摘要
目的 探讨糖尿病视网膜病变(DR)患者血清微小核糖核酸(miRNA)-20b-3p、miR-192表达与NOD样受体热蛋白结构域相关蛋白3(NLRP3)炎症小体和预后不良的关系.方法 选取2021年1月至2022年3月我院收治的DR患者165例.根据临床分级标准分为增生型DR(PDR)组89例和非增生型DR(NPDR)组76例,另选取同期我院收治的100例单纯2型糖尿病(T2DM)患者纳入T2DM组及100例体检健康志愿者纳入对照组.检测并对比4组血清miR-20b-3p、miR-192和外周血单核细胞NLRP3 mRNA、半胱氨酸蛋白酶-1(Caspase-1)mRNA表达、白细胞介素(IL)-1 β、IL-18水平.采用Pearson相关性分析DR患者血清miR-20b-3p、miR-192表达与NLRP3炎症小体相关指标的相关性.DR患者出院后随访1年,根据是否发生视力残疾分为预后不良组47例和预后良好组118例,比较预后不良组和预后良好组血清miR-20b-3p、miR-192水平.收集DR患者的临床资料,单因素和多因素Logistic回归分析影响DR患者预后不良的因素.结果 对照组、T2DM组、NPDR组、PDR组血清miR-20b-3p、miR-192表达依次降低,外周血单核细胞NLRP3 mRNA、Caspase-1 mRNA和血清IL-1β、IL-18水平依次升高(P＜0.05).Pearson相关性分析显示,DR患者血清miR-20b-3p、miR-192 表达与 NLRP3 mRNA、Caspase-1 mRNA、IL-1 β、IL-18 水平呈负相关(P＜0.05).随访 1 年,165 例 DR 患者视力残疾发生率为28.48％(47/165).多因素Logistic回归分析显示,T2DM病程偏长、PDR占比偏高和糖化血红白蛋白(HbAlc)、NLRP3 mRNA、Caspase-1 mRNA、IL-1 β、IL-18 水平升高为影响 DR 患者预后的独立危险因素,miR-20b-3p、miR-192升高为独立保护因素(P＜0.05).结论 DR患者血清miR-20b-3p、miR-192低表达,与NLRP3炎症小体激活和预后不良密切相关,可能成为DR患者病情和预后评估的指标.
Abstract
Objective To investigate the relationship between serum microribonucleic acid(miRNA)-20b-3p,miR-192 expression and NOD-like receptor thermal protein domain associated protein 3(NLRP3)inflammasome and poor prognosis in dia-betic retinopathy(DR)patients.Methods From January 2021 to March 2022,165 DR patients who were admitted to our hospital were selected.Patients were divided into proliferative DR(PDR)group(n=89)and non-proliferative DR(NPDR)group(n=76)ac-cording to clinical grading standard,and 100 patients with simple type 2 diabetes mellitus(T2DM)who were admitted to our hospi-tal during the same period were selected as T2DM group and 100 healthy volunteers were included in control group.Serum miR-20b-3p,miR-192,NLRP3 mRNA,cysteine proteinase-1(Caspase-1)mRNA expression,interleukin(IL)-1β and IL-18 in pe-ripheral blood mononuclear cells were detected and compared in four groups.The correlation between serum miR-20b-3p,miR-192 expression and NLRP3 inflammasome-related indicators in DR patients were analyzed by Pearson correlation analysis.DR patients were followed up for 1 year after discharge,patients were divided into 47 cases in poor prognosis group and 118 cases in good prog-nosis group according to whether visual disability occurred,serum miR-20b-3p and miR-192 in poor prognosis group and good prog-nosis group were compared.Clinical data of DR patients were collected,and factors affecting poor prognosis of DR patients were an-alyzed by univariate and multivariate Logistic regression analysis.Results The expression of serum miR-20b-3p and miR-192 in control group,T2DM group,NPDR group and PDR group decreased in turn,and NLRP3 mRNA,Caspase-1 mRNA in peripheral blood mononuclear cells and serum IL-1 β and IL-18 increased in turn(P＜0.05).Pearson correlation analysis showed that serum miR-20b-3p and miR-192 in DR patients was negatively correlated with NLRP3 mRNA,Caspase-1 mRNA,IL-1β and IL-18(P＜0.05).After 1 year of follow up,the incidence of visual disability in 165 DR patients was 28.48％(47/165).Multivariate Logistic regression analysis showed that longer course of T2DM,higher proportion of PDR and higher glycosylated hemoglobin albumin(HbA1c),NLRP3 mRNA,Caspase-1 mRNA,IL-1β and IL-18 were independent risk factors affecting the prognosis of DR pa-tients,and higher miR-20b-3p and miR-192 were independent protective factors(P＜0.05).Conclusion Low expression of ser-um miR-20b-3p and miR-192 in DR patients is closely relate to NLRP3 inflammasome and poor prognosis,which may be an index for evaluating the condition and prognosis of DR patients.
维普
万方数据