDR and PDR groups were significantly higher than those in the NC group(P<0.05). The levels of BMI, FPG, 2hPG, TC, TG, HDL-C and LDL-C of PDR group were significantly higher than those in the NPDR group(P<0.05). The differences of serum TNF-α, tear TNF-α and serum HbA1c in four groups were statistically significant(F=337.256, 215.471, 40.522, P<0.05). The levels of serum TNF-α, tear TNF-α and serum HbA1c in the DM, NPDR and PDR groups were significantly higher than those in the NC group; the serum levels of serum TNF-α, tear TNF-α and serum HbA1c of the NPDR and PDR groups were significantly higher than those in the DM group(P<0.05), the serum levels of serum TNF-α, tear TNF-α and serum HbA1c of PDR group were significantly higher than those in the NPDR group(P<0.05). There was a positive correlation between tear TNF - α and serum TNF–α(r=0.289, P<0.01), and a positive correlation between serum TNF-α and serum HbA1c(r=0.375, P<0.01).

CONCLUSION: The tear TNF-α levels in middle-aged patients with diabetic retinopathy is higher than normal, and with the increase of retinopathy severity, tear TNF-α levels increases. There is a positive correlation between TNF-α in tear fluid and serum TNF-α and HbA1c.