目的：探究微小RNA(miRNA，miR)-27在糖尿病视网膜病变(DR)中的表达及临床价值。

方法：前瞻性研究。收集2019-01/2020-01我院收治的DR患者80例(DR组)，采集同期收治单纯2型糖尿病(T2DM)患者40例(T2DM组)及正常健康人40例(对照组)，均提取血浆RNA，反转录实时荧光定量聚合酶连反应法(RT-PCR)测定血浆miR-27表达，酶联免疫吸附法测定各组血清血管内皮生长因子(VEGF)水平，比较各组血浆miR-27、血清VEGF表达的差异，分析不同DR分期患者以上各因子的差异，多因素Logistic回归分析筛选DR患者miR-27表达影响因素，Pearson相关分析法分析miR-27与血清VEGF、血糖指标的相关性。

结果：DR组、T2DM组血浆miR-27、血清VEGF高于对照组(P<0.05)，DR组又高于T2DM组(P<0.05)； 增生型糖尿病视网膜病变(PDR)患者血浆miR-27、血清VEGF、空腹血糖及糖化血红蛋白水平均高于非增生型糖尿病视网膜病变(NPDR)患者(P<0.05)； 病程(OR=3.206)、空腹血糖(OR=2.570)、糖化血红蛋白(OR=2.787)、VEGF(OR=3.442)、DR分期(OR=5.842)均为DR患者血浆miR-27相对表达量的影响因素(P<0.05)； DR患者血浆miR-27相对表达量与血清VEGF、空腹血糖、糖化血红蛋白均呈正相关(r=0.548、0.398、0.522，均P<0.05)。

结论：DR患者miR-27表达水平较单纯T2DM及正常健康人高，糖尿病病程、空腹血糖、糖化血红蛋白、DR分期均影响患者miR-27表达，且miR-27与血清VEGF、糖化血红蛋白、空腹血糖呈正相关，推测miR-27可能通过调控糖代谢、促血管生成等途径介导DR发病及进展。

METHODS: A total of DR 80 patients(DR group)treated between January 2019 and January 2020 were retrospectively reviewed. Meanwhile, 40 patients with simple type 2 diabetes mellitus(T2DM)(T2DM group)and 40 normal healthy persons(control group)were enrolled, and plasma RNA was extracted. Real time fluorescent quantitative reverse transcription polymerase chain reaction(RT-PCR)was adopted to determine plasma miR-27 expression, and enzyme-linked immunosorbent assay was performed to determine the vascular endothelial growth factor(VEGF)level. Plasma miR-27 and serum VEGF expression in different groups and in patients with different severities of DR was comparatively analyzed. Multivariate Logistic regression analysis was performed to screen factors influencing the expression of miR-27 in patients with DR, and Pearson correlation analysis of miR-27, serum VEGF and blood glucose indexes was conducted. Meanwhile, significance of miR-27 in pathogenesis of DR was summarized.

RESULTS: DR group had the highest plasma miR-27 and serum VEGF levels, followed by T2DM group, and then the control group(P<0.05). Proliferative diabetic retinopathy(PDR)patients had higher levels of plasma miR-27, serum VEGF, fasting blood glucose and glycated hemoglobin than those with non-proliferative diabetic retinopathy(NPDR)(P<0.05). It was found that course of disease(OR=3.206), fasting blood glucose(OR=2.570), glycated hemoglobin(OR=2.787), VEGF(OR=3.442)and severity of DR(OR=5.842)were influencing factors of plasma miR-27 expression in DR patients(P<0.05). In DR patients, relative expression of plasma miR-27 was positively correlated with serum VEGF, fasting blood glucose and glycated hemoglobin(r=0.548, 0.398, 0.522, all P<0.05).

CONCLUSION: DR patients have higher plasma miR-27 expression level than those with simple T2DM and normal healthy people. The duration of diabetes, fasting blood glucose, glycated hemoglobin and severity of DR all affect the expression of miR-27. Besides, miR-27 is positively correlated with serum VEGF, glycated hemoglobin and fasting blood glucose. It is speculated that miR-27 may mediate the pathogenesis and progression of DR by regulating glucose metabolism and promoting angiogenesis.