血管内皮生长因子与糖尿病黄斑囊样水肿严重程度的相关性

doi:10.11958/20250186

天津医药 ›› 2025, Vol. 53 ›› Issue (9): 927-931.doi: 10.11958/20250186

血管内皮生长因子与糖尿病黄斑囊样水肿严重程度的相关性

解鹏亮¹(), 郑陆芳², 李琰³, 郑艳瑾¹, 白领娣¹^,^△(), 赵霞³, 路迎龙¹

1 唐山市眼科医院玻璃体视网膜外科（邮编063000）
2 唐山市眼科医院眼功能检查科（邮编063000）
3 唐山市眼科医院糖网病科（邮编063000）

收稿日期:2025-01-12 修回日期:2025-06-09 出版日期:2025-09-15 发布日期:2025-09-16
通讯作者: ^△E-mail：bailingdi56@163.com
作者简介:解鹏亮（1987），男，副主任医师，主要从事眼科疾病方面研究。E-mail：xiepengliang58@163.com
基金资助:
河北省医学科学研究课题计划(20231819)

Correlation of vascular endothelial growth factor with the severity of cystoid macular edema in patients with diabetes mellitus

XIE Pengliang¹(), ZHENG Lufang², LI Yan³, ZHENG Yanjin¹, BAI Lingdi¹^,^△(), ZHAO Xia³, LU Yinglong¹

1 Department of Vitreoretinal Surgery, Tangshan Eye Hospital, Tangshan 063000, China
2 Department of Ocular Function Examination, Tangshan Eye Hospital, Tangshan 063000, China
3 Department of Diabetic Retinopathy, Tangshan Eye Hospital, Tangshan 063000, China

Received:2025-01-12 Revised:2025-06-09 Published:2025-09-15 Online:2025-09-16
Contact: ^△E-mail: bailingdi56@163.com

解鹏亮, 郑陆芳, 李琰, 郑艳瑾, 白领娣, 赵霞, 路迎龙. 血管内皮生长因子与糖尿病黄斑囊样水肿严重程度的相关性[J]. 天津医药, 2025, 53(9): 927-931.

XIE Pengliang, ZHENG Lufang, LI Yan, ZHENG Yanjin, BAI Lingdi, ZHAO Xia, LU Yinglong. Correlation of vascular endothelial growth factor with the severity of cystoid macular edema in patients with diabetes mellitus[J]. Tianjin Medical Journal, 2025, 53(9): 927-931.

摘要/Abstract

摘要：

目的探讨血清血管内皮生长因子（VEGF）水平与糖尿病黄斑囊样水肿（CME）严重程度的相关性。方法前瞻性选取2023年6月—2024年6月唐山市眼科医院玻璃体视网膜外科收治的糖尿病CME患者（病例组）及糖尿病无眼部并发症患者（对照组）各57例（57眼），均接受系统的眼科专科检查及血清VEGF检测。采用多因素Logistic回归明确糖尿病CME发病的危险因素，并绘制受试者工作特征（ROC）曲线分析VEGF对糖尿病CME的诊断价值，采用Spearman相关性分析VEGF水平与糖尿病CME患者病情程度相关指标[矫正视力、囊样水肿个数、黄斑中心凹无血管区（FAZ）非圆度指数]的关系。结果与对照组相比，病例组糖尿病病程较长，合并高血压占比较高，糖化血红蛋白（HbA1c）、血肌酐、血清VEGF水平较高，估算的肾小球滤过率（eGFR）较低（P<0.05）。多因素Logistic回归分析结果显示，糖尿病病程长，HbA1c、VEGF水平升高是糖尿病CME发病的危险因素，eGFR水平升高是保护因素（P<0.05）。ROC曲线分析显示，VEGF诊断糖尿病CME的曲线下面积（AUC）为0.758（95%CI：0.669~0.834）。糖尿病病程、HbA1c、eGFR、VEGF联合应用诊断糖尿病CME的AUC为0.916（95%CI：0.877~0.941），较VEGF单独应用时有明显提升（P<0.05）。VEGF水平与糖尿病CME患者矫正视力[0.34（0.24，0.44）]呈负相关（r_s=-0.771），与黄斑囊样水肿检出[3（2，5）个]和FAZ非圆度指数[1.16（1.08，1.20）]呈正相关（r_s分别为0.700和0.788，均P<0.05）。结论血清VEGF水平与CME病情严重程度密切相关，可作为诊断CME发病的可靠参考指标。

关键词: 糖尿病, 黄斑水肿, 血管内皮生长因子类, 严重程度

Abstract:

Objective To investigate the correlation between serum vascular endothelial growth factor (VEGF) level and the development and severity of diabetes mellitus cystoid macular edema (CME). Methods A total of 57 patients (57 eyes) with diabetic CME (the case group) and diabetes without eye complications (the control group) admitted to the Vitreoretinal Surgery Department of Tangshan Eye Hospital from June 2023 to June 2024 were prospectively selected, and all of them underwent systematic ophthalmic specialty examination and serum VEGF detection. Multivariate Logistic regression analysis was used to identify the risk factors of diabetes mellitus CME. The diagnostic value of VEGF in patients with diabetes CME was analyzed by receiver operating characteristic (ROC) curve. Spearman correlation was used to analyze the relationship between VEGF levels and the severity of CME in patients with diabetes, such as corrected visual, number of cystoid edema and non-round index of macular foveal avascular zone (FAZ). Results Compared with the control group, the course of diabetes in the case group was longer, the incidence of hypertension was higher, levels of glycosylated hemoglobin (HbA1c), serum creatinine and serum VEGF were higher, and the estimated glomerular filtration rate (eGFR) was lower (P<0.05). Multivariate Logistic regression results showed that long duration of diabetes, increased levels of HbA1c and VEGF were risk factors for CME in diabetes mellitus patients, while elevated eGFR was protective factor (P<0.05). ROC curve analysis showed that the area under the curve (AUC) of VEGF in diagnosing diabetes mellitus CME was 0.758 (95%CI：0.669-0.834). The AUC of the combined application of diabetes duration, HbA1c, eGFR and VEGF in the diagnosis of diabetes mellitus CME was 0.916 (95%CI：0.877-0.941), which was significantly higher than that of the application of VEGF alone (P<0.05). The VEGF level was negatively correlated with the corrected visual acuity [0.34 (0.24, 0.44)] in patients with diabetic CME, and positively correlated with the detection of cystoid macular edema [3 (2,5)] and FAZ non-roundness index [1.16 (1.08, 1.20)] (r_s were 0.771, 0.700, respectively, P<0.05). Conclusion Serum VEGF levels are closely related to the onset and severity of CME, and which can be used as a reliable reference index for the diagnosis of CME.

Key words: diabetes mellitus, macular edema, vascular endothelial growth factors, severity

中图分类号:

R774.1

图/表 4

参考文献 23

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组别	年龄/岁	性别（男/女）	BMI/（kg/m²）	DM病程/年	心血管病史	合并高血压	应用胰岛素	FBG/（mmol/L）
对照组	53.16±7.44	32/25	22.80±2.35	8.25±2.60	3（5.26）	19（33.33）	22（38.60）	9.50±2.38
病例组	55.60±8.71	30/27	23.16±2.27	11.19±2.84	6（10.53）	33（57.89）	27（47.37）	9.32±2.85
t或χ²	1.608	0.141	0.834	5.775^＊＊	0.483	6.931^＊＊	0.895	0.385
组别	HbA1c/%	血Cr/ （μmol/L）	eGFR/[mL/（min·1.73 m²）]	TC/ （mmol/L）	TG/ （mmol/L）	LDL-C/（mmol/L）	HDL-C/（mmol/L）	VEGF/ （ng/L）
对照组	8.85±1.81	64.60±11.41	98.64±15.25	5.32±1.34	1.95±0.38	3.25±0.89	1.34±0.33	236.90±64.16
病例组	9.54±1.77	70.91±15.26	91.57±12.54	5.01±1.26	2.01±0.42	3.30±0.97	1.24±0.31	378.33±69.98
t或χ²	2.058^＊	2.500^＊	3.048^＊＊	1.314	0.669	0.230	1.643	11.246^＊＊

组别	年龄/岁	性别（男/女）	BMI/（kg/m²）	DM病程/年	心血管病史	合并高血压	应用胰岛素	FBG/（mmol/L）
对照组	53.16±7.44	32/25	22.80±2.35	8.25±2.60	3（5.26）	19（33.33）	22（38.60）	9.50±2.38
病例组	55.60±8.71	30/27	23.16±2.27	11.19±2.84	6（10.53）	33（57.89）	27（47.37）	9.32±2.85
t或χ²	1.608	0.141	0.834	5.775^＊＊	0.483	6.931^＊＊	0.895	0.385
组别	HbA1c/%	血Cr/ （μmol/L）	eGFR/[mL/（min·1.73 m²）]	TC/ （mmol/L）	TG/ （mmol/L）	LDL-C/（mmol/L）	HDL-C/（mmol/L）	VEGF/ （ng/L）
对照组	8.85±1.81	64.60±11.41	98.64±15.25	5.32±1.34	1.95±0.38	3.25±0.89	1.34±0.33	236.90±64.16
病例组	9.54±1.77	70.91±15.26	91.57±12.54	5.01±1.26	2.01±0.42	3.30±0.97	1.24±0.31	378.33±69.98
t或χ²	2.058^＊	2.500^＊	3.048^＊＊	1.314	0.669	0.230	1.643	11.246^＊＊

变量	β	SE	Wald χ²	P	OR	OR 95%CI
糖尿病病程	0.500	0.202	6.127	0.012	1.649	1.110~2.460
HbA1c	0.313	0.106	8.719	0.001	1.368	1.111~1.683
eGFR	-0.874	0.257	11.565	<0.001	0.417	0.252~0.691
VEGF	0.941	0.243	14.996	<0.001	2.563	1.592~4.126
常数项	-7.869	3.637	4.682	0.030	0.000

变量	β	SE	Wald χ²	P	OR	OR 95%CI
糖尿病病程	0.500	0.202	6.127	0.012	1.649	1.110~2.460
HbA1c	0.313	0.106	8.719	0.001	1.368	1.111~1.683
eGFR	-0.874	0.257	11.565	<0.001	0.417	0.252~0.691
VEGF	0.941	0.243	14.996	<0.001	2.563	1.592~4.126
常数项	-7.869	3.637	4.682	0.030	0.000

指标	AUC（95%CI）	阈值	敏感度/ %	特异度/ %	约登指数
DM病程	0.776（0.689~0.849）	8年	85.96	54.39	0.404
HbA1c	0.590（0.494~0.682）	8%	84.21	40.35	0.246
eGFR	0.658（0.563~0.744）	97.1 mL/ （min·1.73 m²）	66.67	61.40	0.281
VEGF	0.758（0.669~0.834）	288.63 ng/L	75.44	71.93	0.474
联合应用	0.916（0.877~0.941）	0.9*	85.96	84.21	0.719

血管内皮生长因子与糖尿病黄斑囊样水肿严重程度的相关性

Correlation of vascular endothelial growth factor with the severity of cystoid macular edema in patients with diabetes mellitus

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