老年性白内障患者泪液中miR-223和miR-143-3p水平表达与术后干眼症的相关性研究

Correlation between the Expression of miR-223 and miR-143-3p Levels in Tears of Elderly Cataract Patients and Postoperative Dry Eye Syndrome

目的探究老年性白内障患者术后干眼与泪液中miR-223,miR-143-3p水平表达的相关性。方法选取2022年5月~2023年2月于贵港东晖医院眼科行白内障术的92例老年性白内障患者作为研究对象,根据术后7天内有无发生干眼将其分为干眼症组(n=42)和无干眼症组(n=50),另选取同期体检的92例健康者作为健康对照组。采用Pearson法分析泪液miR-223,miR-143-3p表达水平与干眼诊断指标:泪膜破裂时间(break-up time,BUT)、角膜荧光素染色(corneal fluorescein staining,FL)评分和泪液分泌试验(schirmers test,SIt)的相关性;采用多因素Logistic回归分析影响白内障术后干眼发生的相关因素;采用受试者工作特征(receiver operating characteristic,ROC)曲线分析泪液miR-223和miR-143-3p对白内障术后干眼的预测价值。结果无干眼症组患者BUT(12.27±1.69s)及SIt(9.17±1.66mm)高于干眼症组(8.95±1.02s,4.36±0.97mm),FL(0.74±0.11分)则低于干眼症组(2.52±0.37分),差异具有统计学意义(t=11.136,16.546,32.386,均P<0.05)。干眼症组患者泪液miR-223(0.87±0.08)表达水平低于健康对照组(1.02±0.03)和无干眼症组(0.92±0.13),泪液miR-143-3p(1.37±0.32)表达水平高于健康对照组和无干眼症组(1.01±0.02,1.15±0.26),差异具有统计学意义(t=15.772,2.170;10.793,3.638,均P<0.05)。泪液中miR-223表达水平与BUT,SIt呈正相关(r=0.587,0.503,均P<0.001),与FL呈负相关(r=-0.442,P<0.001),miR-143-3p与BUT,SIt呈负相关(r=-0.714,-0.549,均P<0.001),与FL呈正相关(r=0.667,P<0.001)。干眼症组有角结膜疾病史、手术切口长度≥3 mm的患者所占比例高于无干眼症组(χ2=12.583,6.505,均P<0.05),且干眼症组患者泪液miR-223表达水平低于无干眼症组,miR-143-3p表达水平则高于无干眼症组,差异具有统计学意义(t=2.170,3.638,均P<0.05)。角结膜疾病史(OR=1.982)、手术切口长度(OR=2.036)及miR-143-3p(OR=1.653)为白内障患者术后发生干眼的危险因素,miR-223(OR=0.574)则为保护因素(P<0.05);泪液miR-223和miR-143-3p单独检测预测白内障术后干眼发生的曲线下面积(area under the cure,AUC)分别为0.692,0.719,而二者联合检测的AUC为0.880,二者联合检测优于miR-223和miR-143-3p各自单独检测(Z=3.869,3.810,均P<0.001)。结论老年性白内障术后干眼的发生与泪液中miR-223和miR-143-3p表达水平有关。

Objective To investigate the correlation between postoperative dry eye syndrome and micro RNA(miR)-223 and miR-143-3p factors in tears of elderly cataract patients.Methods From May 2022 to February 2023,92 elderly cataract patients who underwent cataract surgery in Department of Ophthalmology,Guigang Donghui Hospital were regarded as the study subjects.These subjects were separated into a dry eye group(n=42)and a non dry eye group(n=50)based on the occurrence of dry eyes within 7 days after surgery.Meanwhile,92 healthy individuals who underwent physical examination were collected as the healthy control group.Pearson method was applied to analyze the correlation between the expression levels of miR-223 and miR-143-3p in tears and dry eye diagnostic indicators such as tear film break-up time(BUT),corneal fluorescein staining(FL)score,and tear schirmer’s test(SIt).Multivariate logistic regression was applied to analyze the relevant factors affecting the occurrence of dry eye after cataract surgery.Receiver operating characteristic(ROC)curve was applied to analyze the predictive value of tear miR-223 and miR-143-3p for the occurrence of dry eye after cataract surgery.Results The BUT(12.27±1.69s)and SIt(9.17±1.66mm)in the non dry eye group were higher than those in the dry eye group(8.95±1.02s,4.36±0.97mm),while FL(0.74±0.11 score)was lower than that in the dry eye group(2.52±0.37score).and the differences were statistically significant(t=1.136,16.546,32.386,all P<0.05).The expression level of miR-223(0.87±0.08)in tears of patients in the dry eye group was lower than that of the healthy control group(1.02±0.03)and the non dry eye group(0.92±0.13),while the expression level of miR-143-3p(1.37±0.32)in tears was opposite(1.01±0.02,1.15±0.26),and the differences were statistically significant(t=15.772,2.170,10.793,3.638,all P<0.05).The expression level of miR-223 in tears was positively correlated with BUT and SIt(r=0.587,0.503,all P<0.001),and was negatively correlated with FL(r=-0.442,P<0.001).The expression level of miR-143-3p in tears negatively correlated with BUT and SIt(r=-0.714,-0.549,all P<0.001),and was positively correlated with FL(r=0.667,P<0.001).The proportions of patients with a history of angular conjunctival disease and a surgical incision length of≥3mm in the dry eye group were higher than that in the non dry eye group(χ2=12.583,6.505,all P<0.05).The expression level of miR-223 in tears of patients in the dry eye group was lower than that of the non dry eye group,while the expression level of miR-143-3p was higher than that of the non dry eye group(t=2.170,3.638,all P<0.05).A history of conjunctival disease(OR=1.982),surgical incision length(OR=2.036),and miR-143-3p(OR=1.653)were risk factors for postoperative dry eye in cataract patients,while miR-223(OR=0.574)was a protective factor(P<0.05).The areas under the curve(AUC)of tear miR-223 and miR-143-3p detection alone predicted the occurrence of dry eye after cataract surgery were 0.692 and 0.719,respectively,while the AUC of their combined detection was 0.880.The combined detection of the two was superior to miR-223 and miR-143-3p detection alone(Z=3.869,3.810,all P<0.001).Conclusion The occurrence of dry eye in postoperative elderly cataract patients was related to the expression levels of miR-223 and miR-143-3p in tears.