目的：探究糖尿病性白内障患者房水中血管生成素样蛋白4(ANGPTL4)、低氧诱导因子1α(HIF-1α)水平对术后发生黄斑水肿的预测效能。

方法：选取2021-01/2023-12在青岛市胶州中心医院进行手术治疗并出现黄斑水肿的糖尿病性白内障患者61例作为研究组，并收集未出现黄斑水肿的糖尿病性白内障患者42例作为对照组。按照黄斑水肿分级不同分为黄斑水肿Ⅰ级39例、黄斑水肿Ⅱ级18例，黄斑水肿Ⅲ级4例。采用酶联免疫吸附法测定房水中ANGPTL4、HIF-1α和炎症因子血管内皮生长因子(VEGF)、白细胞介素-8(IL-8)、单核细胞趋化蛋白-1(MCP-1)的水平； 根据光学相干断层扫描仪测定黄斑中心凹厚度。采用Pearson相关分析糖尿病性白内障患者术后房水中ANGPTL4和HIF-1α与炎症因子、黄斑中心凹厚度的相关性； 采用Logistic回归分析影响糖尿病性白内障术后发生黄斑水肿的因素； 采用受试者工作曲线(ROC)分析房水中ANGPTL4和HIF-1α水平对术后发生黄斑水肿的预测效能。

结果：研究组房水中ANGPTL4、HIF-1α、VEGF、IL-8、MCP-1水平及黄斑中心凹厚度显著高于对照组(均P<0.01)。随着黄斑水肿严重程度的增加，房水中ANGPTL4、HIF-1α水平明显升高(均P<0.01)。房水中ANGPTL4、HIF-1α水平分别与VEGF、IL-8、MCP-1和黄斑中心凹厚度呈正相关(均P<0.05)。ANGPTL4、HIF-1α、VEGF、MCP-1是影响糖尿病性白内障术后发生黄斑水肿的危险因素(均P<0.05)。房水中ANGPTL4、HIF-1α及二者联合预测术后发生黄斑水肿的AUC分别为0.883、0.844、0.945，二者联合预测明显高于ANGPTL4、HIF-1α水平单独预测。

结论：糖尿病性白内障患者房水中ANGPTL4和HIF-1α水平显著升高，二者联合可有效预测术后发生黄斑水肿，临床治疗可通过干扰二者水平，降低术后黄斑水肿发生的概率。

METHODS: A total of 61 cases of diabetic cataract patients who underwent surgical treatment and developed macular edema in Jiaozhou Central Hospital of Qingdao from January 2021 to December 2023 were selected as study group, and 42 cases of patients who did not develop macular edema were collected as control group. According to the grading of macular edema, they were separated into 39 cases of grade I macular edema, 18 cases of grade II macular edema, and 4 cases of grade III macular edema. Enzyme-linked immunosorbent assay(ELISA)was applied to determine the levels of ANGPTL4, HIF-1α, inflammatory factors such as vascular endothelial growth factor(VEGF), interleukin-8(IL-8), and monocyte chemotactic protein-1(MCP-1)in aqueous humor. Optical coherence tomography was applied to measure the thickness of the macular fovea. Pearson method was applied to analyze the correlation of ANGPTL4 and HIF-1α in aqueous humor with inflammatory factors and foveal thickness in patients with diabetic cataract. Logistic regression was applied to analyze factors affecting the prediction of macular edema after surgery in diabetic cataract. Receiver operating curve(ROC)was applied to analyze the performance of ANGPTL4 and HIF-1α levels in aqueous humor on predicting postoperative macular edema.

RESULTS: The levels of ANGPTL4, HIF-1α, VEGF, IL-8, MCP-1 in the aqueous humor of the study group and the macular foveal thickness were obviously higher than those of the control group(all P<0.01). With the exacerbation of macular edema, the levels of ANGPTL4 and HIF-1α in aqueous humor obviously increased(all P<0.01). The levels of ANGPTL4 and HIF-1α in aqueous humor were positively correlated with VEGF, IL-8, MCP-1, and macular foveal thickness, respectively(all P<0.05). ANGPTL4, HIF-1α, VEGF and MCP-1 were risk factors for predicting macular edema after cataract surgery in diabetic cataract(all P<0.05). The AUC for predicting postoperative macular edema of ANGPTL4, HIF-1α, and their combination in aqueous humor was 0.883, 0.844, and 0.945, respectively, and the combined prediction was obviously higher than the levels of ANGPTL4 and HIF-1α predicted separately.

CONCLUSION: The levels of ANGPTL4 and HIF-1α in aqueous humor of diabetic cataract patients are obviously increased, the combination of the two can effectively predict the occurrence of postoperative macular edema, and clinical treatment can reduce the probability of postoperative macular edema by interfering with the levels of the two.