摘要
目的分析房水中内皮素(ET)-1、超氧化物歧化酶(SOD)与糖尿病视网膜病变(DR)患者玻璃体切割术后视力残疾的关系,探讨能够改善DR患者术后视力的治疗靶点。方法前瞻性研究。纳入2019年2月至2021年1月在我院眼科接受玻璃体切割术治疗的112例(112眼)DR患者进行研究,以术后随访1年内裸眼视力检查结果进行分组,分为视力残疾组和视力良好组。入院检查项目包括血糖[空腹血糖(FBG)、餐后2 h血糖(2hBG)、糖化血红蛋白(HbAlc)]、肝肾功能[血肌酐(Scr)、总胆红素(TBIL)]、D-二聚体(D-D)、C反应蛋白(CRP)、ET-1、SOD,根据检查结果,分析患者房水中ET-1、SOD及相关指标与DR患者术后1年内视力残疾的关系,并检验房水中ET-1、SOD对DR患者术后1年内视力残疾的预测效能。结果入组的112例DR患者中,随访期间失访2例,退出研究1例,中风死亡1例,剩余108例患者随访时间为4~12个月,28例患者接受裸眼视力检查时诊断为视力残疾,发生率为25.93%。视力残疾组患者重度增生病变占比多于视力良好组,视力残疾组患者血浆D-D、CRP,血清Scr、TBIL水平均高于视力良好组,视力残疾组患者房水中ET-1水平高于视力良好组,视力残疾组患者SOD水平低于视力良好组,差异均有统计学意义(均为P<0.05)。构建Logistic回归模型,重度增生,血浆D-D、CRP高表达,房水中ET-1高表达、SOD低表达均能够增加DR患者术后1年内视力残疾的风险(均为P<0.05)。绘制ROC曲线,房水中ET-1、SOD单独及联合预测术后1年内视力残疾风险的AUC值分别为0.806、0.816、0.870。结论DR患者接受玻璃体切割术治疗后1年容易发生视力残疾,房水中ET-1高表达、SOD低表达均能够增加术后1年内视力残疾的风险,房水中ET-1、SOD能够作为DR患者术后1年内视力残疾的预测因子。
Objective To analyze the relationship between endothelin-1(ET-1),superoxide dismutase(SOD)in aqueous humor and visual disability of patients with diabetic retinopathy(DR)after vitrectomy and to explore the therapeutic targets that can improve the postoperative visual acuity of DR patients.Methods A prospective study was conducted on 112 DR patients(112 eyes)who underwent the vitrectomy in the Department of Ophthalmology of our hospital from February 2019 to January 2021.The patients were divided into two groups according to the results of the naked vision examination within one year of follow-up,namely,the visual disability group and the normal visual acuity group.The admission examination items include blood glucose[fasting blood glucose(FBG),2 h postprandial blood glucose(2hBG),and glycosylated hemoglobin(HbAlc)],liver and kidney functions[serum creatinine(Scr)and total bilirubin(TBIL)],D-dimer(D-D),C-reactive protein(CRP),ET-1,and SOD.According to the examination results,the relationship between ET-1,SOD and related indicators in aqueous humor and visual disability in DR patients within 1 year after surgery was analyzed,and the predictive efficacy of ET-1 and SOD in the aqueous humor on visual disability in DR patients within 1 year after surgery was verified.Results Of the 112 DR patients enrolled in the study,2 were lost during the follow-up period,1 withdrew from the study,and 1 died of stroke.The remaining 108 patients were followed up for 4-12 months.A total of 28 patients were diagnosed with visual disability upon the naked vision examination,with an incidence of 25.93%.In the visual disability group,the proportion of severe hyperplasia,levels of plasma D-D,CRP,serum Scr,TBIL,and ET-1 in the aqueous humor were higher than those in the normal visual acuity group,and the level of SOD was lower than that in the normal visual acuity group,with statistically significant differences(all P<0.05).A logistic regression model was established.Severe hyperplasia,high expressions of plasma D-D and CRP,as well as ET-1 in the aqueous humor,and low expression of SOD in the aqueous humor could increase the risk of visual disability in DR patients within 1 year after surgery(all P<0.05).The receiver operating characteristic curve was drawn.The areas under the curve that ET-1 and SOD in the aqueous humor alone and jointly predicted the risk of visual disability within 1 year after surgery were 0.806,0.816 and 0.870,respectively.Conclusion DR patients are prone to visual disability one year after vitrectomy.Both high expression of ET-1 and low expression of SOD in the aqueous humor can increase the risk of visual disability within one year after surgery.Thus the ET-1 and SOD in the aqueous humor can be used as predictors of visual disability within one year after surgery in DR patients.
作者
王爽
李晓鹏
WANG Shuang;LI Xiaopeng(Department of Ophthalmology,the Third Afiliated Hospital of Xinxiang Medical University,Xixiang 453003,Henan Province,China)
出处
《眼科新进展》
CAS
北大核心
2023年第3期203-207,共5页
Recent Advances in Ophthalmology
基金
河南省医学科技攻关计划(联合共建)项目(编号:LHGJ20190492)。
