目的：探讨2型糖尿病(T2DM)非增殖期糖尿病视网膜病变(NPDR)患者血脂异常与黄斑区硬性渗出(HEs)的相关性。

方法：选取2021年1月至2023年12月于我院眼科门诊就诊的NPDR患者，根据HEs的严重程度将其分为三组：A组(无或少量HEs)、B组(明确HEs)和C组(显著HEs)。常规检测总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、脂蛋白(a)\〖Lp(a)\〗及其他血脂相关指标水平，并分析上述指标与HEs的相关性。

结果：A组(24眼)男9例，女15例，平均年龄54.71±6.15岁； B组(52眼)男20例，女32例，平均年龄55.08±6.27岁； C组(14眼)男9例，女5例，平均年龄53.93±6.08岁。C组TC、TG、LDL-C及Lp(a)水平最高，B组次之，A组最低，组间差异均有统计学意义(P<0.001)。三组间空腹血糖(FPG)、糖化血红蛋白(HbA1c)、血肌酐(Cr)及HDL-C水平差异均无统计学意义(P>0.05)。多因素Logistic回归分析显示TC、TG、LDL-C及Lp(a)水平升高与黄斑HEs的发生相关。受试者工作特征(ROC)曲线分析显示，TC、TG、LDL-C、Lp(a)单项及联合检测预测NPDR患者黄斑HEs的曲线下面积(AUC)分别为0.785、0.718、0.784、0.742和0.911，联合模型的预测效能最高。

结论：血脂异常与T2DM合并NPDR患者黄斑区HEs的发生及进展密切相关。TC、TG、LDL-C及Lp(a)水平与HEs严重程度相关，提示血脂异常可能参与了黄斑HEs形成的病理过程。

METHODS: NPDR patients attending the outpatient ophthalmology clinic from January 2021 to December 2023 were selected and divided into three groups according to the severity of macular HEs. Group A: None or minimal HEs; Group B: Definite HEs; Group C: Prominent HEs. Total cholesterol(TC), triglycerides(TG), low-density lipoprotein cholesterol(LDL-C), high-density lipoprotein cholesterol(HDL-C), lipoprotein(a)\〖Lp(a)\〗 levels and other lipid-related indicators were routinely measured. The correlation between these indicators and HEs was analyzed.

RESULTS:Group A(24 eyes)consisted of 9 males and 15 females with the mean age of 54.71±6.15 y, group B(52 eyes)consisted of 20 males and 32 females with the mean age of 55.08±6.27 y, group C(14 eyes)consisted of 9 males and 5 females with the mean age of 53.93±6.08 y. The concentration of TC, TG, LDL-C and Lp(a)was highest in group C, followed by group B and lowest in group A with statistically significant differences(P<0.001). There were no statistically significant differences between the three groups for fasting plasma glucose(FPG), glycated hemoglobin A1c(HbA1c), creatinine(Cr), and HDL-C(P>0.05). The results of multivariate Logistic regression analysis showed that elevated levels of TC, TG, LDL-C, and Lp(a)were associated with the presence of macular HEs. Receiver operating characteristiccurve analysis showed that the area under the curve(AUC)for TC, TG, LDL-C, Lp(a), and their combination in predicting macular HEs in NPDR were 0.785, 0.718, 0.784, 0.742, and 0.911, respectively, with the combined model demonstrating the highest predictive performance.

CONCLUSION: Dyslipidemia is closely associated with the development and progression of macular HEs in patients with NPDR and T2DM. The levels of TC, TG, LDL-C, and Lp(a)were correlated with the severity of macular HEs, suggesting that dyslipidemia may be involved in the pathological process of macular HEs formation.