目的：探究血清脱氢表雄酮(DHEA)，促红细胞生成素(Epo)，血管生成抑制蛋白1(VASH-1)水平与2型糖尿病(T2DM)患者糖尿病视网膜病变(DR)的关系。

方法：选取2021年4月至2024年3月于本院治疗的T2DM患者185例185眼，根据是否发生视网膜病变分为T2DM组102例102眼和DR组83例83眼，并将DR患者根据其病变严重程度分期分为非增殖期DR组(NPDR，47例47眼)和增殖期DR组(PDR，36例36眼)。使用全自动生化分析仪检测血清生化指标，使用ELISA法检测血清DHEA、Epo和VASH-1水平，使用Pearson相关性分析血清DHEA、Epo和VASH-1水平与DR病情程度的相关性，使用Logistic回归分析影响DR发生的因素，使用ROC曲线分析血清DHEA、Epo和VASH-1水平对T2DM合并DR以及PDR的诊断价值。

结果：与T2DM组相比，DR组的DM病程、空腹血糖、尿酸、肌酐和Epo显著升高，DHEA和VASH-1水平显著降低(均P<0.05)； 与NPDR组相比，PDR组血清DHEA和VASH-1水平显著降低，Epo水平显著升高(均P<0.05)； 血清DHEA和VASH-1水平与DR病情程度呈负相关，Epo水平与DR病情程度呈正相关(均P<0.05)； DHEA和VASH-1是DR发生的保护因素，Epo是DR发生的危险因素(均P<0.05)； 血清DHEA、Epo、VASH-1水平单独及联合诊断T2DM合并DR的AUC分别为0.804、0.797、0.805和0.903，联合诊断价值高于单独诊断(均P<0.05)； 血清DHEA、Epo和VASH-1水平单独及联合诊断PDR的AUC分别为0.852、0.850、0.841和0.946，联合诊断的价值明显高于单独诊断(均P<0.05)。

结论：DR患者血清DHEA和VASH-1水平相较于T2DM患者明显降低，Epo水平明显升高，且三者水平与DR患者病情程度密切相关，联合检测对T2DM合并DR或PDR的诊断价值更高。

METHODS: Totally 185 T2DM patients(185 eyes)treated in our hospital from April 2021 to March 2024 were selected and divided into T2DM group(102 eyes)and DR group(83 eyes)based on whether retinal lesions occurred. DR patients were divided into nonproliferative DR group(NPDR, 47 cases, 47 eyes)and proliferative DR group(PDR, 36 cases, 36 eyes)based on the severity of their lesions. Fully automatic biochemical analyzer was used to detect serum biochemical indicators. ELISA was applied to detect serum levels of DHEA, Epo, and VASH-1. Pearson correlation was applied to analyze the correlation between serum DHEA, Epo, and VASH-1 levels and the severity of diabetic retinopathy. Logistic regression was applied to analyze the factors affecting the occurrence of DR. ROC curve was applied to analyze the diagnostic value of serum DHEA, Epo, and VASH-1 levels for T2DM combined with DR or PDR.

RESULTS: Compared with the T2DM group, the DR group showed significantly increased DM duration, fasting blood glucose, uric acid, creatinine, and Epo, while DHEA and VASH-1 levels were significantly reduced(all P<0.05); Compared with the NPDR group, the PDR group showed a significant decrease in serum DHEA and VASH-1 levels, and a significant increase in Epo levels(all P<0.05); the levels of serum DHEA and VASH-1 were negatively correlated with the severity of DR, while the level of Epo was positively correlated with the severity of DR(all P<0.05); DHEA and VASH-1 were protective factors against DR, while Epo was a risk factor for DR(all P<0.05); the AUC of serum DHEA, Epo, and VASH-1 levels alone and in combination for the diagnosis of T2DM with DR were 0.804, 0.797, 0.805, and 0.903, respectively. The combined diagnostic value was higher than that of single diagnosis(all P<0.05); the AUC of serum DHEA, Epo, and VASH-1 levels alone and in combination for diagnosing PDR were 0.852, 0.850, 0.841, and 0.946, respectively. The value of combined diagnosis was significantly higher than that of individual diagnosis(all P<0.05).

CONCLUSION:The levels of serum DHEA and VASH-1 in DR patients are clearly reduced, the level of Epo is clearly increased, and their levels are closely related to the severity of DR patients; therefore, combined detection has higher value for T2DM complicated with DR or PDR.