【摘要】 目的 探讨糖尿病性视网膜病变(DR)患者行抗血管内皮生长因子(VEGF)治疗疗效与房水中细胞因子的相关性。方法 纳入2023年7月至2023年12月在新乡医学院第三附属医院眼科行抗VEGF药物治疗的50例56眼DR患者，将患者分为糖尿病性黄斑水肿(DME)组(30例36眼)和增生型DR(PDR)组(20例20眼)。DME组患者每月玻璃体内注射阿柏西普眼内注射溶液1次，连续3次，每次注射前抽取房水；PDR组在行玻璃体切割术前1周玻璃体内注射阿柏西普眼内注射溶液1次，在注射前抽取房水，并在行玻璃体切割术时再次抽取房水。采用Luminex液相芯片检测每次抽取的房水内VEGF-A、胎盘生长因子(PLGF)、白细胞介素(IL)-1β、IL-23、IL-17A及肿瘤坏死因子α(TNF-α)的浓度。注射治疗前，所有患者均行最佳矫正视力(BCVA)和黄斑中心凹厚度(CMT)检测，分析注射治疗前各细胞因子浓度与DR患者BCVA及CMT的相关性。结果 DME组患者注射治疗前后比较，房水中VEGF-A、PLGF及IL-23浓度均降低，差异均有统计学意义(均为P<0.05),此外，患者CMT值降低，BCVA提高，差异均有统计学意义(均为P<0.05)。PDR患者注射治疗后，房水中VEGF、PLGF、IL-1β、IL-23、IL-17A和TNF-α浓度均较注射治疗前降低，差异均有统计学意义(均为P<0.05)。注射治疗前，DME组患者房水中VEGF-A、PLGF及IL-23水平均高于PDR组患者，差异均有统计学意义(均为P<0.05)。相关分析结果显示，注射治疗前，DME组患者中，VEGF与BCVA呈负相关(r=-0.767,P=0.004);VEGF与CMT呈正相关(r=0.662,P=0.019);VEGF与IL-23呈正相关(r=0.765,P=0.004)。PDR组患者注射治疗前各房水细胞因子之间均无相关性(均为P>0.05)。结论 VEGF-A、PLGF、IL-23的浓度变化与DR的发生发展密切相关，抗VEGF治疗可使DME患者BCVA得到改善，CMT下降。房水中IL-23的表达水平可作为DR患者抗VEGF疗效的预测因子，为DR的早诊断、早治疗提供新的靶点。更多还原

【Abstract】 Objective To investigate the relationship between the therapeutic effect of anti-vascular endothelial growth factor(VEGF) and cytokines in aqueous humor in patients with diabetic retinopathy(DR). Methods From July 2023 to December 2023, 50 DR patients(56 eyes) who were treated with anti-VEGF drugs in the Department of Ophthalmology, the Third Affiliated Hospital of Xinxiang Medical University were included in this study. The patients were divided into the diabetic macular edema(DME) group(30 patients, 36 eyes) and the proliferative DR(PDR) group(20 patients, 20 eyes). Patients in the DME group received an intravitreal injection of aflibercept once a month for three consecutive times, with aqueous humor extracted before each injection. Patients in the PDR group received an intravitreal injection of aflibercept one week before vitrectomy, with aqueous humor extracted before injection and during vitrectomy, respectively. The concentrations of vascular endothelial growth factor A(VEGF-A), placental growth factor(PLGF), interleukin(IL)-1β, IL-23, IL-17A, and tumor necrosis factor-α(TNF-α) in the aqueous humor were detected using the Luminex assay. Before injection therapy, all patients underwent best corrected visual acuity(BCVA) and central macular thickness(CMT) examinations, and their correlations with cytokine concentrations in DR patients before injection therapy were analyzed. Results Compared to before injection therapy, the concentrations of VEGF-A, PLGF, and IL-23 in the aqueous humor of patients in the DME group decreased significantly after treatment(all P<0.05); additionally, the CMT decreased, and the BCVA increased(both P<0.05). After injection therapy, the concentrations of VEGF, PLGF, IL-1β, IL-23, IL-17A, and TNF-α in the aqueous humor of patients in the PDR group significantly decreased compared to before injection therapy(all P<0.05). Before injection therapy, the levels of VEGF-A, PLGF, and IL-23 in the aqueous humor of patients in the DME group were higher than those in the PDR group, and the differences were statistically significant(all P<0.05). The correlation analysis results showed that before injection therapy, VEGF was negatively correlated with BCVA(r=-0.767, P=0.004) and was positively correlated with CMT(r=0.662, P=0.019) and IL-23(r=0.765, P=0.004) in the DME group. There was no correlation between the cytokines in the aqueous humor of patients in the PDR group before injection therapy(all P>0.05). Conclusion Changes in the concentration of VEGF-A, PLGF, and IL-23 are closely related to the occurrence and development of DR. Anti-VEGF treatment can improve BCVA and decrease CMT in DME patients. The expression level of IL-23 in aqueous humor can serve as a predictive factor for the anti-VEGF efficacy in DR patients, providing new targets for early diagnosis and treatment of DR.更多还原