糖尿病微血管并发症

　　【摘要】 目的 探讨血浆褪黑素(MLT)与DR的关系。 方法 选取T2DM患者82例和正常对照(NC)者41名检测血浆MLT水平，将T2DM患者分为无DR(T2DM)组29例、非增殖型DR(NPDR)组30例和增殖型DR(PDR)组23例。各组分别采血检测日间、夜间血浆MLT水平。 结果 PDR组夜间血浆MLT水平低于NC、T2DM、NPDR组[22.50(18.50，24.70) vs 32.70(29.30，36.70)、35.70(30.00，39.20)、32.30(28.50，35.90)，P<0.05或P<0.01]，NC、T2DM和NPDR组夜间血浆MLT水平比较差异无统计学意义(P>0.05)。NC、T2DM、NPDR和PDR组日间血浆MLT水平比较差异无统计学意义[2.16(1.70,2.75) vs 1.76(1.46,2.12) vs 1.67(1.43,1.99) vs 1.50(0.93,1.60)，P>0.05]。日间血浆MLT水平与病程呈负相关(r=﹣0.287，P=0.009)，夜间血浆MLT水平与病程、胰岛素抵抗指数(HOMA-IR)呈负相关(r=﹣0.382、﹣0.238，P=0.001、0.009)。多元逐步回归分析结果显示，病程、FIns是日间血浆MLT水平的独立影响因素，病程是夜间血浆MLT水平的独立影响因素。 结论 T2DM患者夜间血浆MLT水平降低，日间血浆MLT水平无明显变化，MLT可能在DR发病机制中发挥作用且与DR严重程度相关。

　　【关键词】糖尿病，2型;褪黑素;糖尿病视网膜病变

　　【Abstract】 Objective To investigate the correlation of plasma melatonin (MLT) level with DR. Methods A total of 82 T2DM patients and 41 normal control (NC) subjects were enrolled in this study.Plasma MLT levels were measured by high-performance liquid chromatography.All the patients were divided into three subgroups： without DR (T2DM) group (n=29), non-proliferative DR (NPDR) group (n=30)and proliferative DR (PDR) group (n=23).Plasma MLT levels were tested in the daytime and at night. Results Nighttime MLT levels were significantly lower in PDR group than in NC group, T2DM group and NPDR group [22.50(18.50，24.70) vs 32.70(29.30，36.70), 35.70(30.00，39.20), 32.30(28.50，35.90)，P<0.05 or P<0.01], but no significant difference was found among NC group, T2DM group and NPDR group. The daytime MLT level did not significantly differ among T2DM, NPDR and PDR groups [2.16(1.70,2.75) vs 1.76(1.46,2.12) vs 1.67(1.43,1.99) vs 1.50(0.93,1.60)，P>0.05]. The daytime MLT level was correlated negatively with duration (r=﹣0.287, P=0.009). The nighttime MLT level was correlated negatively with duration and HOMA-IR (r=﹣0.382, ﹣0.238，P=0.001, 0.009). Multiple stepwise regression analysis showed that, duration and FIns were independently relative factors for the daytime MLT in T2DM patients. The nighttime MLT was negatively correlated with duration only. Conclusion The nighttime MLT level is decreased in T2DM patients. However, there is no significant alteration of the daytime MLT in T2DM patients. MLT may play a role in the pathogenesis of DR and is associated with severity of DR.

　　【Key words】Diabetes mellitus，type 2;Melatonin (MLT);Diabetic retinopathy (DR)