目的：探讨糖尿病视网膜病变(DR)患者血清生长分化因子11(GDF11)、血小板反应蛋白1(TSP1)表达及其与微血管损伤的关系。

方法：选取开滦总医院DR患者102例为DR组，根据DR病变情况分为非增生型DR组(NPDR组)和增生型DR组(PDR组)。同期选取100例单纯2型糖尿病患者为对照组。测定各组血清微血管损伤指标[血管内皮生长因子(VEGF)、内皮细胞(ECs)、内皮祖细胞(EPCs)]及GDF11、TSP1水平； Pearson法分析GDF11、TSP1与微血管损伤指标的相关性； Logistic回归分析影响DR发生的因素； 绘制ROC曲线评估GDF11、TSP1对DR病情的诊断价值。

结果：与对照组相比，DR组EPCs、GDF11水平降低，VEGF、ECs、TSP1水平升高(均P<0.05)。PDR组GDF11水平低于NPDR组，TSP1水平高于NPDR组(均P<0.05)。DR患者血清GDF11与VEGF、ECs呈负相关(r=-0.486、-0.511，均P<0.001)，与EPCs呈正相关(r=0.475，P<0.001)； TSP1与VEGF、ECs呈正相关(r=0.579、0.594，均P<0.001)，与EPCs呈负相关(r=-0.505，P<0.001)； GDF11与TSP1水平呈负相关(r=-0.443，P<0.001)。T2DM病程、VEGF、TSP1是DR发生的危险因素，GDF11为保护因素(均P<0.05)。GDF11、TSP1单独及联合诊断PDR发生的AUC分别为0.819、0.822、0.915，联合优于单独诊断(Z_联合-GDF11=2.070，P=0.039； Z_联合-TSP1=2.274，P=0.023)。

结论：DR患者血清GDF11、TSP1与微血管损伤存在密切关联，且与DR病情进展有关，联合检测二者血清水平对评估DR病情具有一定临床价值。

METHODS: Totally 102 DR patients were served as DR group and assigned into non proliferative DR group(NPDR group)and proliferative DR group(PDR group)based on the severity of DR lesions. Meantime, 100 patients with simple diabetes were served as control group. Serum indicators of microvascular injury including vascular endothelial growth factor(VEGF), endothelial cells(ECs), endothelial progenitor cells(EPCs), and levels of GDF11 and TSP1 were measured in each group. Pearson method was used to discuss the correlation between GDF11, TSP1 and microvascular injury indicators. Logistic regression was used to discuss the factors that affected the occurrence of DR. Receiver operating characteristic(ROC)curve was applied to analyze the evaluation value of serum GDF11 and TSP1 for the DR conditions.

RESULTS: For the control group, DR group had lower EPCs and GDF11, and higher VEGF, ECs, and TSP1 levels(all P<0.05). The PDR group had lower GDF11 and higher TSP1 than the NPDR group(all P<0.05). Serum GDF11 was negatively related to VEGF and ECs(r=-0.486, -0.511, all P<0.001), and positively related to EPCs(r=0.475, P<0.001). TSP1 was positively related to VEGF and ECs(r=0.579, 0.594, all P<0.001), and negatively related to EPCs(r=-0.505, P<0.001). Moreover, GDF11 and TSP1 were negatively correlated(r=-0.443, P<0.001). The course of T2DM, VEGF, and TSP1 were risk factors for DR, while GDF11 was a protective factor(all P<0.05). The AUC of GDF11, TSP1, and combined diagnosis for PDR conditions was 0.819, 0.822, and 0.915, respectively. The combined diagnosis was better than single diagnosis(Z_{combination-GDF11}=2.070, P=0.039, Z_{combination-TSP1}=2.274, P=0.023).

CONCLUSION: GDF11 and TSP1 are closely associated with microvascular injury in DR patients and are related to the progression of DR disease, and the combined detection of their serum levels is of clinical value in the assessment of DR disease.