目的：探究2型糖尿病(T2DM)伴干眼(DE)患者血清脂质运载蛋白2(LCN2)、趋化因子样受体1(CMKLR1)、嗜酸细胞趋化因子11(CCL11)表达与病情严重程度的相关性。

方法：前瞻性研究。纳入2022-05/2024-05 我院诊治的T2DM伴DE患者97例194眼为干眼组，并根据干眼程度分为轻度组47例94眼、中度组34例68眼、重度组16例32眼； 另选取T2DM未伴DE患者97例194眼为非干眼组； 同期体检健康志愿者97例194眼为对照组。检测所有参与者血清LCN2和CMKLR1及CCL11水平； Spearman分析血清LCN2和CMKLR1及CCL11水平与T2DM伴DE病情严重程度相关性； 多因素Logistic分析影响T2DM伴DE患者病情严重程度的因素； 绘制受试者工作特征(ROC)曲线分析血清LCN2和CMKLR1及CCL11水平对T2DM患者伴中重度干眼诊断价值。

结果：对照组、非干眼组、干眼组血清LCN2和CMKLR1及CCL11水平依次增加(均P<0.05)； 轻度组、中度组、重度组干眼患者血清LCN2和CMKLR1及CCL11水平依次增加(均P<0.05)； Spearman相关性分析，血清LCN2和CMKLR1及CCL11水平与病情严重程度正相关(r_s=0.604、0.591、0.559，均P<0.05)； 逐步向前多因素Logistic分析表明泪液分泌试验(SⅠt)、泪膜破裂时间(BUT)及血清LCN2和CMKLR1及CCL11水平是影响T2DM伴DE患者病情严重程度的因素； ROC曲线表明血清LCN2和CMKLR1及CCL11联合诊断2型糖尿病伴干眼患者严重程度曲线下面积(AUC)值为0.896，显著大于LCN2和CMKLR1及CCL11单独诊断(Z=2.925、2.704、3.483，P=0.003、0.007、<0.001)。

结论：T2DM伴DE患者血清LCN2和CMKLR1及CCL11水平升高，与干眼症状严重程度呈正相关，三者联合对中重度DE诊断价值较高。

METHODS:A prospective selection of 97 patients(194 eyes)diagnosed with T2DM and DE at our hospital from May 2022 to May 2024 was made as the DE group, which was further divided into mild(47 cases, 94 eyes), moderate(34 cases, 68 eyes), and severe(16 cases, 32 eyes)subgroups based on the severity of dry eye. Additionally, 97 patients(194 eyes)of T2DM without DE were selected as non-DE group, and 97 healthy volunteers(194 eyes)who underwent physical examination during the same period were chosen as control group. Serum levels of LCN2, CMKLR1, and CCL11 were measured in all participants. Spearman correlation analysis was used to assess the relationship between serum levels of LCN2, CMKLR1, and CCL11 and the severity of DE in T2DM patients; multivariate Logistic analysis was used to analyze the factors affecting the severity of T2DM patients with DE. The receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic value of serum LCN2, CMKLR1 and CCL11 levels for moderate to severe dry eye in T2DM patients.

RESULTS: Serum levels of LCN2, CMKLR1, and CCL11 increased progressively from the control group to the non-DE group and then to the DE group(all P<0.05). Within the DE group, these levels also increased progressively from the mild to moderate and then to the severe subgroups(all P<0.05). Spearman correlation analysis showed that serum levels of LCN2, CMKLR1, and CCL11 were positively correlated with the severity of disease(r_s=0.604, 0.591, 0.559, respectively; all P<0.05). Stepwise forward multivariate Logistic analysis showed that Schirmer's test(SⅠt), tear break-up time(BUT), serum levels of LCN2, CMKLR1 and CCL11 were the factors affecting the severity of T2DM patients with DE; ROC curve analysis indicated that the combined diagnosis of serum LCN2, CMKLR1, and CCL11 for the progression of T2DM with DE to moderate-to-severe stages had an area under curve(AUC)value of 0.896, which was significantly higher than that of individual diagnoses of LCN2, CMKLR1, and CCL11(Z=2.925, 2.704, 3.483, respectively; P=0.003, 0.007, <0.001).

CONCLUSION: Serum LCN2, CMKLR1 and CCL11 levels are increased in T2DM patients with DE, and are positively correlated with the severity of DE. The combination of the three has a high diagnostic value for moderate to severe DE.