白内障超声乳化人工晶体植入术对患者泪液叉头框蛋白O3、核苷酸结合寡聚化结构域样受体1表达的影响及与术后干眼症的关系

Effect of Cataract Phacoemulsification and Intraocular Lens Implantation on FOXO3 and Nod-1 Expression in Tears of Patients and Their Relationship with Postoperative Dry Eye

目的探讨白内障超声乳化人工晶体植入术患者泪液中叉头框蛋白O3(FOXO3)、核苷酸结合寡聚化结构域样受体1(Nod-1)表达及与术后干眼症的关系。方法选取2022年3月至2023年8月接受白内障超声乳化人工晶体植入术的患者96例,均单眼行手术,以术眼为观察组(n=96),非术眼为对照组(n=96)。比较观察组手术前后与对照组泪液中FOXO3、Nod-1的变化情况。根据术后1个月术眼是否出现干眼症分为干眼组34例与非干眼组62例,比较干眼组与非干眼组临床资料及泪液中FOXO3、Nod-1表达水平,分析影响患者术后发生干眼症的危险因素及FOXO3、Nod-1水平检测对术后发生干眼症的预测价值。结果术后观察组FOXO3水平较术前降低且低于对照组,Nod-1水平较术前升高且高于对照组(P<0.05)。干眼组与非干眼组术后FOXO3水平均较术前降低,Nod-1水平均较术前升高,且干眼组术后FOXO3水平低于非干眼组,Nod-1水平高于非干眼组(P<0.05)。干眼组中糖尿病、睑板腺功能障碍患者占比高于非干眼组(P<0.05)。糖尿病、睑板腺功能障碍、FOXO3、Nod-1水平是白内障超声乳化人工晶体植入术后发生干眼症的独立影响因素(P<0.05,P<0.01)。FOXO3、Nod-1及联合检测对患者术后发生干眼症预测的曲线下面积分别为0.717、0.764、0.877。结论白内障超声乳化人工晶体植入术后泪液中FOXO3低表达、Nod-1高表达是白内障患者术后发生干眼症的独立危险因素,检测FOXO3、Nod-1的表达水平,对术后是否发生干眼症具有一定的预测价值。

Objective To investigate the expression of FOXO3 and nucleotide-binding oligomerized domain receptor 1(Nod-1)in tears of patients treated by cataract phacoemulsification and intraocular lens implantation and their relationship with postoperative dry eye.Methods A total of 96 patients who underwent cataract phacoemulsification from March 2022 to August 2023 were selected,all of whom underwent surgery in one eye.The operative eye was used as the observation group(n=96),and the other non-operative eye was used as the control group(n=96).The changes of FOXO3 and Nod-1 in tears of observation group and control group were compared before and after operation.According to presence of dry eye at one month after operation,they were divided into dry eye group(n=34)and non-dry eye group(n=62).The clinical data and expression levels of FOXO3 and Nod-1 in tears between dry eye group and non-dry eye group were compared.The risk factors affecting postoperative dry eye syndrome in patients,and the predictive value of FOXO3 and Nod-1 level detection for postoperative dry eye syndrome were analyzed.Results The level of FOXO3 in the observation group was lower than that before operation and that in the control group,and Nod-1 level was higher than that before operation and that in the control group(P<0.05).After operation,FOXO3 level in dry eye group and non-dry eye group was lower than that before operation,while Nod-1 level was higher than that before operation;FOXO3 level in dry eye group was lower than that in non-dry eye group,while Nod-1 level was higher than that in non-dry eye group(P<0.05).The proportion of patients with diabetes and meibomian gland dysfunction in dry eye group was higher than that in non-dry eye group(P<0.05).Diabetes mellitus,meibomian gland dysfunction,FOXO3 and Nod-1 levels were independent influencing factors for dry eye after cataract phacoemulsification and intraocular lens implantation(P<0.05,P<0.01).The area under the receiver operating characteristic(ROC)curve(AUC)of FOXO3 and Nod-1 detected alone and in combination for predicting postoperative dry eye was 0.717,0.764 and 0.877,respectively.Conclusion Low expression of FOXO3 and high expression of Nod-1 in tears of cataract patients after cataract phacoemulsification and intraocular lens implantation are independent risk factors for dry eye after operation for cataract.Detection of the expression levels of FOXO3 and Nod-1 has certain predictive value for postoperative dry eye.