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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, 07100;2 Baoding Mbụ Ngalaba Nkà Ọgwụ Nuclear, Central Hospital, Baoding, Hebei 071000;3 Ngalaba nlekọta ahụike nke Baoding First Central Hospital, Baoding, Hebei Province, 071000;4 Ngalaba Ophthalmology, Ụlọ Ọgwụ Njikọ nke Hebei University, Baoding, Hebei, 071000 * Ndị ode akwụkwọ a enyela aka n'otu aka ahụ n'ọrụ a.Onye edemede na-emekọrịta ihe: Li Dan, Ngalaba Ophthalmology, Ụlọ Ọgwụ Mahadum Hebei, Baoding, Hebei, 071000 Tel +86 189 31251885 Fax +86 031 25981539 Email [email protected] Zhang Yunliang Endocrinology Laboratory, Baoviding People mbụ, Central Hebei000. Republic of China Tel +86 151620373737373737375axe Email echebe ] Nzube: Ọmụmụ ihe a na-achọ ịkọwa ọkwa haemoglobin glycosylated (HbA1c), D-dimer (DD) na fibrinogen (FIB) n'ụdị dị iche iche nke ọrịa mamịrị retinopathy (DR).Usoro: Ngụkọta nke ndị ọrịa shuga 61, ndị natara ọgwụgwọ na ngalaba anyị site na Nọvemba 2017 ruo Mee 2019, ahọpụtara.Dị ka nsonaazụ nke foto na-abụghị mydriatic fundus foto na fundus angiography, e kewara ndị ọrịa ụzọ atọ, ya bụ ndị na-abụghị DR (NDR) otu (n=23), ndị na-abụghị proliferative DR (NPDR) otu (n=17) na proliferative. Otu DR (PDR) (n=21).Ọ gụnyekwara otu njikwa nke mmadụ 20 nwalere adịghị mma maka ọrịa shuga.Tulee ma tulee ọkwa HbA1c, DD na FIB n'otu n'otu.Nsonaazụ: Nkezi ụkpụrụ nke HbA1c bụ 6.8% (5.2%, 7.7%), 7.4% (5.8%, 9.0%) na 8.5% (6.3%), 9.7%) na NDR, NPDR na PDR otu, n'otu n'otu. .Uru njikwa bụ 4.9% (4.1%, 5.8%).Nsonaazụ ndị a na-egosi na enwere nnukwu ọdịiche ọnụ ọgụgụ dị n'etiti otu.N'ime otu NDR, NPDR, na PDR, nkezi ụkpụrụ nke DD bụ 0.39 ± 0.21 mg/L, 1.06 ± 0.54 mg/L, na 1.39 ± 0.59 mg/L, n'otu n'otu.Nsonaazụ nke otu njikwa bụ 0.36 ± 0.17 mg / L.Ụkpụrụ nke otu NPDR na otu PDR dị elu karịa nke ndị NDR na ndị na-achịkwa, na ọnụ ahịa otu PDR dị elu karịa nke NPDR otu, na-egosi na ọdịiche dị n'etiti otu ahụ dị ịrịba ama. (P <0.001).Nkezi ụkpụrụ nke FIB na NDR, NPDR, na PDR otu bụ 3.07 ± 0.42 g/L, 4.38 ± 0.54 g/L, na 4.46 ± 1.09 g/L, n'otu n'otu.Nsonaazụ nke otu njikwa bụ 2.97 ± 0.67 g/L.Ọdịiche dị n'etiti otu dị iche iche dị ịrịba ama (P <0.05).Mmechi: Ọkwa HbA1c, DD, na FIB n'ime otu PDR dị elu nke ukwuu karịa ndị nọ na otu NPDR.Keywords: glycosylated haemoglobin, HbA1c, D-dimer, DD, fibrinogen, FIB, ọrịa mamịrị retinopathy, DR, microangiopathy.
Ọrịa shuga mellitus (DM) aghọọla ọtụtụ ọrịa n'afọ ndị na-adịbeghị anya, nsogbu ya nwere ike ịkpata ọtụtụ ọrịa sistemu, nke microangiopathy bụ isi ihe na-akpata ọnwụ na ndị ọrịa nwere ọrịa shuga.1 Glycated haemoglobin (HbA1c) bụ isi akara nke njikwa glucose ọbara, nke na-egosipụtakarị nkezi ọkwa glucose ọbara nke ndị ọrịa n'ime ọnwa abụọ ma ọ bụ atọ mbụ, ma bụrụkwa ọkọlọtọ ọla edo nke mba ụwa amatala maka nyocha glucose ọbara ogologo oge maka ọrịa shuga. .N'ime ule ọrụ coagulation, D-dimer (DD) nwere ike gosipụta nke ọma hyperfibrinolysis nke abụọ na hypercoagulability n'ime ahụ, dị ka ihe na-egosi mmetụta nke thrombosis.Ntinye uche fibrinogen (FIB) nwere ike igosi ọnọdụ prethrombotic n'ime ahụ.Nnyocha ndị dị ugbu a egosila na nlekota ọrụ coagulation na HbA1c nke ndị ọrịa nwere DM na-ekere òkè n'ikpe ikpe ọganihu nke nsogbu ọrịa, 2,3 karịsịa microangiopathy.4 Ọrịa mamịrị retinopathy (DR) bụ otu n'ime nsogbu microvascular na-emekarị na isi ihe na-akpata kpuru ìsì nke ọrịa shuga.Uru dị n'ụdị nyocha atọ ndị a dị n'elu bụ na ha dị mfe iji rụọ ọrụ ma bụrụ ndị ama ama na ntọala ụlọ ọgwụ.Ọmụmụ ihe a na-enyocha ụkpụrụ HbA1c, DD, na FIB nke ndị ọrịa nwere ogo DR dị iche iche, wee jiri ha tụnyere nsonaazụ nke ndị na-abụghị DR DM na ndị na-enyocha anụ ahụ, ka ha wee chọpụta mkpa HbA1c, DD pụtara. na FIB.A na-eji ule FIB iji nyochaa ihe omume na mmepe nke DR.
Ọmụmụ ihe a ahọpụtara ndị ọrịa 61 na-arịa ọrịa shuga (anya 122) bụ ndị a na-agwọ na ngalaba outpatient nke Baoding First Central Hospital site na Nọvemba 2017 ruo Mee 2019. Usoro nsonye nke ndị ọrịa bụ: Achọpụtara ndị ọrịa shuga dị ka "Ntuziaka maka Mgbochi na Ọgwụgwọ nke Ụdị 2 Ọrịa shuga mellitus na China (2017)”, na ewepụghị isiokwu nyocha ahụike ahụike maka ọrịa shuga.Usoro mwepu bụ ndị a: (1) ndị ọrịa dị ime;(2) ndị ọrịa nwere ọrịa shuga mellitus;(3) ndị ọrịa na-erubeghị afọ 14;(4) enwere mmetụta ọgwụ pụrụ iche, dị ka ngwa glucocorticoids na-adịbeghị anya.Dabere na foto ha na-abụghị nke mydriatic fundus na nsonaazụ fluorescein fundus angiography, e kewara ndị sonyere na otu atọ ndị a: Otu ndị na-abụghị DR (NDR) gụnyere ndị ọrịa 23 (anya 46), ụmụ nwoke 11, ụmụ nwanyị 12, na afọ 43- 76 afọ.Afọ, nkezi afọ 61.78± 6.28 afọ;Otu DR (NPDR) na-abụghị proliferative, ikpe 17 (anya 34), ụmụ nwoke 10 na ụmụ nwanyị 7, 47-70 afọ, nkezi afọ 60.89± 4.27;proliferative DR (E nwere ikpe 21 (anya 42) na otu PDR, gụnyere ụmụ nwoke 9 na ụmụ nwanyị 12, ndị dị afọ 51-73, na nkezi afọ 62.24± 7.91. Ngụkọta nke mmadụ 20 (anya 40) na Ndị na-achịkwa na-adịghị mma maka ọrịa shuga, gụnyere ụmụ nwoke 8 na ụmụ nwanyị 12, ndị dị afọ 50-75, na nkezi afọ 64.54 ± 3.11. ewepụrụ ịwa ahụ, ọrịa, etuto ọjọọ ma ọ bụ ọrịa nje ndị ọzọ n'ozuzu ya.
Ndị ọrịa DR na-ezute usoro nyocha nke Ngalaba Ophthalmology nke Alaka Ophthalmology na Medical Association China nyere.5 Anyị ji igwefoto fundus na-abụghị nke mydriatic (Canon CR-2, Tokyo, Japan) iji dekọọ mkpanaka azụ nke ego onye ọrịa.Ma were foto fundus 30°–45°.Onye na-ahụ maka anya a zụrụ nke ọma nyere akụkọ nyocha ederede dabere na onyonyo.N'ihe banyere DR, jiri Heidelberg Retinal Angiography-2 (HRA-2) (Heidelberg Engineering Company, Germany) maka fundus angiography, na-eji asaa-ubi n'oge ọgwụgwọ ọrịa mamịrị retinopathy ọmụmụ (ETDRS) fluorescein angiography (FA) iji Kwenye NPDR ma ọ bụ PDR.Dị ka ma ndị sonyere gosiri retinal neovascularization, ndị sonyere kewara n'ime NPDR na PDR otu.Akpọrọ ndị ọrịa na-abụghị DR ọrịa shuga dị ka otu NDR;A na-ahụ ndị ọrịa nwalere ihe ọjọọ maka ọrịa shuga dị ka otu njikwa.
N'ụtụtụ, a na-anakọta 1.8 ml nke ọbara venous na-ebu ọnụ ma tinye ya na tube mgbochi mgbochi.Mgbe awa 2 gachara, centrifuge maka nkeji 20 iji chọpụta ọkwa HbA1c.
N'ụtụtụ, a na-anakọta 1.8 ml nke ọbara venous na-ebu ọnụ, gbanye ya n'ime tube anticoagulation, na centrifud maka 10 min.A na-ejizi ihe dị elu maka nchọpụta DD na FIB.
A na-eme nchọpụta HbA1c site na iji Beckman AU5821 akpaka biochemical analyzer na reagents na-akwado ya.Ọnụ ahịa mbelata ọrịa shuga>6.20%, uru nkịtị bụ 3.00% ~ 6.20%.
Emere ule DD na FIB site na iji STA Compact Max® akpaaka coagulation analyzer (Stago, France) na reagents na-akwado ya.Ụkpụrụ ntụaka dị mma bụ DD> 0.5 mg / L na FIB> 4 g / L, ebe ụkpụrụ nkịtị bụ DD ≤ 0.5 mg / L na FIB 2-4 g / L.
A na-eji mmemme ngwanrọ SPSS Statistics (v.11.5) hazie nsonaazụ ya;A na-akọwapụta data ahụ dịka ntụgharị ± ọkọlọtọ (± s).Dabere na ule nkịtị, data dị n'elu kwekọrọ na nkesa nkịtị.A na-eme nyocha nke iche iche otu ụzọ na otu anọ nke HbA1c, DD, na FIB.Tụkwasị na nke ahụ, a na-atụnyere ọkwa dị ịrịba ama nke DD na FIB;P <0.05 na-egosi na ihe dị iche bụ ọnụ ọgụgụ dị ịrịba ama.
Afọ nke isiokwu dị na otu NDR, otu NPDR, otu PDR, na otu njikwa bụ 61.78 ± 6.28, 60.89 ± 4.27, 62.24 ± 7.91, na 64.54 ± 3.11 afọ, n'otu n'otu.A na-ekesa afọ ahụ mgbe ule nkesa nkịtị gasịrị.Otu ụzọ nyocha nke ọdịiche gosipụtara na ọdịiche ahụ abụghị ihe ndekọ ọnụ ọgụgụ (P=0.157) (Table 1).
Tebụl 1 Ntụle nke ntọala ụlọ ọgwụ na njirimara ophthalmological n'etiti otu njikwa na otu NDR, NPDR na PDR
Nkezi HbA1c nke otu NDR, otu NPDR, otu PDR na otu njikwa bụ 6.58±0.95%, 7.45±1.21%, 8.04±1.81% na 4.53±0.41%, n'otu n'otu.A na-ekesa HbA1cs nke otu anọ a ma nwalee ya site na nkesa nkịtị.N'iji nyocha nke otu ụzọ nke ọdịiche, ọdịiche ahụ dị ịrịba ama (P<0.001) (Table 2).Ntụle ndị ọzọ n'etiti otu anọ ahụ gosipụtara ọdịiche dị ịrịba ama n'etiti otu (P<0.05) (Table 3).
Nkezi ụkpụrụ nke DD na NDR otu, NPDR otu, PDR otu, na njikwa otu bụ 0.39 ± 0.21mg / L, 1.06 ± 0.54mg / L, 1.39 ± 0.59mg / L na 0.36 ± 0.17mg / L, n'otu n'otu.A na-ekesa DD niile ma nwalee site na nkesa nkịtị.N'iji nyocha nke otu ụzọ nke ọdịiche, ọdịiche ahụ dị ịrịba ama (P<0.001) (Table 2).Site n'ịtụle ndị otu anọ ahụ, nsonaazụ na-egosi na ụkpụrụ nke otu NPDR na otu PDR dị elu karịa otu NDR na otu njikwa, na uru nke otu PDR dị elu karịa otu NPDR. , na-egosi na ọdịiche dị n'etiti otu dị ịrịba ama (P<0.05).Otú ọ dị, ọdịiche dị n'etiti otu NDR na ndị na-ahụ maka njikwa abụghị ihe ndekọ ọnụ ọgụgụ (P> 0.05) (Table 3).
Nkezi FIB nke otu NDR, otu NPDR, otu PDR na otu njikwa bụ 3.07 ± 0.42 g / L, 4.38 ± 0.54 g / L, 4.46 ± 1.09 g / L na 2.97 ± 0.67 g / L, n'otu n'otu.FIB nke otu anọ a na-egosi nkesa nkịtị na ule nkesa nkịtị.N'iji nyocha nke otu ụzọ nke ọdịiche, ọdịiche ahụ dị ịrịba ama (P<0.001) (Table 2).Ntụle ọzọ n'etiti otu anọ ahụ gosiri na ụkpụrụ nke otu NPDR na otu PDR dị elu karịa nke NDR na otu njikwa, na-egosi na ọdịiche dị n'etiti otu dị iche iche (P<0.05).Otú ọ dị, ọ dịghị ihe dị iche n'etiti otu NPDR na otu PDR, na NDR na otu njikwa (P> 0.05) (Table 3).
N'afọ ndị na-adịbeghị anya, ọnụ ọgụgụ nke ọrịa shuga amụbawo kwa afọ, ọnụ ọgụgụ DR amụbawokwa.DR bụ ihe na-akpatakarị ìsì ugbu a.6 Mgbanwe siri ike na glucose ọbara (BG) / shuga nwere ike ime ka ọnọdụ ọbara hypercoagulable, na-eduga n'ọtụtụ nsogbu vaskụla.7 Ya mere, iji nyochaa ọkwa BG na ọkwa coagulation nke ndị ọrịa na-arịa ọrịa shuga na mmepe nke DR, ndị nchọpụta na China na ebe ndị ọzọ nwere mmasị.
Mgbe haemoglobin dị na mkpụrụ ndụ ọbara uhie jikọtara ya na shuga ọbara, a na-emepụta haemoglobin glycosylated, nke na-egosipụtakarị njikwa shuga ọbara nke onye ọrịa n'ime izu 8-12 mbụ.Mmepụta HbA1c na-eji nwayọ, ma ozugbo emechara ya, ọ naghị adị mfe agbaji;ya mere, ọnụnọ ya na-enyere aka nyochaa glucose ọbara n'ọbara.8 Hyperglycemia na-adịte aka nwere ike ịkpata mgbanwe vaskụla na-agaghị agbanwe agbanwe, mana HbAlc ka bụ ezigbo ngosipụta nke ọkwa glucose ọbara na ndị ọrịa nwere ọrịa shuga.Ọkwa HbAlc ọ bụghị naanị na-egosipụta ọdịnaya shuga dị n'ọbara, kamakwa ọ nwere njikọ chiri anya na ọkwa shuga ọbara.Ọ na-ejikọta ya na nsogbu ọrịa shuga dị ka ọrịa microvascular na ọrịa macrovascular.10 N'ime ọmụmụ ihe a, atụnyere HbAlc nke ndị ọrịa nwere ụdị DR dị iche iche.Nsonaazụ gosiri na ụkpụrụ nke otu NPDR na otu PDR dị elu karịa nke otu NDR na otu njikwa, na uru otu PDR dị elu karịa nke otu NPDR.Nnyocha e mere n'oge na-adịbeghị anya egosila na mgbe ọkwa HbA1c na-aga n'ihu na-arị elu, ọ na-emetụta ikike hemoglobin iji jikọta na ibu oxygen, si otú ahụ na-emetụta ọrụ retinal.11 Mmụba ọkwa HbA1c na-ejikọta ya na ihe ize ndụ dị ukwuu nke nsogbu ọrịa shuga, 12 na mbelata ọkwa HbA1c nwere ike ibelata ohere nke DR.13 An et al.14 chọpụtara na ọkwa HbA1c nke ndị ọrịa DR dị elu nke ukwuu karịa nke ndị ọrịa NDR.N'ime ndị ọrịa DR, ọkachasị ndị ọrịa PDR, ọkwa BG na HbA1c dị oke elu, yana ka ọkwa BG na HbA1c na-abawanye, ogo nhụhụhụhụhụ na-abawanye na ndị ọrịa.15 Nchọpụta a dị n'elu kwekọrọ n'ihe anyị rụpụtara.Agbanyeghị, ọkwa HbA1c na-emetụta ihe ndị dị ka anaemia, ogologo ndụ hemoglobin, afọ, afọ ime, agbụrụ, wdg, na enweghị ike igosipụta mgbanwe ngwa ngwa na glucose ọbara n'oge dị mkpirikpi, ma nwee “mmetụta igbu oge”.Ya mere, ụfọdụ ndị ọkà mmụta kwenyere na uru ntụaka ya nwere oke.16
The pathological atụmatụ nke DR bụ retinal neovascularization na ọbara-retinal mgbochi mmebi;Agbanyeghị, usoro etu ọrịa shuga si ebute mmalite nke DR gbagwojuru anya.A kwenyere ugbu a na mmebi arụ ọrụ nke uru ahụ dị nro na mkpụrụ ndụ endothelial na arụ ọrụ fibrinolytic na-adịghị mma nke capillaries retinal bụ isi ihe abụọ na-akpata ọrịa na-akpata ndị ọrịa nwere ọrịa mamịrị retinopathy.17 Mgbanwe nke ọrụ coagulation nwere ike ịbụ ihe ngosi dị mkpa maka ikpe retinopathy.Ọganihu nke microangiopathy mamịrị.N'otu oge ahụ, DD bụ ngwaahịa na-emebi emebi nke fibrinolytic enzyme na fibrin jikọtara ya, nke nwere ike ikpebi ngwa ngwa, dị mfe, na ọnụ ahịa nke ọma na-ekpebi ntinye nke DD na plasma.Dabere na uru ndị a na ndị ọzọ, a na-eme nnwale DD.Ọmụmụ ihe a chọpụtara na otu NPDR na otu PDR dị elu karịa otu NDR na otu njikwa site n'iji atụnyere nkezi DD uru, na otu PDR dị elu karịa otu NPDR.Ọmụmụ China ọzọ na-egosi na ọrụ coagulation nke ndị ọrịa mamịrị agaghị agbanwe na mbụ;Otú ọ dị, ọ bụrụ na onye ọrịa ahụ nwere ọrịa microvascular, ọrụ coagulation ga-agbanwe nke ukwuu.4 Ka ogo nke mmebi DR na-abawanye, ọkwa DD ji nwayọọ nwayọọ na-ebili ma rute ọnụ ọgụgụ kasị elu na ndị ọrịa PDR.18 Nchọpụta a kwekọrọ na nsonaazụ ọmụmụ ihe ugbu a.
Fibrinogen bụ ihe na-egosi ọnọdụ hypercoagulable na mbelata ọrụ fibrinolytic, yana mmụba ya ga-emetụta oke coagulation ọbara na hemorheology.Ọ bụ ihe na-ebute ụzọ nke thrombosis, yana FIB n'ime ọbara nke ndị ọrịa mamịrị bụ ihe ndabere dị mkpa maka ịmepụta ọnọdụ hypercoagulable na plasma ọrịa shuga.Ntụle nke nkezi FIB ụkpụrụ na ọmụmụ a na-egosi na ụkpụrụ nke NPDR na PDR otu dị nnọọ elu karịa ụkpụrụ nke NDR na njikwa otu.Nnyocha ọzọ chọpụtara na ọkwa FIB nke ndị ọrịa DR dị elu karịa nke ndị ọrịa NDR, na-egosi na mmụba nke ọkwa FIB nwere mmetụta ụfọdụ na omume na mmepe nke DR ma nwee ike ime ka ọganihu ya dịkwuo elu;Otú ọ dị, usoro ndị a kapịrị ọnụ dị na usoro a ezughị ezu.doro anya.19,20
Nsonaazụ dị n'elu dabara na ọmụmụ a.Tụkwasị na nke ahụ, nchọpụta ndị metụtara ya egosiwo na nchọpụta DD na FIB jikọtara ọnụ nwere ike nyochaa ma hụ mgbanwe na ọnọdụ hypercoagulable nke anụ ahụ na hemorheology, nke na-eme ka nchọpụta mmalite, ọgwụgwọ na prognosis nke ụdị ọrịa shuga 2 na-arịa ọrịa shuga.Microangiopathy 21
Ekwesiri iburu n'uche na enwere otutu njedebe na nyocha nke ugbua nke nwere ike imetụta nsonaazụ.Ebe ọ bụ na nke a bụ ọmụmụ ihe na-emekọrịta ihe, ọnụ ọgụgụ ndị ọrịa dị njikere ịga ma nyocha anya na ọbara n'oge oge ọmụmụ ihe dị oke.Na mgbakwunye, ụfọdụ ndị ọrịa chọrọ fundus fluorescein angiography kwesịrị ịchịkwa ọbara mgbali ha ma ga-enwerịrị akụkọ ihe mere eme nke allergies tupu nyocha.Ọjụjụ ịlele n'ihu butere ọnwụ nke ndị sonyere ya.Ya mere, nha nlele dị obere.Anyị ga-aga n'ihu ịgbasa nha nlele nlele na ọmụmụ ihe n'ọdịnihu.Tụkwasị na nke ahụ, a na-eme nyocha anya naanị dị ka otu qualitative;Ọ dịghị nyocha ọnụọgụgụ ọzọ a na-eme, dị ka nleba anya ọnụ ọgụgụ tomography nke ọkpụrụkpụ macular ma ọ bụ ule ọhụụ.N'ikpeazụ, ọmụmụ ihe a na-anọchite anya ihe nleba anya n'ofe akụkụ na enweghị ike igosipụta mgbanwe na usoro ọrịa ahụ;ọmụmụ ihe n'ọdịnihu chọrọ nleba anya dị ike ọzọ.
Na nchịkọta, enwere nnukwu ọdịiche dị na ọkwa HbA1c, DD, na FIB n'ime ndị ọrịa nwere ogo DM dị iche iche.Ọkwa ọbara nke NPDR na PDR dị elu nke ukwuu karịa NDR na otu euglycemic.Ya mere, na nchoputa na ọgwụgwọ nke ndị ọrịa mamịrị, nchikota nke HbA1c, DD, na FIB nwere ike ime ka ọnụọgụ mbụ nke microvascular mebiri na ndị ọrịa mamịrị, mee ka nyocha nke ihe ize ndụ nke nsogbu microvascular, ma nyere aka n'oge nyocha nke ọrịa shuga. na retinopathy.
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