目的：探究房水miR-21、miR-29b水平与原发性开角型青光眼(POAG)患者视神经损伤程度、GMPE参数的关系。

方法：前瞻性选取2023年5月至2025年5月于本院就诊的POAG患者为疾病组，同期白内障患者为对照组，比较两组基线资料和房水miR-21、miR-29b水平。以视野平均缺损(MD)值将POAG患者分为轻度组和中重度组，比较两组临床资料和miR-21、miR-29b水平； 分析miR-21/miR-29b与RNFL厚度、视野MD值、BMO-MRW的相关性及非线性检验； 分析影响患者视神经损伤程度加重的因素。以预后结局将POAG患者分为预后良好组和预后不良组，比较两组房水miR-21、miR-29b水平； ROC法分析GMPE参数联合miR-21、miR-29b对POAG患者预后结局的预测价值，并进行内部验证和DCA曲线分析。

结果：本研究纳入疾病组151例(年龄56.07±7.59岁，男84例，女67例)，对照组138例(年龄56.84±8.25岁，男68例，女70例)。轻度组45例(年龄54.63±7.34岁，男27例，女18例)，中重度组106例(年龄56.68±8.39岁，男57例，女49例)。预后良好组118例(年龄55.83±8.07岁，男67例，女51例)，预后不良组33例(年龄56.94±8.23岁，男17例，女16例)。与对照组比较，疾病组miR-21水平升高，miR-29b水平降低(均P<0.001)。与轻度组比较，中重度组眼压和miR-21水平升高，RNFL厚度、视野MD值、BMO-MRW和miR-29b水平降低(均P<0.01)。miR-21/miR-29b比值与RNFL厚度、视野MD值、BMO-MRW呈负相关(均P<0.05)。眼压、miR-21、RNFL厚度、视野MD值、BMO-MRW、miR-29b是POAG患者视神经损伤的影响因素(均P<0.05)。与预后良好组比较，预后不良组miR-21水平升高，miR-29b、RNFL厚度、BMO-MRW水平降低(均P<0.001)。房水miR-21、miR-29b、RNFL厚度、BMO-MRW水平联合预测POAG患者预后结局的AUC和特异性明显高于四者单独预测(均P<0.05)。ROC预测模型一致性较好，且联合预测模型的临床实用性较高。

结论：POAG患者房水miR-21水平明显升高，miR-29b水平明显降低，与视神经损伤程度、GMPE参数相关。

METHODS:POAG patients who presented to the hospital from May 2023 to May 2025 were prospectively enrolled as the disease group, and patients with cataract treated during the same period were included as the control group. Baseline characteristics and aqueous humor levels of miR-21 and miR-29b were compared between the two groups. POAG patients were categorized into mild and moderate-to-severe groups according to the mean deviation(MD)of visual field. Clinical characteristics and the expression levels of miR-21 and miR-29b in aqueous humor were compared between the two groups. Correlations and nonlinear associations between miR-21/miR-29b levels and RNFL thickness, visual field MD, and BMO-MRW were evaluated. Furthermore, factors influencing the progression of optic nerve damage were analyzed. Based on prognostic outcomes, patients were divided into good prognosis and poor prognosis groups, and the aqueous humor levels of miR-21 and miR-29b were compared. ROC curve analysis was performed to assess the predictive value of combined GMPE with miR-21 and miR-29b for prognosis in POAG patients.Internal validation and decision curve analysis(DCA)were also conducted.

RESULTS:This study included 151 patients in the disease group(age 56.07±7.59 y, 84 males and 67 females)and 138 patients in the control group(age 56.84±8.25 y, 68 males and 70 females). There were 45 cases in the mild group(age 54.63±7.34 y, 27 males and 18 females)and 106 cases in the moderate-severe group(age 56.68±8.39 y, 57 males and 49 females). There were 118 cases in the good prognosis group(age 55.83±8.07 y, 67 males and 51 females)and 33 cases in the poor prognosis group(age 56.94±8.23 y, 17 males and 16 females). Compared with the control group, the disease group exhibited significantly higher miR-21 levels and lower miR-29b levels(all P<0.001). Compared with the mild group, intraocular pressure and miR-21 levels were significantly higher in the moderate-to-severe group, while RNFL thickness, visual field MD, BMO-MRW, and miR-29b levels were significantly lower(all P<0.01). The miR-21/miR-29b ratio was negatively correlated with RNFL thickness, visual field MD, and BMO-MRW(all P<0.05). Elevated intraocular pressure and miR-21 levels, reduced RNFL thickness, lower visual field MD, and decreased BMO-MRW and miR-29b levels were identified as risk factors for aggravated optic nerve damage in POAG patients(all P<0.05). Compared with the good prognosis group, the poor prognosis group showed significantly higher miR-21 levels and lower miR-29b, RNFL, and BMO-MRW levels(all P<0.001). The combined prediction model incorporating aqueous humor miR-21, miR-29b, RNFL, and BMO-MRW yielded significantly higher AUC and specificity for predicting POAG prognosis than individual parameters alone(both P<0.05). The ROC prediction model demonstrated good consistency, and the combined prediction model exhibited high clinical utility.

CONCLUSION: Aqueous humor levels of miR-21 are significantly elevated while miR-29b levels are significantly decreased in POAG patients, and these alterations are closely correlated with the severity of optic nerve damage and GMPE parameters.