目的：探究血清长正五聚蛋白3(PTX3)、Toll样受体4(TLR4)、基质细胞衍生因子-1(SDF-1)对2型糖尿病(T2DM)合并白内障患者术后并发干眼(DED)的预测价值。

方法：前瞻性研究。选取2024年2月至2025年8月在本院接受超声乳化白内障吸除术以及人工晶状体植入术治疗的T2DM合并白内障患者，根据术后有无并发干眼(DED)分为DED组和N-DED组，并选择同期本院收治的120例单纯白内障患者(白内障组)为对照。酶联免疫吸附法(ELISA)检测血清PTX3、TLR4、SDF-1水平； 多因素Logistic回归分析筛选影响T2DM合并白内障患者术后并发DED的因素； 受试者工作特征(ROC)曲线评估血清PTX3、TLR4、SDF-1对T2DM合并白内障患者术后并发DED的预测价值； Bootstrap重抽取法绘制校准曲线进行内部验证； 决策曲线分析(DCA)曲线评估联合预测模型对T2DM合并白内障患者术后并发DED的临床适用性。

结果：本研究纳入T2DM合并白内障组120例120眼(DED组39例39眼，N-DED组81例81眼)，白内障组120例120眼。T2DM合并白内障组中男63例，女57例，平均年龄58.38±7.11岁。白内障组中男65例，女55例，平均年龄58.62±7.21岁。DED组男21例，女18例，平均年龄58.61±7.25岁。N-DED组男42例，女39例，平均年龄58.27±7.04岁。T2DM合并白内障组血清PTX3、TLR4、SDF-1水平均显著高于白内障组(均P<0.001)； DED组T2DM病程、HbA1c、血清PTX3、TLR4、SDF-1水平均显著高于N-DED组，BUT小于N-DED组(均P<0.001)； 血清PTX3、TLR4、SDF-1水平是影响患者术后并发DED的危险因素(均P<0.05)； 血清PTX3、TLR4、SDF-1水平三者联合预测DED的曲线下面积(AUC)显著高于单独预测(Z=2.394、2.538、2.529，均P<0.05)； 血清PTX3、TLR4、SDF-1联合模型预测T2DM合并白内障患者术后并发DED的校准曲线与理想曲线较为一致； 在高风险阈值0.04-0.85范围内，血清PTX3、TLR4、SDF-1联合模型预测T2DM合并白内障患者术后并发DED的净获益率优于单独预测。

结论：术后并发DED的T2DM合并白内障患者中，血清PTX3、TLR4、SDF-1显著升高，且对患者术后并发DED有一定预测价值。

METHODS:Prospective study.T2DM patients with cataract who underwent phacoemulsification combined with intraocular lens implantation in the hospital from February 2024 to August 2025 were enrolled. Patients were divided into the DED group and the non-DED(N-DED)group according to the occurrence of postoperative DED. Meanwhile, another patients with simple cataract admitted during the same period were selected as the control group(cataract group). The levels of serum PTX3, TLR4, and SDF-1 were measured by enzyme-linked immunosorbent assay(ELISA). Multivariate Logistic regression analysis was performed to screen the factors influencing the occurrence of postoperative DED in patients with T2DM complicated with cataract. Receiver operating characteristic(ROC)curves were used to evaluate the predictive value of serum PTX3, TLR4, and SDF-1 for postoperative DED in these patients. Internal validation was performed by generating a calibration curve using the bootstrap resampling method. Decision curve analysis(DCA)was used to evaluate the clinical applicability of the combined prediction model for postoperative DED in these patients.

RESULTS: This study included 120 patients in the T2DM with cataract group(39 cases in the DED group and 81 cases in the N-DED group)and 120 patients in the cataract group. In the T2DM with cataract group, there were 63 males and 57 females, with a mean age of 58.38±7.11 y; in the cataract group, there were 65 males and 55 females, with a mean age of 58.62±7.21 y; in the DED group, there were 21 males and 18 females, with a mean age of 58.61±7.25 y; and in the N-DED group, there were 42 males and 39 females, with a mean age of 58.27±7.04 y. The serum levels of PTX3, TLR4, and SDF-1 in the T2DM combined with cataract group were significantly higher than those in the simple cataract group(all P<0.001). Meanwhile, the duration of T2DM, HbA1c, and serum levels of PTX3, TLR4, SDF-1 in the DED group were markedly elevated compared with the N-DED group, and the BUT was shorter than that in the N-DED group(all P<0.001). Serum levels of PTX3, TLR4, and SDF-1 were identified as risk factors for postoperative DED in patients(all P<0.05). The area under the curve(AUC)of combination of serum PTX3, TLR4, and SDF-1 levels in predicting DED was significantly higher than that of individual predictions(Z=2.394, 2.538, 2.529, all P<0.05). The calibration curve of the combined model of serum PTX3, TLR4, and SDF-1 for predicting postoperative DED in T2DM patients with cataract showed good agreement with the ideal curve. Within the high-risk threshold range of 0.04 to 0.85, the combined model of serum PTX3, TLR4, and SDF-1 in predicting the net benefit rate of postoperative DED in these patients was superior to the individual prediction.

CONCLUSION:In T2DM patients with cataract who develop postoperative DED, serum PTX3, TLR4, and SDF-1 levels are significantly elevated and demonstrate certain predictive value for postoperative DED.