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Zhao Heng, 1, * Zhang Lidan, 2, * Liu Lifang, 1 Li Chunqing, 3 Song Weili, 3 Peng Yongyang, 1 Zhang Yunliang, 1 Li Dan 41 Endocrinology Laboratory, First Baoding Central Hospital, Baoding, Hebei Province, 071000;2 Baoding First Department of Nuclear Medicine, Central Hospital, Baoding, Hebei 071000;3 Odwala Odwala Pachipatala cha Baoding First Central Hospital, Baoding, Province la Hebei, 071000;4 Department of Ophthalmology, Affiliated Hospital of Hebei University, Baoding, Hebei, 071000 *Olemba awa athandizira chimodzimodzi pantchitoyi.Wolemba wofananira: Li Dan, Dipatimenti ya Ophthalmology, Hebei University Hospital, Baoding, Hebei, 071000 Tel +86 189 31251885 Fax +86 031 25981539 Imelo [imelo yotetezedwa] Zhang Yunliang Endocrinology Endocrinology First Laboratory07 People's Hospital Hebei, Baoding Hospital 07 People's First Hospital Hebei Republic of China Tel +86 151620373737373737375axe Email protected ] Cholinga: Kafukufukuyu akufuna kufotokoza milingo ya glycosylated hemoglobin (HbA1c), D-dimer (DD) ndi fibrinogen (FIB) mumitundu yosiyanasiyana ya matenda ashuga retinopathy (DR).Njira: Odwala 61 odwala matenda ashuga, omwe adalandira chithandizo ku dipatimenti yathu kuyambira Novembara 2017 mpaka Meyi 2019, adasankhidwa.Malinga ndi zotsatira za kujambula kwa non-mydriatic fundus ndi fundus angiography, odwala adagawidwa m'magulu atatu, omwe ndi gulu la non-DR (NDR) (n = 23), gulu la non-proliferative DR (NPDR) (n = 17) ndi kuchulukana. DR ( PDR) gulu (n=21).Zimaphatikizanso gulu lowongolera la anthu 20 omwe adapezeka kuti alibe matenda a shuga.Yezerani ndi kufananiza milingo ya HbA1c, DD ndi FIB motsatana.Zotsatira: Mtengo wapakati wa HbA1c unali 6.8% (5.2%, 7.7%), 7.4% (5.8%, 9.0%) ndi 8.5% (6.3%), 9.7%) m'magulu a NDR, NPDR ndi PDR, motsatana. .Mtengo wowongolera unali 4.9% (4.1%, 5.8%).Zotsatirazi zikuwonetsa kuti pali kusiyana kwakukulu kwa chiwerengero pakati pa magulu.M'magulu a NDR, NPDR, ndi PDR, chiwerengero cha DD chinali 0.39 ± 0.21 mg/L, 1.06 ± 0.54 mg/L, ndi 1.39 ± 0.59 mg/L, motsatira.Zotsatira za gulu lolamulira linali 0.36 ± 0.17 mg/L.Makhalidwe a gulu la NPDR ndi gulu la PDR anali apamwamba kwambiri kuposa a gulu la NDR ndi gulu lolamulira, ndipo mtengo wa gulu la PDR unali wapamwamba kwambiri kuposa gulu la NPDR, kusonyeza kuti kusiyana pakati pa maguluwo kunali kwakukulu. (P<0.001).Mtengo wapakati wa FIB m'magulu a NDR, NPDR, ndi PDR anali 3.07 ± 0.42 g/L, 4.38 ± 0.54 g/L, ndi 4.46 ± 1.09 g/L, motsatana.Zotsatira za gulu lolamulira linali 2.97 ± 0.67 g/L.Kusiyana pakati pamagulu kunali kofunikira kwambiri (P <0.05).Kutsiliza: Miyezo ya magazi HbA1c, DD, ndi FIB mu gulu la PDR inali yaikulu kwambiri kuposa ya gulu la NPDR.Mawu ofunika: glycosylated hemoglobin, HbA1c, D-dimer, DD, fibrinogen, FIB, diabetesic retinopathy, DR, microangiopathy
Diabetes mellitus (DM) yakhala matenda angapo m'zaka zaposachedwa, ndipo zovuta zake zimatha kuyambitsa matenda angapo am'mitsempha, pomwe microangiopathy ndizomwe zimayambitsa kufa kwa odwala matenda ashuga.1 Glycated hemoglobin (HbA1c) ndiye chizindikiro chachikulu chowongolera shuga m'magazi, chomwe chimawonetsa kuchuluka kwa shuga m'magazi a odwala m'miyezi iwiri kapena itatu yoyambirira, ndipo wakhala muyeso wodziwika padziko lonse lapansi wowunika shuga wamagazi kwa nthawi yayitali. .Pakuyesa kwa ntchito ya coagulation, D-dimer (DD) imatha kuwonetsa makamaka hyperfibrinolysis yachiwiri ndi hypercoagulability m'thupi, monga chizindikiro chodziwika bwino cha thrombosis.Kuchuluka kwa Fibrinogen (FIB) kungasonyeze mkhalidwe wa prethrombotic m'thupi.Kafukufuku omwe alipo awonetsa kuti kuyang'anira kuchuluka kwa shuga m'magazi ndi HbA1c ya odwala omwe ali ndi DM kumathandizira kuwunika momwe matenda akukulirakulira, 2,3 makamaka microangiopathy.4 Diabetic retinopathy (DR) ndi amodzi mwazovuta zomwe zimachitika m'mitsempha yamagazi komanso zomwe zimayambitsa khungu la matenda ashuga.Ubwino wa mitundu itatu ya mayesowa ndikuti ndi yosavuta kugwiritsa ntchito ndipo ndi yotchuka kwambiri m'machipatala.Kafukufukuyu amawona momwe HbA1c, DD, ndi FIB amayendera odwala omwe ali ndi magawo osiyanasiyana a DR, ndikuwayerekeza ndi zotsatira za odwala omwe si a DR DM komanso oyesa thupi omwe si a DM, kuti azindikire kufunika kwa HbA1c, DD. ndi FIB.Kuyesa kwa FIB kumagwiritsidwa ntchito kuyang'anira zomwe zimachitika ndikukula kwa DR.
Kafukufukuyu adasankha odwala 61 omwe ali ndi matenda a shuga (maso 122) omwe adalandira chithandizo kuchipatala cha Baoding First Central Hospital kuyambira Novembala 2017 mpaka Meyi 2019. Njira zophatikizira odwala ndi: Odwala matenda a shuga omwe amapezeka molingana ndi "Malangizo Opewera ndi Kuchiza Mtundu 2 Diabetes in China (2017)”, komanso maphunziro oyezetsa thanzi a shuga samaphatikizidwa.Njira zochotserako ndi izi: (1) odwala oyembekezera;(2) odwala prediabetes;(3) odwala osakwana zaka 14;(4) pali zotsatira zapadera za mankhwala, monga kugwiritsa ntchito kwaposachedwa kwa glucocorticoids.Malinga ndi kujambula kwawo kwa non-mydriatic fundus ndi zotsatira za fluorescein fundus angiography, otenga nawo mbali adagawidwa m'magulu atatu otsatirawa: Gulu la non-DR (NDR) linaphatikizapo odwala 23 (maso 46), amuna 11, akazi 12, ndi zaka 43- Zaka 76.Zaka zakubadwa, zaka pafupifupi 61.78± 6.28 zaka;gulu losagwirizana ndi DR (NPDR), milandu ya 17 (maso a 34), amuna a 10 ndi akazi a 7, zaka 47-70, zaka zapakati pa 60.89 ± 4.27;proliferative DR (Panali milandu 21 (maso 42) mu gulu la PDR, kuphatikiza amuna 9 ndi akazi 12, azaka za 51-73, omwe ali ndi zaka zapakati pa 62.24 ± 7.91. Anthu onse a 20 (maso 40) mu gulu lolamulira linali loipa kwa matenda a shuga, kuphatikizapo amuna a 8 ndi akazi 12, a zaka za 50-75, omwe ali ndi zaka zapakati pa 64.54 ± 3.11. Opaleshoni, matenda, zotupa zowopsa kapena matenda ena onse achilengedwe sanaphatikizidwe.Onse omwe adatenga nawo gawo adapereka chilolezo chodziwitsidwa cholembedwa kuti chiphatikizidwe mu kafukufukuyu.
Odwala a DR amakumana ndi zowunikira zomwe zimaperekedwa ndi Ophthalmology Division ya Ophthalmology Branch ndi Chinese Medical Association.5 Tinagwiritsa ntchito kamera yopanda mydriatic fundus (Canon CR-2, Tokyo, Japan) kuti tilembe mzati wapambuyo wa fundus wa wodwalayo.Ndipo adatenga chithunzi cha 30°–45° fundus.Katswiri wophunzitsidwa bwino wa ophthalmologist anapereka lipoti la matenda olembedwa pogwiritsa ntchito zithunzi.Pankhani ya DR, gwiritsani ntchito Heidelberg Retinal Angiography-2 (HRA-2) (Heidelberg Engineering Company, Germany) pofufuza fundus angiography, ndikugwiritsa ntchito njira zisanu ndi ziwiri zoyambira chithandizo cha matenda a shuga a retinopathy (ETDRS) fluorescein angiography (FA) kutsimikizira NPDR kapena PDR.Malinga ndi zomwe ochita nawo adawonetsa retinal neovascularization, otenga nawo mbali adagawidwa m'magulu a NPDR ndi PDR.Odwala matenda a shuga omwe si a DR adalembedwa kuti gulu la NDR;odwala omwe adapezeka kuti alibe matenda a shuga adawonedwa ngati gulu lowongolera.
M'mawa, 1.8 ml ya magazi osala kudya adasonkhanitsidwa ndikuyikidwa mu chubu cha anticoagulation.Pambuyo pa maola awiri, centrifuge kwa mphindi 20 kuti muwone mulingo wa HbA1c.
M'mawa, 1.8 ml ya magazi osala kudya adasonkhanitsidwa, kubayidwa mu chubu cha anticoagulation, ndi centrifuged kwa mphindi 10.Chowonjezeracho chinagwiritsidwa ntchito pozindikira DD ndi FIB.
Kuzindikira kwa HbA1c kumachitika pogwiritsa ntchito Beckman AU5821 automatic biochemical analyzer ndi ma reagents ake othandizira.Kudula kwa matenda a shuga> 6.20%, mtengo wabwinobwino ndi 3.00% ~ 6.20%.
Mayeso a DD ndi FIB adachitidwa pogwiritsa ntchito STA Compact Max® automatic coagulation analyzer (Stago, France) ndi ma reagents ake othandizira.Makhalidwe abwino ndi DD> 0.5 mg/L ndi FIB> 4 g/L, pomwe zodziwika bwino ndi DD ≤ 0.5 mg/L ndi FIB 2-4 g/L.
Pulogalamu ya SPSS Statistics (v.11.5) imagwiritsidwa ntchito pokonza zotsatira;deta imawonetsedwa ngati ± kupatuka kokhazikika (±s).Kutengera kuyeserera kwanthawi zonse, zomwe zili pamwambapa zikugwirizana ndi kugawa kwanthawi zonse.Kusanthula kwa njira imodzi yosiyana kunachitika pamagulu anayi a HbA1c, DD, ndi FIB.Kuonjezera apo, chiwerengero cha chiwerengero cha DD ndi FIB chinafaniziridwanso;P <0.05 ikuwonetsa kuti kusiyana kuli kofunikira.
Zaka za maphunziro mu gulu la NDR, gulu la NPDR, gulu la PDR, ndi gulu lolamulira linali 61.78 ± 6.28, 60.89 ± 4.27, 62.24 ± 7.91, ndi 64.54 ± 3.11 zaka, motero.Zakazo nthawi zambiri zimagawidwa pambuyo poyesa kugawa.Kusanthula kwa njira imodzi yosiyana kunasonyeza kuti kusiyana sikunali kofunika kwambiri (P = 0.157) (Table 1).
Table 1 Kuyerekeza kwa zizindikiro zoyambira zachipatala ndi ophthalmological pakati pa gulu lolamulira ndi magulu a NDR, NPDR ndi PDR
Pafupifupi HbA1c ya gulu la NDR, gulu la NPDR, gulu la PDR ndi gulu lolamulira linali 6.58 ± 0.95%, 7.45 ± 1.21%, 8.04 ± 1.81% ndi 4.53 ± 0.41%, motero.Ma HbA1cs amagulu anayiwa nthawi zambiri amagawidwa ndikuyesedwa ndi kugawa koyenera.Pogwiritsa ntchito njira imodzi yowunikira kusiyana, kusiyana kunali kofunikira kwambiri (P <0.001) (Table 2).Kuyerekeza kwina pakati pa magulu anayiwa kunawonetsa kusiyana kwakukulu pakati pa magulu (P <0.05) (Table 3).
Makhalidwe apakati a DD mu gulu la NDR, gulu la NPDR, gulu la PDR, ndi gulu lolamulira anali 0.39±0.21mg/L, 1.06±0.54mg/L, 1.39±0.59mg/L ndi 0.36±0.17mg/L, motsatana.Ma DD onse amagawidwa ndikuyesedwa ndi kugawa bwino.Pogwiritsa ntchito njira imodzi yowunikira kusiyana, kusiyana kunali kofunikira kwambiri (P <0.001) (Table 2).Kupyolera mu kuyerekezanso kwa magulu anayiwa, zotsatira zikuwonetsa kuti makhalidwe a NPDR ndi gulu la PDR ndi apamwamba kwambiri kuposa gulu la NDR ndi gulu lolamulira, ndipo mtengo wa gulu la PDR ndi wapamwamba kwambiri kuposa gulu la NPDR. , kusonyeza kuti kusiyana pakati pa magulu ndi kwakukulu (P<0.05).Komabe, kusiyana pakati pa gulu la NDR ndi gulu lolamulira silinali lofunika kwambiri (P> 0.05) (Table 3).
Pafupifupi FIB ya gulu la NDR, gulu la NPDR, gulu la PDR ndi gulu lolamulira linali 3.07±0.42 g/L, 4.38±0.54 g/L, 4.46±1.09 g/L ndi 2.97±0.67 g/L, motero.FIB yamagulu anayiwa Ikuwonetsa kugawa kwanthawi zonse ndi mayeso ogawa bwino.Pogwiritsa ntchito njira imodzi yowunikira kusiyana, kusiyana kunali kofunikira kwambiri (P <0.001) (Table 2).Kuyerekeza kwina pakati pa magulu anayiwa kunawonetsa kuti zikhulupiriro za gulu la NPDR ndi gulu la PDR zinali zapamwamba kwambiri kuposa za gulu la NDR ndi gulu lowongolera, zomwe zikuwonetsa kuti kusiyana pakati pamagulu kunali kofunika (P <0.05).Komabe, panalibe kusiyana kwakukulu pakati pa gulu la NPDR ndi gulu la PDR, ndi NDR ndi gulu lolamulira (P> 0.05) (Table 3).
M'zaka zaposachedwapa, chiwerengero cha matenda a shuga chikuwonjezeka chaka ndi chaka, ndipo chiwerengero cha DR chawonjezeka.DR panopa ndi amene amachititsa khungu kwambiri.6 Kusinthasintha kwakukulu kwa shuga m'magazi (BG)/shuga kungayambitse kukomoka kwa magazi, zomwe zimapangitsa kuti pakhale zovuta zingapo zamitsempha.7 Chifukwa chake, kuyang'anira kuchuluka kwa BG ndi mawonekedwe a coagulation a odwala matenda a shuga ndi chitukuko cha DR, ofufuza ku China ndi malo ena ali ndi chidwi kwambiri.
Pamene hemoglobini m'maselo ofiira a magazi imaphatikizidwa ndi shuga wa magazi, glycosylated hemoglobin imapangidwa, yomwe nthawi zambiri imasonyeza kulamulira kwa shuga m'magazi a wodwala m'masabata 8-12 oyambirira.Kupanga kwa HbA1c kumakhala pang'onopang'ono, koma kukamalizidwa, sikuwonongeka mosavuta;Chifukwa chake, kupezeka kwake kumathandizira kuwunika kwa shuga m'magazi.8 Hyperglycemia yanthawi yayitali imatha kuyambitsa kusintha kosasinthika m'mitsempha, koma HbAlc akadali chizindikiro chabwino cha kuchuluka kwa shuga m'magazi mwa odwala matenda ashuga.Mulingo wa 9 HbAlc sikuti umangowonetsa kuchuluka kwa shuga m'magazi, komanso umagwirizana kwambiri ndi kuchuluka kwa shuga m'magazi.Zimakhudzana ndi zovuta za matenda a shuga monga matenda a microvascular ndi matenda a macrovascular.10 Mu phunziro ili, HbAlc ya odwala omwe ali ndi mitundu yosiyanasiyana ya DR anafanizidwa.Zotsatira zake zidawonetsa kuti zikhalidwe za gulu la NPDR ndi gulu la PDR zinali zapamwamba kwambiri kuposa za gulu la NDR komanso gulu lowongolera, ndipo mtengo wa gulu la PDR unali wokwera kwambiri kuposa gulu la NPDR.Kafukufuku waposachedwapa wasonyeza kuti pamene milingo ya HbA1c ikupitirira kukwera, imakhudza kuthekera kwa hemoglobini kumangirira ndi kunyamula mpweya, motero kumakhudza kugwira ntchito kwa retina.11 Kuchulukitsa kwa HbA1c kumalumikizidwa ndi chiwopsezo chowonjezereka cha zovuta za matenda a shuga, 12 ndi kuchepa kwa HbA1c kumatha kuchepetsa chiwopsezo cha DR.13 An et al.14 anapeza kuti mlingo wa HbA1c wa odwala DR unali wapamwamba kwambiri kuposa odwala a NDR.Odwala a DR, makamaka odwala PDR, milingo ya BG ndi HbA1c imakhala yochulukirapo, ndipo pamene milingo ya BG ndi HbA1c ikuwonjezeka, kuchuluka kwa kuwonongeka kwa odwala kumawonjezeka.15 Kafukufuku amene ali pamwambawa akugwirizana ndi zotsatira zathu.Komabe, milingo ya HbA1c imakhudzidwa ndi zinthu monga kuchepa kwa magazi m'thupi, kutalika kwa moyo wa hemoglobini, zaka, mimba, mtundu, ndi zina zotero, ndipo sangathe kuwonetsa kusintha kofulumira kwa shuga m'magazi pakanthawi kochepa, ndipo "kuchedwa" kumabweretsa.Choncho, akatswiri ena amakhulupirira kuti mfundo zake n’zochepa.16
The pathological mbali DR ndi retinal neovascularization ndi magazi-retinal chotchinga kuwonongeka;komabe, njira ya momwe shuga imayambira kuyambika kwa DR ndizovuta.Pakali pano amakhulupirira kuti kuwonongeka kwa minofu yosalala ndi ma endothelial cell ndi matenda a fibrinolytic a retinal capillaries ndizomwe zimayambitsa matenda a odwala matenda ashuga retinopathy.17 Kusintha kwa ntchito ya coagulation kungakhale chizindikiro chofunikira pakuweruza retinopathy.Kukula kwa diabetesic microangiopathy.Panthawi imodzimodziyo, DD ndi mankhwala osokoneza bongo a fibrinolytic enzyme kuti agwirizane ndi fibrin, yomwe imatha mwamsanga, mophweka, komanso yotsika mtengo kudziwa kuchuluka kwa DD mu plasma.Kutengera zabwino izi ndi zina, kuyesa kwa DD nthawi zambiri kumachitika.Kafukufukuyu adapeza kuti gulu la NPDR ndi gulu la PDR linali lalikulu kwambiri kuposa gulu la NDR ndi gulu lolamulira poyerekezera chiwerengero cha DD mtengo, ndipo gulu la PDR linali lalikulu kwambiri kuposa gulu la NPDR.Kafukufuku wina wa ku China akuwonetsa kuti ntchito ya coagulation ya odwala matenda a shuga sidzasintha poyamba;komabe, ngati wodwalayo ali ndi matenda a microvascular, ntchito ya coagulation idzasintha kwambiri.4 Pamene mlingo wa kuwonongeka kwa DR ukuwonjezeka, mlingo wa DD umakwera pang'onopang'ono ndikufika pachimake cha odwala PDR.18 Kupeza uku kukugwirizana ndi zotsatira za kafukufuku wamakono.
Fibrinogen ndi chizindikiro cha hypercoagulable state ndi kuchepa kwa fibrinolytic ntchito, ndipo kuchuluka kwake kumakhudza kwambiri coagulation ya magazi ndi hemorrheology.Ndi kalambulabwalo wa thrombosis, ndipo FIB m'mwazi wa odwala matenda a shuga ndi maziko ofunika mapangidwe hypercoagulable boma mu plasma shuga.Kuyerekeza kwamitengo yapakati pa FIB mu phunziroli kukuwonetsa kuti zikhulupiriro zamagulu a NPDR ndi PDR ndizokwera kwambiri kuposa zomwe NDR ndi magulu olamulira.Kafukufuku wina anapeza kuti chiwerengero cha FIB cha odwala a DR ndi apamwamba kwambiri kuposa odwala a NDR, kusonyeza kuti kuwonjezeka kwa mlingo wa FIB kumakhala ndi zotsatira zina pazochitika ndi chitukuko cha DR ndipo zikhoza kupititsa patsogolo;komabe, njira zenizeni zomwe zikukhudzidwa ndi ntchitoyi sizinakwaniritsidwe.zomveka.19,20
Zotsatira zomwe zili pamwambazi zikugwirizana ndi kafukufukuyu.Kuphatikiza apo, kafukufuku wokhudzana ndi izi awonetsa kuti kuzindikira kophatikizana kwa DD ndi FIB kumatha kuwunika ndikuwona kusintha kwa thupi la hypercoagulable state ndi hemorrheology, zomwe zimathandizira kuzindikira koyambirira, chithandizo komanso kuzindikirika kwa mtundu wachiwiri wa matenda a shuga.Matenda a Microangiopathy 21
Tiyenera kuzindikira kuti pali zolephera zingapo mu kafukufuku wamakono zomwe zingakhudze zotsatira.Popeza uku ndi kafukufuku wamagulu osiyanasiyana, chiwerengero cha odwala omwe ali okonzeka kuyesedwa ndi maso ndi magazi panthawi yophunzira ndi yochepa.Kuphatikiza apo, odwala ena omwe amafunikira fundus fluorescein angiography amayenera kuwongolera kuthamanga kwa magazi ndipo ayenera kukhala ndi mbiri ya ziwengo asanamupime.Kukana kuyang'ana kwina kunapangitsa kuti otenga nawo mbali atayike.Choncho, kukula kwachitsanzo ndi kochepa.Tipitiliza kukulitsa kukula kwachitsanzo chowonera m'maphunziro amtsogolo.Kuonjezera apo, kufufuza kwa maso kumangochitika ngati magulu amtundu;palibe mayeso owonjezera owonjezera omwe amachitidwa, monga kuyeza kwa kuwala kogwirizana ndi tomography ya makulidwe a macular kapena kuyesa kwa masomphenya.Pomaliza, phunziroli likuyimira kuwonetsetsa kwapakati ndipo silingawonetse kusintha kwa matenda;maphunziro amtsogolo amafunikira kuwunika kowonjezereka.
Mwachidule, pali kusiyana kwakukulu m'magazi a HbA1c, DD, ndi FIB kwa odwala omwe ali ndi madigiri osiyanasiyana a DM.Magazi a magulu a NPDR ndi PDR anali apamwamba kwambiri kuposa magulu a NDR ndi euglycemic.Chifukwa chake, pakuzindikira ndi kuchiza odwala matenda a shuga, kuzindikira kophatikizana kwa HbA1c, DD, ndi FIB kumatha kukulitsa kuchuluka kwa kuwonongeka koyambirira kwa ma microvascular mwa odwala omwe ali ndi matenda a shuga, kumathandizira kuwunika kuopsa kwa zovuta za microvascular, ndikuthandizira kuzindikira matenda a shuga. ndi retinopathy.
Kafukufukuyu adavomerezedwa ndi Ethics Committee of the Affiliated Hospital of Hebei University (nambala yovomerezeka: 2019063) ndipo idachitika motsatira Declaration of Helsinki.Chivomerezo chodziwitsidwa cholembedwa chinapezedwa kwa onse omwe atenga nawo mbali.
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