原发性开角型青光眼患者血清硝基酪氨酸、褪黑素水平的表达及临床意义

Expression of serum nitrotyrosine and melatonin in patients with primary open angle glaucoma and its clinical significance

目的 探讨血清硝基酪氨酸(NT)、褪黑素水平与原发性开角型青光眼(POAG)患者视神经损伤和炎症因子的相关性,并探讨其对POAG患者视神经损伤程度的评估价值。方法 选取徐州市第一人民医院2020年7月至2021年7月收治的POAG患者81例(121眼),根据视野平均缺损(MD)值分成轻、中、重度组,纳入同期该院收治的白内障患者45例(63眼)及于该院体检的健康志愿者40例(80眼)分别作为白内障组、对照组,检测并比较5组血清NT、褪黑素水平,比较轻、中、重度组炎症因子水平,采用Pearson相关分析POAG患者的NT、褪黑素与视神经损伤及炎症因子的相关性。绘制受试者工作特征(ROC)曲线分析NT、褪黑素对POAG患者视神经损伤程度的评估价值。结果 血清NT在5组间的水平差异表现为:重度组高于中度组,中度组高于轻度组,轻度组高于白内障组,白内障组高于对照组,差异均有统计学意义(P<0.05);褪黑素在5组间的水平差异表现为:重度组低于中度组,中度组低于轻度组,轻度组低于白内障组,白内障组低于对照组,差异均有统计学意义(P<0.05)。重度组和中度组的血清白细胞介素(IL)-1β、IL-2、IL-6、IL-8、IL-18、肿瘤坏死因子-α(TNF-α)水平均高于轻度组(P<0.05),且重度组上述指标水平高于中度组(P<0.05)。血清NT水平与POAG患者的视神经损伤程度及炎症因子水平均呈正相关(P<0.05),而褪黑素水平与POAG患者的视神经损伤程度及炎症因子水平均呈负相关(P<0.05)。血清NT、褪黑素评估POAG患者视神经损伤程度的ROC曲线下面积分别为0.748、0.729。结论 POAG患者血清NT水平升高,褪黑素水平下降,且与视神经受损程度及炎症情况有关,二者对POAG患者的视神经损害程度有一定评估价值。

Objective To investigate the relationship between serum nitrotyrosine(NT),melatonin and optic nerve injury and inflammatory factors in patients with primary open angle glaucoma(POAG),and to explore thier value in evaluating the degree of optic nerve injury in patients with POAG.Methods A total of 81 patients(121 eyes) with POAG admitted to Xuzhou First People′s Hospital from July 2020 to July 2021 were selected.According to the mean visual field defect(MD) value, they were divided into mild, moderate and severe groups.Meanwhile, 45 patients with cataract(63 eyes) who were admitted to the hospital during the same period and 40 healthy volunteers(80 eyes) who came to the hospital for physical examination were served cataract group and control group.The levels of serum NT and melatonin in the 5 groups were detected and compared.The levels of inflammatory factors in the mild, moderate and severe groups were compared.Pearson correlation analysis was used to analyze the correlation between NT,melatonin and optic nerve injury and inflammatory factors in patients with POAG.Receiver operating characteristic(ROC) curve was drawn to analyze the evaluation value of NT and melatonin on optic nerve injury in POAG patients.Results The differences of serum NT level among the 5 groups were as follows: severe group was higher than moderate group, moderate group was higher than mild group, mild group was higher than cataract group, cataract group was higher than control group, the differences were statistically significant(P<0.05).The differences of serum melatonin level among the 5 groups were as follows: severe group was lower than moderate group, moderate group was lower than mild group, mild group was lower than cataract group, and cataract group was lower than control group, the differences were statistically significant(P<0.05).Serum levels of interleukin(IL)-1β,IL-2,IL-6,IL-8,IL-18 and tumor necrosis factor-α(TNF-α) in severe group and moderate group were higher than those in mild group, the levels of above indexes in severe group were higher than those in moderate group(P<0.05).The level of serum NT was positively correlated with the degree of optic nerve injury and the level of inflammatory factors in patients with POAG(P<0.05),while melatonin level was negatively correlated with the degree of optic nerve injury and the level of inflammatory factors in patients with POAG(P<0.05).The area under the ROC curve of serum NT and melatonin in evaluating the degree of optic nerve injury in POAG patients were 0.748 and 0.729,respectively.Conclusion The level of NT in POAG patients is increased, and the level of melatonin is decreased, which are related to the degree of optic nerve injury and inflammation.Both of them have certain evaluation value for the degree of optic nerve injury in POAG patients.