目的：探究泪液分泌型卷曲相关蛋白5(SFRP-5)、缺氧诱导因子-1α(HIF-1α)、干扰素调节因子4(IRF4)对年龄相关性白内障患者术后干眼的预测价值。

方法：前瞻性选取本院2024年1月至2024年12月收治的年龄相关性白内障患者的212例(研究组)，根据术后是否发生干眼分为干眼组96例和无干眼组116例，另选同期健康体检者110例(对照组)。Pearson和Spearman法分析干眼组泪液SFRP-5、HIF-1α、IRF4水平和有角结膜疾病史、BUT和FL的相关性； Logistic回归分析术后干眼的因素； 相对危险度分析泪液SFRP-5、HIF-1α、IRF4不同水平对术后干眼的影响； ROC曲线分析术后干眼预测价值。

结果：研究组和对照组一般资料具有可比性，研究组泪液SFRP-5表达较对照组低，泪液HIF-1α、IRF4表达较对照组高(均P<0.05)。干眼组有角结膜疾病史的比例较无干眼组高(P<0.05)。干眼组泪液SFRP-5表达较无干眼组低，泪液HIF-1α、IRF4表达较无干眼组高(均P<0.05)。根据Pearson相关性分析得知，泪液SFRP-5、HIF-1α、IRF4与BUT和FL存在相关性(均P<0.05)。SFRP-5为术后干眼的保护因素，HIF-1α、IRF4、有角结膜疾病史为危险因素(均P<0.05)。低表达SFRP-5的患者术后发生干眼的风险为高表达SFRP-5患者的1.678倍，高表达HIF-1α患者术后干眼风险为低表达HIF-1α患者的1.536倍，高表达IRF患者术后干眼风险为低表达IRF患者的1.616倍。泪液SFRP-5、HIF-1α、IRF4单独及联合预测术后发生干眼的AUC分别为0.772、0.699、0.724、0.872，联合优于各自单独预测(均P<0.05)。

结论：年龄相关性白内障患者泪液SFRP-5表达下调，HIF-1α、IRF4表达上调，且与术后发生干眼有关，联合检测可提高对术后干眼的预测价值。

METHODS: A total of 212 patients with age-related cataracts admitted to our hospital from January 2024 to December 2024 were prospectively selected(study group). According to whether postoperative dry eye occurred, they were divided into a dry eye group(96 cases)and a non-dry eye group(116 cases). Additionally, 110 individuals who underwent health check-ups during the same period were selected as the control group. The correlation between tear fluid levels of SFRP-5, HIF-1α, and IRF4 and the history of keratoconjunctival disease, tear film break-up time(BUT), and fluorescein(FL)in dry eye syndrome patients was analyzed through Pearson and Spearman methods. Logistic regression analysis was used to identify factors for postoperative dry eye; relative risk analysis was conducted to assess the impact of different levels of tear SFRP-5, HIF-1α, and IRF4 on postoperative dry eye; ROC curve analysis was performed to evaluate the predictive value for postoperative dry eye.

RESULTS: The general data of the study group and the control group were comparable. The study group showed lower expression of SFRP-5 in tears and higher expression of HIF-1α and IRF4 in tears compared to the control group(all P<0.05). The proportion of patients with a history of corneal and conjunctival disease was higher in the dry eye group than in the non-dry eye group(P<0.05). Tear SFRP-5 expression was lower and tear HIF-1α and IRF4 expression was higher in the dry eye group compared to the non-dry eye group(all P<0.05). According to Pearson correlation analysis, tear SFRP-5, HIF-1α, and IRF4 correlated with BUT and FL(all P<0.05). SFRP-5 was a protective factor for postoperative dry eye, while HIF-1α, IRF4, and a history of corneal and conjunctival disease were risk factors(all P<0.05). The risk of postoperative dry eye in patients with low expression of SFRP-5 was 1.678 times that of patients with high expression of SFRP-5, the risk of postoperative dry eye in patients with high expression of HIF-1α was 1.536 times that of patients with low expression of HIF-1α, and the risk of postoperative dry eye in patients with high expression of IRF4 was 1.616 times that of patients with low expression of IRF4. The AUCs for predicting postoperative dry eye using tear SFRP-5, HIF-1α, and IRF4 individually and in combination were 0.772, 0.699, 0.724, and 0.872, respectively, with combined prediction outperforming individual markers(all P<0.05).

CONCLUSION: In patients with age-related cataracts, tear SFRP-5 expression is downregulated, while HIF-1α and IRF4 expression are upregulated, and this is associated with the development of dry eye after surgery. Combined detection can improve the predictive value for postoperative dry eye.