Az E-selectin és más pathogenetikai tényezők szerepe a szemfenéki vascularis történésekben
Az E-selectin és más pathogenetikai tényezők szerepe a szemfenéki vascularis történésekben
Dátum
Szerzők
Kasza, Márta
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Kötet címe (évfolyam száma)
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Absztrakt
Pilot study-nk során kimutattuk az RVO-s betegek könnyében megjelenő VEGF-t. Ezek az értékek szignifikánsan magasabbak voltak, mint a beteg másik szem könnyének VEGF szintjei. RVO-s betegek plasmájában is mértük a VEGF szinteket, melyet a kontroll csoporthoz képest emelkedettek voltak. RVO-s betegek könnyében mérhető VEGF szintek növekedésének a mértéke követhető az OCT-vel mért CRT értékek változásával. A könnyben lévő VEGF szint változásával az OCT-vel mérhető CRT értékek párhuzamosan változnak.
Másrészt, munkánk során igazoltuk, hogy DM betegek plasmájában a sE-sel szignifikánsan magasabb, mint a kontroll csoportban. Azon diabeteses csoportban, ahol jelen volt a retinopathia, a sE-sel szint szignifikánsan magasabb volt. Ha az AAO ajánlása szerinti stadium beosztásban („A”-„B”-„C” csoport) vizsgáljuk a retinopathiás betegek sE-sel szintjét, szignifikáns különbséget nem láthatunk, de a „B” csoportban emelkedő tendencia figyelhető meg.
Igazolódni látszik, hogy az emelkedett sE-sel inkább a DM korai szakában játszhat pathogenetikai szerepet.
A sE-sel szintek csupán addig mutattak szignifikáns emelkedést, amíg a retinopathia ki nem alakult. Proliferatív DM retinopathia esetén viszont a sE-sel, mint pathogenetikai tényező, már elveszítheti jelentőségét.
Összegezve, a DM korai szakában és a háttér retinopathia kialakulásában szerepe lehet az emelkedett VC szintnek, vércukor háztartás egyensúlyának (HbA1C), a cardiovascularis rizikótényezőknek (HT, ISZB, HC), valamint az emelkedett sE-sel-nek, mint artheriosleroticus tényezőknek. Viszont, amikor már a capillarisok endothel károsodása kialakult, és a lumenük beszűkült, a fenti tényezők hatása mérséklődik.
In our pilot study we were able to detect VEGF in the tears of RVO patients; its level was significantly elevated in the affected eye compared to the fellow eye. We found that the plasma VEGF levels of RVO patients at baseline were elevated in comparison to an age-matched control group, and that the difference was strongly significant. In accordance with the elevation of VEGF level in tears, we found similar changes (retinal thickening) in the macula, which were represented as an increase in CRT on OCT maps. We were able to investigate the changes of VEGF levels in tears and the severity of macular oedema over time. On the other hand, we found the sE-sel level in the plasma was significantly higher in patients with diabetes compared to controls. Dividing patients into groups by the presence of retinopathy, the sE-sel level was also significantly higher in the retinopathy group. When we examined diabetic patients by the severity of retinopathy (groups A, B and C, by the guidelines of the AAO), however, we did not find any significant difference in sE-sel levels, although it tended to be higher in group B. According to our study it seems that the increased sE-sel plays a pathogenetic role in the early stage of DM. sE-sel levels showed significant increase until the retinopathy developed. However, it counts less in the development of proliferative retinopathy. To summarize, the increased blood glucose, HbA1C, cardiovascular risk factors (HT, IHD, HC) and increased sE-sel as atherosclerotic agents play a role in the early stage of DM and the development of non-proliferativ retinopathy. However, after the impairment of capillary endothelial cells and luminal narrowing these agents lose significance.
In our pilot study we were able to detect VEGF in the tears of RVO patients; its level was significantly elevated in the affected eye compared to the fellow eye. We found that the plasma VEGF levels of RVO patients at baseline were elevated in comparison to an age-matched control group, and that the difference was strongly significant. In accordance with the elevation of VEGF level in tears, we found similar changes (retinal thickening) in the macula, which were represented as an increase in CRT on OCT maps. We were able to investigate the changes of VEGF levels in tears and the severity of macular oedema over time. On the other hand, we found the sE-sel level in the plasma was significantly higher in patients with diabetes compared to controls. Dividing patients into groups by the presence of retinopathy, the sE-sel level was also significantly higher in the retinopathy group. When we examined diabetic patients by the severity of retinopathy (groups A, B and C, by the guidelines of the AAO), however, we did not find any significant difference in sE-sel levels, although it tended to be higher in group B. According to our study it seems that the increased sE-sel plays a pathogenetic role in the early stage of DM. sE-sel levels showed significant increase until the retinopathy developed. However, it counts less in the development of proliferative retinopathy. To summarize, the increased blood glucose, HbA1C, cardiovascular risk factors (HT, IHD, HC) and increased sE-sel as atherosclerotic agents play a role in the early stage of DM and the development of non-proliferativ retinopathy. However, after the impairment of capillary endothelial cells and luminal narrowing these agents lose significance.
Leírás
Kulcsszavak
Occlusio Venae Centralis Retinae (RVO), vascularis endothelialis növekedési factor (VEGF), könny film, Diabeteses retinopathia, solubilis E-selectin (sE-sel), Retinal vein occlusion (RVO), vascular endothelial growth factor (VEGF), tear fluid, Diabetic retinopathy, soluble E-selectin (E-sel)