摘要
目的 评价房水中瘦素对糖尿病性白内障(DC)患者术后黄斑水肿(ME)发生的影响.方法 前瞻性队列研究.选取咸阳市第一人民医院 2021 年 3 月至 2023 年 3 月接受超声乳化人工晶状体植入术治疗的 122 例DC患者为研究对象,研究期间剔除、脱落 3 例,最终 119 例完成研究.119例患者在超声乳化人工晶状体植入术前房穿刺后,采集患眼房水检测瘦素表达情况,根据其术前房水中瘦素表达中位值分组,另根据患者术后随访期间ME发生情况再次分为ME组与无ME组;比较不同瘦素表达组、ME组与无ME组一般资料及实验室指标;重点分析房水中瘦素表达对DC患者术后ME的影响.结果 以119 例患者房水中瘦素中位值(155.81 ng/L)作为分界点分组,将60 例纳入瘦素≥155.81 ng/L组,将 59 例纳入瘦素<155.81 ng/L 组.瘦素≥155.81 ng/L 组术前空腹血糖[(6.00±1.22)mmol/L]、糖化血红蛋白[(7.99±0.99)%]、血管内皮生长因子[(277.67±16.38)pg/mL]水平高于瘦素<155.81 ng/L组[(5.53±1.08)mmol/L、(7.46±1.18)%、(271.08±14.53)pg/mL],差异均有统计学意义(t=2.23、2.67、2.32,P=0.028、0.009、0.022);所有患者术后随访 3 个月ME发生率为29.41%(35/119);瘦素≥155.81 ng/L组ME发生率(50.00%,30/60)高于瘦素<155.81 ng/L组(8.47%,5/59),差异有统计学意义(χ2=24.71,P<0.001);ME组术前空腹血糖[(6.18±1.21)mmol/L]、糖化血红蛋白[(8.21±1.10)%]、瘦素[(166.18±8.41)ng/L]、血管内皮生长因子[(284.31±12.27)pg/mL]水平均高于无ME组[(5.59±1.11)mmol/L、(7.53±1.06)%、(153.35±8.12)ng/L、(270.28±15.29)pg/mL],差异有统计学意义(t=2.53、3.19、7.77、4.82,P=0.013、0.002、<0.001、<0.001);logistic回归分析发现,房水中瘦素、血管内皮生长因子可能是DC患者术后ME发生的影响因素(OR=1.19、1.06,P<0.001、P=0.008);限制性立方样条法结果显示,DC患者术后ME发生风险与房水中瘦素表达呈线性剂量反应关系(P<0.05).结论 DC患者房水中瘦素表达升高会增加其术后 ME 发生风险.
Abstract
Objective To evaluate the efficacy of leptin in aqueous humor on postoperative macular edema(ME)in patients with diabetic cataract(DC).Methods This was a prospective cohort study.A total of 122 DC patients who underwent phacoemulsification and intraocular lens implantation in the First People's Hospital of Xianyang City from Mar.2021 to Mar.2023 were selected as the research subjects.During the research period,3 cases were excluded or dropped out,and finally 119 cases completed the study.A total of 119 patients underwent anterior chamber puncture after phacoemulsification and intraocular lens implantation surgery,and their aqueous humor was collected to detect leptin expression.Groups were given based on the median value of leptin expression in aqueous humor before surgery,and the patients were then divided into an ME group and a non-ME group with reference to the occurrence of ME during postoperative follow-up.The general data and laboratory indexes of the different leptin expression groups,the ME group and the non-ME group were compared.The influence of leptin expression in aqueous humor on postoperative ME in DC patients was analyzed.Results A total of 119 patients were divided into two groups based on the median value of leptin in aqueous humor(155.81 ng/L).Sixty patients were included in the leptin≥155.81 ng/L group,and 59 patients were included in the leptin<155.81 ng/L group.The preoperative fasting blood glucose[(6.00±1.22)mmol/L],glycated hemoglobin[(7.99±0.99)%],and vascular endothelial growth factor[(277.67±16.38)pg/mL]levels in the leptin≥155.81 ng/L group were higher than those in the leptin<155.81 ng/L group[(5.53±1.08)mmol/L,(7.46±1.18)%,(271.08±14.53)pg/mL],with a statistical significant difference(t=2.23,2.67,2.32;P=0.028,0.009,0.022).The incidence of ME among all patients followed up for 3 months after surgery was 29.41%(35/119).The incidence of ME in the leptin≥155.81 ng/L group(50.00%,30/60)was higher than that in the leptin<155.81 ng/L group(8.47%,5/59),and the difference was statistically significant(χ2=24.71,P<0.001).The preoperative fasting blood glucose[(6.18±1.21)mmol/L],glycated hemoglobin[(8.21±1.10)%],leptin[(166.18±8.41)ng/L],and vascular endothelial growth factor[(284.31±12.27)pg/mL]levels in the ME group were higher than those in the non-ME group[(5.59±1.11)mmol/L,(7.53±1.06)%,(153.35±8.12)ng/L,(270.28±15.29)pg/mL],with a statistical significant difference(t=2.53,3.19,7.77,4.82;P=0.013,0.002,<0.001,<0.001).Logistic regression analysis found that leptin and vascular endothelial growth factor in aqueous humor might be the influencing factors for postoperative ME in DC patients(OR=1.19,1.06;P<0.001,P=0.008).The results of the restricted cubic spline method showed that there was a linear dose-response relationship between the risk of postoperative ME in DC patients and the expression of leptin in aqueous humor(P<0.05).Conclusion The increased expression of leptin in aqueous humor of DC patients will increase the risk of postoperative ME.
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