目的：探究血清中应激诱导蛋白2(SESN2)、Uegf和Bmp1-表皮生长因子结构域包含蛋白-1(SCUBE-1)、长正五聚蛋白3(PTX3)水平与糖尿病性黄斑水肿(DME)患者病情及预后的相关性。

方法：前瞻性研究。纳入2023年1月至2024年10月于我院就诊的DME患者，另选取同期就诊的单纯2型糖尿病(T2DM)患者和体检健康者。采用ELISA法检测血清中SESN2、SCUBE-1、PTX3水平。分析影响DME患者预后不良的因素。

结果：本研究共纳入DME患者114例114眼(单眼患病纳入患眼，双眼患病选取病情较重眼入组，其中男72例，女42例，平均年龄56.94±7.38岁)，T2DM患者114例(男65例，女49例，平均年龄56.18±7.22岁)和体检健康者114例(男77例，女37例，平均年龄56.33±7.26岁)，无失访病例。DME组和T2DM组FPG、HbA1c水平均显著高于健康组(均P<0.05)。健康组、T2DM组、DME组血清中SESN2水平依次降低，SCUBE-1、PTX3水平依次升高(均P<0.05)。根据病情严重程度将DME患者分为轻度组23例(男14例，女9例，平均年龄55.81±7.52岁)、中度组54例(男35例，女19例，平均年龄56.97±7.35岁)和重度组37例(男23例，女14例，平均年龄57.60±7.41岁)。轻度组、中度组、重度组血清中SESN2水平依次降低，SCUBE-1、PTX3、CST水平依次升高(均P<0.05)。血清中SESN2水平与DME严重程度、CST呈负相关，SCUBE-1、PTX3水平与DME严重程度、CST均呈正相关(均P<0.001)。114例DME患者中，预后良好组81例，预后不良组33例。预后不良组血清中SESN2水平低于预后良好组，SCUBE-1、PTX3水平高于预后良好组(均P<0.05)。血清中低水平SESN2、高水平SCUBE-1、高水平PTX3是影响DME患者预后不良的因素(均P<0.05)。血清中SESN2、SCUBE-1、PTX3水平联合预测DME患者预后不良的AUC(0.916)均高于各自单独预测(0.780、0.782、0.783，均P<0.05)。

结论：DME患者血清中SESN2水平降低，SCUBE-1、PTX3水平升高，三者水平变化与患者病情和预后相关，联合检测对患者预后不良具有较高的预测价值。

METHODS:Prospective study. The study included DME patients who were treated at the hospital between January 2023 and October 2024, as well as patients with type 2 diabetes mellitus(T2DM)and healthy individuals who underwent physical examinations during the same period. Serum levels of SESN2, SCUBE-1, and PTX3 were measured using the ELISA method. Factors influencing poor prognosis in DME patients were analyzed.

RESULTS:This study included a total of 114 eye from 114 DME patients, For unilateral disease, the affected eye was enrolled; for bilateral disease, the more severely affected eye was selected for enrollment.(72 men and 42 women, with a mean age of 56.94±7.38 y), 114 T2DM patients(65 men, 49 women, mean age 56.18±7.22 y), and 114 healthy individuals(77 men, 37 women, mean age 56.33±7.26 y). There were no cases of loss to follow-up. FPG and HbA1c levels in the DME and T2DM groups were significantly higher than those in the healthy group(all P<0.05). Serum SESN2 levels decreased progressively from the healthy group to the T2DM group to the DME group, while SCUBE-1 and PTX3 levels increased progressively(all P<0.05). DME patients were classified by disease severity into a mild group of 23 cases(14 men, 9 women, mean age 55.81±7.52 y), a moderate group 54 cases(35 males, 19 females, mean age 56.97±7.35y), and a severe group 37 cases(23 males, 14 females, mean age 57.60±7.41 y). Serum SESN2 levels decreased progressively from the mild to the moderate and to the severe group, while SCUBE-1, PTX3, and CST levels increased progressively(all P<0.05). Serum SESN2 levels were negatively correlated with DME severity and CST, whereas SCUBE-1 and PTX3 levels were positively correlated with both DME severity and CST(all P<0.001). Among the 114 DME patients, 81 were in the favorable prognosis group and 33 were in the unfavorable prognosis group. In the poor prognosis group, serum SESN2 levels were lower than those in the favorable prognosis group, while SCUBE-1 and PTX3 levels were higher(all P<0.05). Low serum SESN2 levels, high SCUBE-1 levels, and high PTX3 levels were factors associated with poor prognosis in DME patients(all P<0.05). The AUC(0.916)for the combined prediction of poor prognosis in DME patients using serum SESN2, SCUBE-1, and PTX3 levels was higher than that for each marker individually(0.780, 0.782, and 0.783, respectively, all P<0.05).

CONCLUSION:Serum SESN2 levels are reduced in DME patients, while SCUBE-1 and PTX3 levels are elevated. Changes in these three markers are associated with disease severity and prognosis, and the combined detection has high predictive value for poor patient outcomes.