房水ES、VEGF和PDGF水平与2型糖尿病合并白内障术后黄斑水肿的临床研究

Clinical study on the levels of ES,VEGF and PDGF in aqueous humor and macular edema after cataract surgery in patients with type 2 diabetes mellitus

目的观察2型糖尿病合并白内障术后黄斑水肿的多因素分析及房水内皮抑制素(ES)、血管内皮生长因子(VEGF)和血小板衍生生长因子(PDGF)水平对白内障术后黄斑水肿的诊断效能。方法选取2018年1月至2020年12月在该院诊断为2型糖尿病合并白内障的136例患者(136眼)作为研究对象,均行白内障超声乳化联合人工晶体植入术治疗,根据术后是否发生黄斑水肿分为黄斑水肿组(31例)和无黄斑水肿组(105例)。观察2型糖尿病合并白内障术后发生黄斑水肿的单因素和多因素指标,观察白内障术前、术后房水ES、VEGF和PDGF水平变化情况,以及术后4周房水ES、VEGF和PDGF水平与黄斑水肿严重程度及指标之间的相关性。结果两组患者糖化血红蛋白水平比较,差异有统计学意义(P<0.05);两组患者性别、年龄、体质量指数、吸烟史、饮酒史、合并高血压、合并高血脂、白内障病程、术眼侧别和空腹血糖水平比较,差异均无统计学意义(P>0.05)。两组患者术前房水ES、VEGF和PDGF水平比较,差异均无统计学意义(P>0.05)。术后4周,黄斑水肿组患者房水ES水平与术前和无黄斑水肿组比较均明显降低,差异均有统计学意义(P<0.05),并且随着黄斑水肿严重程度升高而降低;而黄斑水肿组患者房水VEGF和PDGF水平与术前和无黄斑水肿组比较均明显升高,差异均有统计学意义(P<0.05),并且随着黄斑水肿严重程度升高而升高。经多因素Logistic回归分析发现,糖尿病病程与白内障术后发生黄斑水肿无明显关系(P>0.05),而糖化血红蛋白、术后4周房水ES、VEGF和PDGF水平是白内障术后发生黄斑水肿的影响因素(P<0.05)。2型糖尿病合并白内障术后4周房水ES水平与VEGF和PDGF水平均呈负相关(r=-0.642、-0.573,P<0.05),而房水VEGF水平与PDGF水平呈正相关(r=0.724,P<0.05)。白内障术后4周房水ES、VEGF和PDGF水平对2型糖尿病合并白内障术后发生黄斑水肿有较高的诊断效能,3项指标联合检测的灵敏度、特异度、受试者工作特征曲线下面积均明显高于ES(Z=3.694,P<0.05)、VEGF(Z=2.203,P<0.05)和PDGF(Z=2.807,P<0.05)单项检测。结论联合检测房水ES、VEGF和PDGF水平对术后发生黄斑水肿有较高的诊断效能,是白内障术后发生黄斑水肿的独立影响因素。

Objective To observe the influencing factors of macular edema after cataract surgery in type 2 diabetes mellitus patients,and the efficacy of aqueous endostatin(ES),vascular endothelial growth factor(VEGF)and platelet-derived growth factor(PDGF)levels in diagnosing macular edema after cataract surgery.Methods A total of 136 patients(136 eyes)who were diagnosed with type 2 diabetes mellitus complicated with cataract in the hospital from January 2018 to December 2020 were selected as the research subjects.All patients underwent cataract phacoemulsification combined with intraocular lens implantation,and were divided into macular edema group(31 cases)and no macular edema group(105 cases)according to whether macular edema occurred after surgery.Observed the single factor and multiple factors indexes of macular edema after type 2 diabetes mellitus combine with cataract surgery,observed the changes of aqueous humor ES,VEGF and PDGF levels before and after cataract surgery,and the correlation between the levels of aqueous humor ES,VEGF and PDGF and the severity of macular edema and indexes at 4 weeks after surgery.Results There was a statistically significant different in the level of glycosylated hemoglobin between the two groups(P<0.05).There was no statistically significant difference in the gender,age,body mass index,smoking history,drinking history,combined with hypertension,combined with hyperlipidemia,course of cataract,side of operation and fasting blood glucose(P>0.05).There was no significant difference in the levels of ES,VEGF and PDGF in aqueous humor between the two groups before surgery(P>0.05).At 4 weeks after surgery,the ES level of aqueous humor in the macular edema group was significantly lower than that before surgery and in the non-macular edema group,and the difference was statistically significant(P<0.05),and it decreased with the increase in the severity of macular edema.The levels of VEGF and PDGF of aqueous humor in the macular edema group were significantly higher than those before surgery and in the non-macular edema group,and the differences were statistically significant(P<0.05),and increased with the severity of macular edema.Multivariate Logistic regression analysis showed that there was no significant relationship between the duration of diabetes and macular edema after cataract surgery(P>0.05),while the levels of glycosylated hemoglobin,aqueous humor ES,VEGF and PDGF were influencing factors for macular edema after cataract surgery(P<0.05).The aqueous humor ES level was negatively correlated with the VEGF and PDGF levels at 4 weeks after cataract surgery in type 2 diabetes mellitus(r=-0.642,-0.573,P<0.05),while the aqueous humor VEGF level was positively correlated with the PDGF level(r=0.724,P<0.05).The aqueous humor ES,VEGF and PDGF levels at 4 weeks after cataract surgery had high diagnostic performance in macular edema after type 2 diabetes mellitus cataract surgery.The combined detection sensitivity,specificity and area under the receiver operating characteristic curve of the three indicators were significantly higher than the ES(Z=3.694,P<0.05),VEGF(Z=2.203,P<0.05)and PDGF(Z=2.807,P<0.05)separate detection.Conclusion Combine detection of aqueous humor ES,VEGF and PDGF levels has high diagnostic performance in postoperative macular edema,and is an independent influencing factor for macular edema after cataract surgery.