目的：探讨房水基质细胞衍生因子1(SDF-1)、中性粒细胞激活肽-78(ENA78)水平对糖尿病视网膜病变(DR)患者玻璃体切割术后视力残疾的预测价值。

方法：选取2022年3月至2024年3月本院眼科收治的进行玻璃体切割术治疗的DR患者(研究组)，根据术后1 a随访裸眼视力检查结果分为视力残疾组和视力良好组。另纳入同期在本院治疗的白内障患者为对照组。酶联免疫吸附(ELISA)法检测房水SDF-1、ENA78水平，Pearson法分析相关性； 多因素Logistic回归分析影响DR患者术后视力残疾的因素； 相对危险度分析不同房水SDF-1、ENA78水平对DR患者术后视力残疾的影响； 受试者工作特征(ROC)曲线分析房水SDF-1、ENA78水平对DR患者术后视力残疾的预测价值。

结果：研究组纳入156例156眼，男87例，女69例，平均年龄60.65±8.91岁； 对照组纳入91例91眼，男53例，女38例，平均年龄58.72±8.43岁。研究组房水SDF-1、ENA78水平较对照组均升高(P<0.001)； 根据术后1 a随访裸眼视力检查结果将研究组分为视力残疾组(n=49)和视力良好组(n=107)，视力残疾组男28例，女21例，平均年龄63.73±7.41岁； 视力良好组男59例，女48例，平均年龄59.24±8.47岁。视力残疾组年龄以及HbA1c水平均高于视力良好组(均P<0.05)； 与视力良好组相比，视力残疾组房水SDF-1、ENA78水平均显著升高(均P<0.05)； 研究组房水SDF-1、ENA78水平与HbA1c均呈正相关(r=0.314、0.362，均P<0.05)； 房水SDF-1(OR=2.936，95%CI：1.628-5.296)、ENA78(OR=3.092，95%CI：1.738-5.502)水平升高是影响DR患者术后发生视力残疾的危险因素(均P<0.05)； SDF-1、ENA78高水平分别使术后发生视力残疾的风险增加至低水平组的1.958倍与2.030倍； 房水SDF-1、ENA78二者联合预测DR患者术后视力残疾的曲线下面积(AUC)为0.936，联合优于房水SDF-1、ENA78各自单独预测(Z_{二者联合-SDF-1}=2.850、Z_{二者联合-ENA78}=2.445，均P<0.05)。

结论：房水SDF-1、ENA78水平升高是DR患者术后视力残疾的危险因素，SDF-1、ENA78二者联合对预测DR患者术后视力残疾有较高的临床应用价值。

METHODS: Patients with DR who underwent vitrectomy in the ophthalmology department of our hospital from March 2022 to March 2024 were enrolled as study group. According to the results of uncorrected visual acuity examination during the 1-year follow-up after surgery, they were further divided into visual impairment group and good visual acuity group. In addition, patients with cataracts who were treated in our hospital during the same period were recruited as control group. The levels of SDF-1 and ENA78 in aqueous humor were detected by enzyme-linked immunosorbent assay(ELISA). Pearson correlation analysis was used to evaluate the correlation of indicators. Multivariate Logistic regression analysis was performed to identify the influencing factors of postoperative visual impairment in DR patients. Relative risk analysis was conducted to assess the impact of different aqueous humor SDF-1 and ENA78 levels on postoperative visual impairment in DR patients. Receiver operating characteristic(ROC)curve analysis was applied to determine the predictive value of aqueous humor SDF-1 and ENA78 levels for postoperative visual impairment in DR patients.

RESULTS: Totally 156 cases(156 eyes)were enrolled in the study group, including 87 males and 69 females, with a mean age of 60.65±8.91 years old; and 91 cases(91 eyes)were enrolled in the control group, including 53 males and 38 females, with a mean age of 58.72±8.43 years old. The levels of SDF-1 and ENA78 in aqueous humor of the study group were significantly higher than those of the control group(P<0.001). According to the results of uncorrected visual acuity during the 1-year follow-up after surgery, the study group was further divided into the visual impairment group(n=49)and the good visual acuity group(n=107), including 28 males and 21 females in the visual impairment group, with a mean age of 63.73±7.41 years, and 59 males and 48 females in the good visual acuity group, with a mean age of 59.24±8.47 years. The age and glycated hemoglobin(HbA1c)levels of the visual impairment group were higher than those of the good visual acuity group(all P<0.05). Compared with the good visual acuity group, the levels of SDF-1 and ENA78 in aqueous humor of the visual impairment group were significantly elevated(all P<0.05). A positive correlation was found in the study group between the levels of SDF-1, ENA78 in aqueous humor and HbA1c(r=0.314, 0.362, all P<0.05). Elevated levels of aqueous humor SDF-1(OR=2.936, 95% CI: 1.628-5.296)and ENA78(OR=3.092, 95% CI: 1.738-5.502)were identified as risk factors for postoperative visual impairment in DR patients(all P<0.05). High levels of SDF-1 and ENA78 increased the risk of postoperative visual impairment by 1.958-fold and 2.030-fold compared with the low-level groups, respectively; the area under the curve(AUC)of combined detection of aqueous humor SDF-1 and ENA78 for predicting postoperative visual impairment in DR patients was 0.936, which was superior to the predictive value of SDF-1 or ENA78 alone(Z_{combination-SDF-1}=2.850, Z_{combination-ENA78}=2.445, all P<0.05).

CONCLUSION: Elevated levels of aqueous humor SDF-1 and ENA78 are risk factors for postoperative visual impairment in DR patients, and the combined detection of SDF-1 and ENA78 has high clinical application value for predicting postoperative visual impairment in DR patients.