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目的 探讨血浆N 乙酰 β D氨基葡萄糖甘酶 (NAG)及肿瘤坏死因子 (TNF α)活性变化与 2型糖尿病(DM)患者视网膜病变 (DR)之间的关系。方法 分别采用ELISA法和生物化学法检测 2 2例 2型DM患者 ,其中 12例伴DR ,10例不伴视网膜病变 (NDR)和 2 0例正常对照者 (NC)血浆TNF α、NAG变化。结果 糖尿病患者血浆NAG活性、TNF α水平明显高于对照组 (P <0 .0 1) ,DR组与NDR组NAG活性差异无显著意义 ,而DR组TNF α水平明显高于NDR组 (P <0 .0 1)。血浆NAG活性变化与TNF α成正相关 (r =0 .66,P <0 .0 5 ) ,与糖化血红蛋白(HbA1c)成正相关 (r =0 .2 2 ,P <0 .0 5 )。TNF α水平与血浆空腹胰岛素 (FINS)成正相关 (r =0 .72 ,P <0 .0 5 ) ,与胰岛素敏感指数 (ISI)成负相关 (r =- 0 .5 4,P <0 .0 5 )。结论 TNF α和NAG共同参与糖尿病视网膜病变的发生发展。NAG活性变化与糖尿病血糖控制情况及TNF α水平密切相关 ,动态监测其活性变化对DR早期诊断和检测糖尿病微血管并发症有重要意义。TNF α则对监测DR的发生、发展及疗效判断具有一定的参考价值
Objective To investigate the relationship between plasma N-acetylglucosaminoglycan (NAG) and tumor necrosis factor (TNF) activity and retinopathy (DR) in type 2 diabetic patients. Methods Twenty-two patients with type 2 diabetes mellitus (T2DM) were enrolled in this study. Serum levels of TNFα and NAG were measured in 12 patients with DR, 10 with no retinopathy (NDR) and 20 normal controls (NC) by ELISA and biochemical methods. Results Plasma NAG activity and TNFα levels in diabetic patients were significantly higher than those in control group (P <0.01). There was no significant difference in NAG activity between DR group and NDR group, but TNFα level in DR group was significantly higher than that in NDR group (P < 0 .0 1). Plasma NAG activity was positively correlated with TNFα (r = 0.66, P <0.05), and positively correlated with HbA1c (r = 0.22, P <0.05). The level of TNFα was positively correlated with fasting insulin (FINS) (r = 0.72, P <0.05), and negatively correlated with insulin sensitivity index (ISI) (r = -0.54, P <0. 0 5). Conclusion TNF α and NAG are involved in the development of diabetic retinopathy. The changes of NAG activity are closely related to the glycemic control of diabetes and the level of TNFα. Dynamic monitoring of the changes of NAG activity plays an important role in the early diagnosis and detection of diabetic microvascular complications. TNFα has a certain reference value for monitoring the occurrence, development and curative effect of DR