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

doi:10.11958/20250186

Abstract

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

CLC Number:

R774.1

Figures/Tables 4

References 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