糖尿病新生血管性青光眼患者血清SDF-1、CXCR7表达及其临床意义

Expression and clinical significance of serum SDF- 1 and CXCR7 in patients with diabetic neovascular glaucoma

目的:探讨糖尿病新生血管性青光眼(NVG)患者血清基质细胞衍生因子-1(SDF-1)、趋化因子受体7(CXCR7)表达及其临床意义。方法:选取2018年9月至2020年12月武汉市第三医院收治的71例由糖尿病性视网膜病变引起的NVG患者为研究组,根据NVG患者临床表现分为Ⅰ期13例、Ⅱ期40例、Ⅲ期18例,同期随机纳入在武汉市第三医院治疗的年龄相关性白内障患者53例为对照组。采用酶联免疫吸附法检测血清SDF-1、CXCR7水平及血管内皮生长因子(VEGF)、白细胞介素-6(IL-6)水平。比较两组血清SDF-1、CXCR7、VEGF、IL-6水平,分析研究组患者血清SDF-1、CXCR7之间以及两者分别与VEGF、IL-6的相关关系,利用受试者工作特征(ROC)曲线分析血清SDF-1、CXCR7、VEGF、IL-6水平对NVG的预测价值。结果:与对照组比较,研究组血清SDF-1、CXCR7、VEGF、IL-6水平均明显升高(P<0.05);随NVG患者临床分期升级,血清SDF-1、CXCR7、VEGF、IL-6水平均呈显著升高,差异均有统计学意义(P<0.05);Pearson结果显示,研究组患者血清SDF-1水平与CXCR7、VEGF、IL-6水平之间均呈正相关(r=0.496、0.413、0.437,均P<0.05),血清CXCR7水平与VEGF、IL-6水平之间均呈正相关(r=0.429、0.441,均P<0.05);ROC曲线分析显示,血清SDF-1、CXCR7、VEGF、IL-6水平预测NVG的曲线下面积(AUC)分别为0.859(95%CI为0.785~0.915)、0.890(95%CI为0.823~0.937)、0.798(95%CI为0.716~0.865)、0.849(95%CI为0.774~0.907),血清SDF-1、CXCR7二者联合预测NVG的AUC为0.946(95%CI为0.883~0.965),与单独诊断的AUC相比差异均有统计学意义(P<0.05);血清SDF-1、CXCR7、VEGF、IL-6四者联合预测NVG的AUC为0.967(95%CI为0.916~0.986),与单独诊断及SDF-1、CXCR7二者联合诊断AUC比较差异均有统计学意义(P<0.05)。结论:研究组患者血清SDF-1、CXCR7水平随临床分期加重而上升,与血清VEGF、IL-6水平均呈正相关,且对NVG发生均有一定的诊断价值,可能作为指示NVG发生发展的潜在生物学指标。

Objective: To investigate the expression and clinical significance of serum stromal cell-derived factor-1(SDF-1) and CXC chemokine receptor 7(CXCR7) in patients with diabetic neovascular glaucoma(NVG). Methods: A total of 71 patients with NVG caused by diabetic retinopathy admitted in the Third Hospital of Wuhan from September 2018 to December 2020 were selected as the study group. According to the clinical manifestations of NVG patients, they were divided into stage Ⅰ(13 cases), stage Ⅱ(40 cases) and stage Ⅲ(18 cases). At the same time, 53 patients with age-related cataract treated in the Third Hospital of Wuhan were randomly included as the control group. The levels of serum SDF-1, CXCR7, vascular endothelial growth factor(VEGF) and interleukin-6(IL-6) were detected by enzyme linked immunosorbent assay. the levels of serum SDF-1, CXCR7, VEGF and IL-6 in each group were compared, the correlation between serum SDF-1 and CXCR7, and their correlation with VEGF, IL-6 in study group were analyzed, the predictive value of serum SDF-1, CXCR7, VEGF and IL-6 levels for NVG was analyzed by receiver operating characteristic(ROC)curve. Results: Compared with those in the control group, the levels of serum SDF-1, CXCR7, VEGF and IL-6 in the study group were significantly increased(P<0.05);the levels of serum SDF-1, CXCR7, VEGF and IL-6 increased significantly with the upgrade of clinical stage of NVG(P<0.05);Pearson results showed that the level of serum SDF-1 was positively correlated with CXCR7, VEGF and IL-6 levels in study group(r=0.496, 0.413, 0.437, all P<0.05), the level of serum CXCR7 was positively correlated with VEGF and IL-6 levels(r=0.429, 0.441, all P<0.05);the area under the curve(AUC) of serum SDF-1, CXCR7, VEGF and IL-6 in predicting NVG was 0.859(95%CI 0.785-0.915), 0.890(95%CI 0.823-0.937), 0.798(95%CI 0.716-0.865) and 0.849(95%CI 0.774-0.907), respectively. The AUC of serum SDF-1 and CXCR7 in predicting NVG was 0.946(95%CI 0.883-0.965), which was significantly different from that of single factor(P<0.05);the AUC of levels of serum SDF-1, CXCR7, VEGF and IL-6 in predicting NVG was 0.967(95%CI 0.916-0.986), which was significantly different from that of single factor diagnosis and SDF-1, CXCR7 combined diagnosis(P<0.05). Conclusion: The levels of serum SDF-1 and CXCR7 in patients with NVG increase with the aggravation of clinical grading, and are positively correlated with the levels of serum VEGF and IL-6. They have certain diagnostic value for the occurrence of NVG, and may be used as potential biological indicators to indicate the occurrence and development of NVG.