目的：探究糖尿病视网膜病变患者血清三叶因子1(Tff1)、骨形态发生蛋白4(BMP4)的水平变化及二者对糖尿病视网膜病变的诊断价值。

方法：选取2022年1月至2024年1月诊断为2型糖尿病的186例患者为研究组，根据是否发生视网膜病变分为视网膜病变组52例和非视网膜病变组134例； 另选取同期186例健康体检志愿者为对照组。采用酶联免疫吸附(ELISA)法对所有血清样本Tff1、BMP4表达水平进行检测； Pearson分析血清Tff1、BMP4水平与部分临床资料的相关性； 多因素Logistic分析2型糖尿病患者发生视网膜病变的影响因素； 绘制受试者工作特征(ROC)曲线分析血清Tff1、BMP4水平对2型糖尿病患者发生视网膜病变的诊断价值。

结果：与对照组相比，视网膜病变组和非视网膜病变组患者血清Tff1表达水平下降，BMP4表达水平上升(均P<0.05)； 并且视网膜病变组患者血清Tff1表达水平低于非视网膜病变组，BMP4表达水平高于非视网膜病变组(均P<0.05)。Pearson分析结果表明，2型糖尿病患者Tff1表达水平与糖尿病病程、糖化血红蛋白水平、甘油三酯水平呈负相关，BMP4则呈正相关(均P<0.05)。多因素Logistic分析结果表明，糖尿病病程、糖化血红蛋白、甘油三酯、Tff1、BMP4是2型糖尿病患者发生视网膜病变的影响因素(均P<0.05)。ROC曲线结果表明，血清Tff1、BMP4二者联合诊断2型糖尿病患者发生视网膜病变的曲线下面积(AUC)值为0.901，显著大于Tff1(Z=2.069，P=0.039)和BMP4(Z=2.072，P=0.038)单独诊断。

结论：糖尿病视网膜病变患者血清Tff1表达水平下降，BMP4表达水平上升，二者联合对糖尿病视网膜病变具有较高的诊断价值。

METHODS: From January 2022 to January 2024, 186 patients with type 2 diabetes were selected as the study group and divided into a retinopathy subgroup(52 cases)and a non-retinopathy subgroup(134 cases)based on the presence of retinopathy. Another 186 healthy volunteers who underwent physical examinations during the same period were chosen as the control group. Serum Tff1 and BMP4 levels were measured using the enzyme-linked immunosorbent assay(ELISA). Pearson analysis was used to assess the correlation between serum Tff1, BMP4 levels, and clinical data. Multivariate Logistic regression analysis was performed to identify factors influencing the development of retinopathy in type 2 diabetic patients. Receiver operating characteristic(ROC)curve analysis was conducted to evaluate the diagnostic value of serum Tff1 and BMP4 levels for retinopathy in type 2 diabetic patients.

RESULTS: Compared to the control group, serum Tff1 levels were lower and BMP4 levels were higher in both retinopathy and non-retinopathy subgroups(all P<0.05). Specifically, serum Tff1 levels were lower and BMP4 levels were higher in the retinopathy subgroup than in the non-retinopathy subgroup(all P<0.05). Pearson analysis revealed that Tff1 levels in type 2 diabetes patients were negatively correlated with disease duration, glycated hemoglobin levels, and triglyceride levels, while BMP4 levels were positively correlated(all P<0.05). Multivariate Logistic regression analysis identified type 2 diabetes duration, glycated hemoglobin, triglycerides, Tff1, and BMP4 as influencing factors for retinopathy development in type 2 diabetes patients(all P<0.05). ROC curve analysis showed that the combined diagnosis of serum Tff1 and BMP4 had an area under the curve(AUC)of 0.901, which was significantly higher than that of Tff1 alone(Z=2.069, P=0.039)and BMP4 alone(Z=2.072, P=0.038).

CONCLUSION: Serum Tff1 levels are decreased and BMP4 levels are increased in patients with diabetic retinopathy, and the combined detection of these two markers offers high diagnostic value for diabetic retinopathy.