Abstract:AIM: To investigate the expression levels of follistatin-like protein 1(FSTL1)and a disintegrin and metalloproteinase with thrombospondin type 1 motif 13(ADAMTS13)in the serum of patients with proliferative diabetic retinopathy(PDR), and to analyze their predictive value for visual disability.
METHODS:A prospective study. From January 2022 to September 2024, patients with diabetes retinopathy(DR)were selected from Fengfeng General Hospital of North China Medical and Health Group. They were divided into non-proliferative diabetes retinopathy(NPDR)group and PDR group. In the same period, simple type 2 diabetes(T2DM)patients were selected as T2DM group, and healthy people were selected as control group. Enzyme linked immunosorbent assay was used to detect serum levels of FSTL1 and ADAMTS13. Patients in the PDR group were followed up for 12 mo to observe the occurrence of visual disability, and were accordingly divided into a non-visual disability group and a visual disability group. Risk factors for visual disability in PDR patients were analyzed by Logistic regression, and the predictive value was assessed via receiver operating characteristic(ROC)curves and decision curve analysis(DCA).
RESULTS: This study included 220 DR patients, including 119 cases in the NPDR group and 101 cases in the PDR group. There were 120 cases in the T2DM group and 120 cases in the control group. The control group had an age of 56.92±8.15 y, with 66 males and 54 females. The T2DM group had an age of 57.21±8.30 y, with 63 males and 57 females. The NPDR group had an age of 57.36±8.25 y, with 60 males and 59 females. The PDR group had an age of 57.45±8.22 y, with 53 males and 48 females. There were 68 patients without visual disability and 33 patients with visual disability in the PDR group. The non-visual disability group had a mean age of 57.26±8.14 y, including 35 males and 33 females. The visual disability group had a mean age of 57.85±8.37 y, including 18 males and 15 females. Diabetes duration was progressively longer in the T2DM, NPDR, and PDR groups. Levels of fasting plasma glucose(FPG), glycated hemoglobin(HbA1c), and FSTL1 progressively increased, while ADAMTS13 levels progressively decreased across the control, T2DM, NPDR, and PDR groups(all P<0.001). Within the PDR group, serum FSTL1 levels increased sequentially while ADAMTS13 levels decreased sequentially in patients with grade Ⅳ, Ⅴ and Ⅵ lesions(all P<0.001). The visual disability group had significantly longer diabetes duration and higher levels of FPG, HbA1c, and FSTL1, as well as lower ADAMTS13 levels, compared to the non-visual disability group(all P<0.001). The diabetes duration, FSTL1, ADAMTS13 were the influencing factors of visual disability in PDR patients(all P<0.001). ROC curve and DCA curve analysis showed that the predictive value of combined detection of serum FSTL1 and ADAMTS13 levels is higher than that of individual measurement(all P<0.05).
CONCLUSION:PDR patients have higher serum FSTL1 levels and lower ADAMTS13 levels. Both are related to the severity of PDR. The combined measurement has a high predictive value for visual disability in PDR patients.
