目的：探究血清Delta样配体4(DLL4)、补体C1q肿瘤坏死因子相关蛋白5(CTRP5)水平对糖尿病视网膜病变(DR)病情严重程度、视力残疾的预测价值。

方法：选取唐山中心医院2022年1月至2024年1月收治的DR患者作为研究对象，依据患者病情分为增殖型DR组及无增殖型DR组，随访1 a，依据视力残疾情况分为视力残疾组及无视力残疾组。ELISA检测血清DLL4、CTRP5水平； 比较不同病情及不同视力残疾情况患者资料及血清DLL4、CTRP5水平； Pearson法分析血清DLL4、CTRP5水平与糖脂代谢指标的相关性； 多因素Logistic回归分析DR患者视力残疾发生的影响因素； ROC曲线分析血清DLL4、CTRP5水平预测DR患者视力残疾的价值。

结果：本研究纳入DR患者245例； 增殖型DR组95例(年龄51.61±3.44岁，男51例，女44例)，无增殖型DR组150例(年龄51.22±3.11岁，男86例，女64例)； 视力残疾组39例(年龄51.64±3.87岁，男21例，女18例)，无视力残疾组206例(年龄51.32±3.12岁，男116例，女90例)。增殖型DR组患者DR病程，FPG、TG、TC、LDL-C及血清DLL4、CTRP5水平高于无增殖型DR组，HDL-C水平低于无增殖型DR组(均P<0.01)。血清DLL4水平与FPG显著正相关(P<0.001)； 血清CTRP5水平与FPG、TG、TC、LDL-C水平显著正相关，与HDL-C水平显著负相关(均P<0.001)。视力残疾组DR病程及血清DLL4、CTRP5水平高于无视力残疾组(均P<0.001)。DR病程及血清DLL4、CTRP5水平是DR患者发生视力残疾的影响因素(均P<0.001)。血清DLL4、CTRP5水平联合预测DR患者发生视力残疾的价值高于单一指标预测(Z_DLL4-联合=3.018，P_DLL4-联合=0.003； Z_CTRP5-联合=2.784，P_CTRP5-联合=0.005)。

结论：DR患者血清DLL4、CTRP5水平升高，与患者病情密切相关，血清DLL4、CTRP5水平联合检测在预测DR患者发生视力残疾方面的价值较高。

METHODS:Patients with DR admitted to Tangshan Central Hospital between January 2022 and January 2024 were enrolled. Based on disease severity, patients were divided into a proliferative DR group and a non-proliferative DR group. After one year of follow-up, patients were further categorized into a vision disability group and a non-visual disability group based on visual impairment status. Enzyme-linked immunosorbent assay(ELISA)was used to detect serum levels of DLL4 and CTRP5. The data and serum levels of DLL4 and CTRP5 were compared among patients with different medical conditions and visual disabilities. Pearson method was used to explore the correlation between serum levels of DLL4, CTRP5 and glucose and lipid metabolism indicators. Multivariate Logistic regression was performed to explore the influencing factors of visual disability in DR Receiver operating characteristic(ROC)curve was performed to explore the value of serum levels of DLL4 and CTRP5 in predicting visual disability in DR.

RESULTS: This study included 245 DR patients.Ninety-five patients were in the proliferative DR group(mean age 51.61±3.44 y, 51 men and 44 women), and 150 patients were in the non-proliferative DR group(mean age 51.22±3.11 y, 86 men and 64 women). The visually disability group consisted of 39 participants(mean age 51.64±3.87 y; 21 men and 18 women), while the non-visually disability group consisted of 206 participants(mean age 51.32±3.12 y; 116 men and 90 women). Patients in the proliferative DR group exhibited longer DR duration, higher levels of FPG, TG, TC, LDL-C, and serum DLL4 and CTRP5, and lower HDL-C levels compared to the non-proliferative DR group(all P<0.05). The serum levels of DLL4 were positively correlated with FPG(P<0.001), while the serum levels of CTRP5 were prominently positively correlated with FPG, TG, TC, LDL-C, and prominently negatively correlated with HDL-C(all P<0.001). The visual disability group had longer duration of DR and higher serum levels of DLL4 and CTRP5 than the non-visual disability group(all P<0.001). The duration of DR and serum levels of DLL4 and CTRP5 were influencing factors for visual disability in DR patients(all P<0.001). The joint detection of serum levels of DLL4 and CTRP5 had a higher value in predicting visual disability in DR patients than the single indicator prediction(Z_DLL4-joint=3.018, P_DLL4-joint=0.003; Z_CTRP5-joint=2.784, P_CTRP5-joint=0.005).

CONCLUSION: Serum levels of DLL4 and CTRP5 are elevated in DR patients, and are closely related to the disease condition. The joint detection of serum levels of DLL4 and CTRP5 has high value in predicting visual disability in DR patients.