目的：探讨糖尿病性黄斑水肿(DME)患者血清中基质细胞衍生因子-1(SDF-1)和血管生成素样蛋白4(ANGPTL4)表达水平与病情严重程度的相关性。

方法：前瞻性研究。选取本院2020-04/2023-08期间收治的糖尿病视网膜病变患者193例，根据患者是否发生黄斑水肿及病情严重程度分为DME组128例(其中轻度组56例，中度组44例，重度组28例)和无DME组65例。采用酶联免疫吸附法(ELISA)测定血清中ANGPTL4和SDF-1水平。采用多因素Logistic回归分析影响DME病情严重程度的因素； 采用受试者工作特征(ROC)曲线分析DME患者血清中ANGPTL4和SDF-1水平对DME病情严重程度的诊断价值。

结果：DME组患者血清中ANGPTL4和SDF-1水平均显著高于无DME组(P<0.01)； 轻度组、中度组和重度组患者血清中ANGPTL4和SDF-1表达水平依次显著增加(P<0.05)； 多因素Logistic回归分析显示，血清中ANGPTL4和SDF-1水平是影响DME病情严重程度的危险因素(P<0.01)。血清中SDF-1诊断DME病情严重程度的曲线下面积(AUC)为0.772(95%CI：0.690-0.842)，ANGPTL4诊断DME病情严重程度的AUC为0.801(95%CI：0.722-0.867)，ANGPTL4和SDF-1联合诊断DME的AUC为0.884(95%CI：0.816-0.934)，敏感度为87.50%，特异度为85.71%，显著高于单独ANGPTL4、SDF-1诊断(Z=2.658、2.469，均P<0.05)。

结论：DME患者血清中ANGPTL4、SDF-1水平均显著升高，其水平随病情严重程度增加而升高，可作为诊断DME病情严重程度的辅助指标，且联合诊断的效果更佳。

METHODS: From April 2020 to August 2023, 193 patients with diabetic retinopathy who were admitted to our hospital were prospectively separated into DME group(128 cases)(56 cases in mild group, 44 cases in moderate group, 28 cases in severe group)and non DME group(65 cases)according to whether the patients had macular edema and the severity of disease. Enzyme-linked immunosorbent assay(ELISA)was applied to determine the levels of ANGPTL4 and SDF-1 in serum. Multivariate Logistic regression was applied to analyze the factors that affected the severity of DME; receiver operating characteristic(ROC)curve was applied to analyze the diagnostic value of ANGPTL4 and SDF-1 levels in serum of DME patients for the severity of DME.

RESULTS: The levels of ANGPTL4 and SDF-1 in serum of the DME group were obviously higher than those of the non DME group(P<0.01); the expression levels of ANGPTL4 and SDF-1 in serum of the mild, moderate, and severe groups increased obviously in sequence(P<0.05); multivariate Logistic regression analysis showed that the levels of ANGPTL4 and SDF-1 in serum were risk factors affecting the severity of DME(P<0.01); The area under the curve(AUC)of serum SDF-1 in the diagnosis of DME severity was 0.772(95%CI: 0.690-0.842), and the AUC of ANGPTL4 in the diagnosis of DME severity was 0.801(95%CI: 0.722-0.867). The AUC of ANGPTL4 combined with SDF-1 in the diagnosis of DME was 0.884(95%CI: 0.816-0.934), the sensitivity was 87.50%, and the specificity was 85.71%, which were significantly higher than ANGPTL4 or SDF-1 alone(Z=2.658, 2.469, all P<0.05).

CONCLUSION: The levels of ANGPTL4 and SDF-1 in serum of DME patients are significantly increased, and their levels increase with the severity of the disease. They can be used as auxiliary indicators for diagnosing the severity of DME disease, and the combined diagnosis has a better effect.