目的：探讨不同分期糖尿病视网膜病变(DR)患者血清血小板衍生生长因子A(PDGFA)、血红素氧合酶1(HMOX1)、细胞因子信号抑制因子6(SOCS6)水平变化及其预测预后的价值。

方法：选取淄博一四八医院2023年4月至2024年4月确诊DR患者为研究组，同期选取单纯2型糖尿病(T2DM)患者为对照组。根据DR分期将DR患者分为非增生型DR组(NPDR组)和增生型DR组(PDR组)，根据预后情况分为预后良好组和预后不良组。ELISA法检测血清PDGFA、HMOX1、SOCS6水平，并采用Pearson法分析其与实验室指标之间相关性； 多因素Logistic回归分析影响DR患者预后不良的风险因素； 绘制受试者工作特征曲线(ROC)分析血清PDGFA、HMOX1、SOCS6水平对DR患者预后预测价值。

结果：研究组纳入DR患者128例，其中男67例，女61例，平均年龄50.65±8.57岁； 对照组T2DM患者120例，男63例，女57例，平均年龄50.32±8.65岁； NPDR组74例，男39例，女35例，平均年龄50.42±8.71岁； PDR组54例，男28例，女26例，平均年龄50.96±8.40岁； 预后良好组81例，男43例，女38例，平均年龄50.51±8.62岁； 预后不良组47例，男24例，女23例，平均年龄50.89±8.48岁。相较于对照组，研究组血清PDGFA、HMOX1、SOCS6水平均显著升高(均P<0.05)。PDR组患者血清PDGFA、HMOX1、SOCS6水平均显著高于NPDR组(均P<0.05)。预后不良组患者血清FBG、HbA1c、SOD、MDA、IL-6、TNF-α、PDGFA、HMOX1、SOCS6水平均显著高于预后良好组(均P<0.05)。DR患者血清PDGFA与FBG、HbA1c、IL-6、TNF-α水平均呈正相关(均P<0.05)，HMOX1与FBG、HbA1c、SOD、MDA、IL-6、TNF-α水平均呈正相关(均P<0.05)，SOCS6与FBG、IL-6、TNF-α水平均呈正相关(均P<0.05)。血清PDGFA、HMOX1、SOCS6及HbA1c水平升高是DR患者预后的危险因素(均P<0.05)。血清PDGFA、HMOX1、SOCS6水平单独预测DR患者预后的AUC分别为0.806、0.822、0.826，三者联合预测的AUC为0.912，联合预测优于单独预测(Z_联合-PDGFA=2.183，P=0.029； Z_联合-HMOX1=2.308，P=0.021； Z_联合-SOCS6=2.620，P=0.009)。

结论：血清PDGFA、HMOX1、SOCS6与DR分期及患者预后均明显相关，三者均对DR患者预后具有较高预测效能，具有一定临床价值。

METHODS: Patients diagnosed with DR in Zibo No.148 Hospital from April 2023 to April 2024 were included as the study group, and patients with simple type 2 diabetes mellitus(T2DM)during the same period were included as the control group. DR patients were separated into non proliferative DR group(NPDR group)and proliferative DR group(PDR group)based on DR staging, and into good prognosis group and poor prognosis group based on prognosis. Enzyme-linked immunosorbent assay(ELISA)method was used to detect serum levels of PDGFA, HMOX1, and SOCS6, and Pearson method was performed to analyze their correlation with laboratory indicators. Multivariate logistic regression was used to explore the risk factors affecting poor prognosis in DR patients. Receiver operating characteristic(ROC)curves were plotted to explore the prognostic value of serum PDGFA, HMOX1, and SOCS6 levels for DR patients.

RESULTS: Totally 128 DR patients(67 males and 61 females)with the mean age 50.65±8.57 y were included. The control group consisted of 120 T2DM patients(63 males, 57 females)with the mean age of 50.32±8.65 y. The NPDR group comprised 74 patients(39 males, 35 females)with mean age of 50.42±8.71 y; the PDR group included 54 patients(28 males, 26 females)with the mean age of 50.96±8.40 y; The good prognosis group comprised 81 patients(43 males, 38 females)with the mean age of 50.51±8.62 y; the poor prognosis group included 47 patients(24 males, 23 females)with the mean age of 50.89±8.48 y. Compared with the control group, the study group had significantly higher serum levels of PDGFA, HMOX1, and SOCS6(all P<0.05). The PDR group had significantly higher serum levels of PDGFA, HMOX1, and SOCS6 than the NPDR group(all P<0.05). The poor prognosis group had significantly higher serum levels of FBG, HbA1c, SOD, MDA, IL-6, TNF-α, PDGFA, HMOX1, and SOCS6 than the good prognosis group(all P<0.05). The serum PDGFA of DR patients was positively related to FBG, HbA1c, IL-6, and TNF-α levels(all P<0.05), HMOX1 was positively related to FBG, HbA1c, SOD, MDA, IL-6, and TNF-α levels(all P<0.05), and SOCS6 was positively related to FBG, IL-6, and TNF-α levels(all P<0.05). Elevated levels of serum PDGFA, HMOX1, SOCS6, and HbA1c were risk factors for the prognosis of DR patients(all P<0.05). The AUC values of serum PDGFA, HMOX1, and SOCS6 alone in predicting the prognosis of DR patients were 0.806, 0.822, and 0.826, respectively. The AUC of their joint prediction was 0.912, and the joint prediction was superior to individual prediction(Z _joint-PDGFA=2.183, P=0.029; Z _joint-HMOX1=2.308, P=0.021; Z _joint-SOCS6=2.620, P=0.009).

CONCLUSION: Serum PDGFA, HMOX1, SOCS6 are significantly correlated with DR staging and prognosis, all showing high predictive efficiency for the prognosis of DR patients, with certain clinical value.