血清TLR4和VEGFA表达对糖尿病视网膜病变的临床诊断及预后价值评估

Clinical diagnosis and prognostic value of serum TLR4 and VEGFA expression in diabetic retinopathy

目的:探讨Toll样受体4(TLR4)、血管内皮生长因子A(VEGFA)在糖尿病视网膜病变(DR)患者血清中的表达情况及临床意义。方法:选取2021-01/2022-01本院收治的183例2型糖尿病(T2DM)患者为研究对象,分为非糖尿病视网膜病变(NDR)组(54例),增殖性糖尿病视网膜病变(PDR)组(68例)和非增殖性糖尿病视网膜病变(NPDR)组(61例)。同期按照年龄、性别分层随机选择70例于本院进行健康体检志愿者作为对照组。出院后随访1a,根据DR患者是否发生视力残疾,分为预后不良组(40例)与预后良好组(89例)。采用酶联免疫吸附法(ELISA)检测血清中TLR4、VEGFA水平;通过Logistic回归分析DR发生的影响因素;利用受试者工作特征曲线(ROC)分析血清TLR4、VEGFA水平诊断DR及预测预后的临床价值。结果:对照组、NDR组、PDR组和NPDR组间TLR4、VEGFA水平比较均具有差异(F=935.753、516.936,均P<0.05),各组两两比较均具有差异(P<0.05)。预后不良组患者血清中TLR4、VEGFA表达水平均高于预后良好组(P<0.01)。Logistic回归分析结果显示,TLR4、VEGFA、病程、HbA1c均是DR发生的危险因素(P<0.05);ROC结果显示,血清TLR4、VEGFA水平及二者联合预测DR的AUC分别为0.869、0.862、0.931,血清TLR4、VEGFA水平及二者联合预测DR患者视力残疾的AUC分别为0.864、0.863、0.938。结论:DR患者血清中TLR4、VEGFA表达均上调,二者联合检测可作为评估DR发生及预后不良的潜在指标。

AIM:To investigate the expression and clinical significance of Toll-like receptor 4(TLR4)and vascular endothelial growth factor A(VEGFA)in the serum of patients with diabetic retinopathy(DR).METHODS:A total of 183 patients with type 2 diabetes mellitus(T2DM)admitted to our hospital from January 2021 to January 2022 were collected as the study subjects.They were grouped into non diabetic retinopathy(NDR)group(n=54),proliferative diabetic retinopathy(PDR)group(n=68)and non proliferative diabetic retinopathy(NPDR)group(n=61).In the same period,70 volunteers who underwent physical examination in our hospital were randomly stratified according to age and sex.After discharge,DR patients were followed up for 1a and grouped into a poor prognosis group(n=40)and a good prognosis group(n=89)based on whether they had visual impairment.Enzyme-linked immunosorbent assay(ELISA)was applied to detect the levels of TLR4 and VEGFA in serum;Logistic regression was applied to analyze the influencing factors of DR;receiver operating characteristic(ROC)curve was applied to analyze the clinical value of serum TLR4 and VEGFA levels in diagnosing DR and predicting prognosis.RESULTS:There were statistical significance in TLR4 and VEGFA levels among the control group,NDR group,PDR group,and NPDR group(F=935.753,516.936,all P<0.05),and further pairwise comparisons showed statistical significance(P<0.05);the expression levels of TLR4 and VEGFA in the serum of patients with poor prognosis were higher than those of patients with good prognosis(P<0.01);the results of Logistic regression analysis showed that TLR4,VEGFA,course of disease,and HbA1c were all risk factors for the occurrence of DR(P<0.05);the ROC results showed that the AUC of serum TLR4,VEGFA levels,and their combination for predicting DR was 0.869,0.862,and 0.931,respectively,the AUC of serum TLR4,VEGFA levels,and their combined prediction of visual disability in DR patients was 0.864,0.863,and 0.938,respectively.CONCLUSION:The expression of TLR4 and VEGFA in serum of DR patients is up-regulated,and the combined detection of TLR4 and VEGFA can be used as a potential indicator to evaluate the occurrence and poor prognosis of DR.