糖尿病视网膜病变患者玻璃体液和血清中信号素3A、CXCL12的表达水平及其临床意义

doi:10.3969/j.issn.1671-7171.2022.08.015

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摘要【目的】探讨信号素3A(Sema 3A)、趋化因子配体12(CXCL12)在糖尿病视网膜病变(DR)患者玻璃体液和血清中的表达情况及其临床意义。【方法】选取2019年7月至2021年7月在本院诊治的113例DR患者为研究对象,根据DR的国际临床分类标准分为增殖性糖尿病视网膜病变组(PDR组,n=44)和非增殖性糖尿病视网膜病变组(NPDR组,n=69);另外,收集同期在本院体检的52例健康志愿者为对照组。收集所有研究对象的一般资料及生化指标,采用酶联免疫吸附法检测所有研究对象血清及DR患者玻璃体液中Sema 3A、CXCL12水平;采用Logistic回归分析DR发生的影响因素;采用受试者工作特征(ROC)曲线分析Sema 3A、CXCL12水平对PDR发生的预测价值。【结果】PDR组、NPDR组患者血清中Sema 3A、CXCL12水平均高于对照组(P<0.05),PDR组患者玻璃体液和血清中Sema 3A、CXCL12水平高于NPDR组(P<0.05)。PDR组、NPDR组患者糖化血红蛋白(HbA1c)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FPG)水平均高于对照组,且PDR组高于NPDR组,差异均有统计学意义(P<0.05)。DR患者血清中Sema 3A、CXCL12表达呈正相关(r=0.664,P<0.05);DR患者玻璃体液中Sema 3A、CXCL12表达呈正相关(r=0.457,P<0.05)。Logistic回归分析结果显示:Sema 3A、CXCL12、FPG、HbA1c、HDL-C、TC、TG、LDL-C均是DR发生的危险因素(P<0.05)。ROC曲线分析结果显示:血清Sema 3A、CXCL12水平预测PDR发生的曲线下面积(AUC)分别为0.951(95%CI:0.906~0.979)、0.953(95%CI:0.909~0.980),敏感度分别为93.18%、95.45%,特异度分别为91.74%、82.64%;血清Sema 3A联合CXCL12水平预测PDR发生的AUC为0.981(95%CI:0.947~0.996),敏感度为95.45%,特异度为92.56%。【结论】在PDR患者血清及玻璃体液中Sema 3A、CXCL12水平均上调,其可能与DR的发生、发展密切相关,且可作为预测PDR发生的潜在指标。

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关键词 ：糖尿病视网膜病变, 玻璃体, 信号素3A/血液, 趋化因子CXCL12/血液

Abstract：【Objective】To investigate the expression and clinical significance of semaphorin 3A (Sema 3A) and CXC chemokine ligand 12 (CXCL12) in vitreous humor and serum of patients with diabetic retinopathy (DR). 【Methods】A total of 113 DR patients who were diagnosed and treated in our hospital from July 2019 to July 2021 were collected as the research objects. The DR patients were divided into proliferative diabetic retinopathy (PDR) group (n=44) and non-proliferative diabetic retinopathy (NPDR) group (n=69) according to the international clinical classification of DR. In addition,52 healthy volunteers who underwent physical examination in our hospital were as the control group. The general information and biochemical indicators of the research subjects were collected,the levels of Sema 3A and CXCL12 in serum and vitreous humor were detected by enzyme-linked immunosorbent assay; the influencing factors of DR were analyzed by logistic regression; and the clinical value of Sema 3A and CXCL12 levels in predicting the occurrence of PDR was analyzed by receiver operating characteristic (ROC) curve. 【Results】The levels of Sema 3A and CXCL12 in the vitreous humor and serum of the patients in the PDR group were higher than those in the NPDR group (P<0.05). The levels of Sema 3A and CXCL12 in the serum of the patients in the PDR and NPDR groups were higher than those in the control group (P<0.05). Levels of HbA1c,TC,TG,LDL-C,HDL-C,and FPG in the PDR group and NPDR group were higher than those in the control group,and these indicators in the PDR group were higher than that in the NPDR group,with statistical significance (P<0.05). the expression of Sema 3A and CXCL12 in serum of DR patients was positively correlated (r=0.664,P<0.05),and the expression of Sema 3A and CXCL12 in vitreous humor was positively correlated (r=0.457,P<0.05). Logistic regression analysis showed that Sema 3A,CXCL12,FPG,HbA1c,HDL-C,TC,TG and LDL-C were all risk factors for DR (P<0.05). ROC curve showed that the areas under the curve (AUC) of serum Sema 3A and CXCL12 levels for predicting PDR were 0.951 (95%CI:0.906-0.979) and 0.953 (95%CI:0.909-0.980),respectively; and the corresponding sensitivities were 93.18 % and 95.45%,respectively,the specificities were 91.74% and 82.64%,respectively. The combined predictive AUC of serum Sema 3A combined with CXCL12 levels was 0.981 (95%CI:0.947-0.996),with a sensitivity of 95.45% and a specificity of 92.56%. 【Conclusion】The levels of Sema 3A and CXCL12 in serum and vitreous humor of patients with PDR are up-regulated,which are closely related to the occurrence and development of DR,and can be used as potential indicators to evaluate the occurrence of PDR.

Key words： Diabetic Retinopathy Vitreous Body Semaphorin-3A/BL Chemokine CXCL12/BL

收稿日期: 2022-03-08

中图分类号:

R587.26

通讯作者: *E-mail:97050394@qq.com

引用本文:

赵铭, 马文婷. 糖尿病视网膜病变患者玻璃体液和血清中信号素3A、CXCL12的表达水平及其临床意义[J]. 医学临床研究, 2022, 39(8): 1174-1177.
ZHAO Ming, MA Wen-ting. Expression and Clinical Significance of Semaphorin 3A and CXCL12 in Vitreous Humor and Serum of Patients with Diabetic Retinopathy. JOURNAL OF CLINICAL RESEARCH, 2022, 39(8): 1174-1177.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2022.08.015 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2022/V39/I8/1174

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