目的：检测2型糖尿病(T2DM)患者血清长链非编码RNA(lncRNA)X非活性特异性转录本(XIST)、沉默信息调节因子2相关酶1(SIRT1)表达水平，并探讨其与糖尿病视网膜病变(DR)的相关性及其诊断价值。

方法：前瞻性研究。选取2022-01/2023-02在我院收治T2DM患者214例作为研究对象。根据是否发生视网膜病变，分为非DR组126例126眼，DR组88例88眼。另选取同期体检健康者130例为对照组。检测三组血清lncRNA XIST、SIRT1水平并进行比较。采用Pearson法分析lncRNA XIST和SIRT1表达与DR的关系，受试者工作特征(ROC)曲线评价血清lncRNA XIST、SIRT1单独及联合对DR的预测价值，多因素Logistic回归分析影响T2DM患者发生DR的因素。

结果：与对照组比较，非DR组和DR组血清lncRNA XIST、SIRT1水平依次降低(均P<0.05)； DR患者血清lncRNA XIST和SIRT1水平呈正相关(r=0.639，P<0.05)； ROC分析显示，血清lncRNA XIST、SIRT1联合预测DR的曲线下面积(AUC)为0.940，高于血清lncRNA XIST、SIRT1单独检测的AUC(0.855、0.875)。Logistic回归分析显示，lncRNA XIST(OR=0.752)、SIRT1(OR=0.694)是DR发生的影响因素(均P<0.01)。

结论：DR患者血清lncRNA XIST、SIRT1水平均降低，lncRNA XIST联合SIRT1对DR发生有较好的评估效能。

METHODS: Prospective study. A total of 214 patients with T2DM admitted to our hospital from January 2022 to February 2023 were selected as the research subjects. Based on whether retinopathy occurred, they were divided into 126 cases(126 eyes)in the non-DR group and 88 cases(88 eyes)in the DR group. An additional 130 healthy individuals who underwent a physical examination during the same period were selected as the control group. The serum levels of lncRNA XIST and SIRT1 in the three groups were measured and compared. The relationship between lncRNA XIST and SIRT1 expression with DR was analyzed using Pearson's method. The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of serum lncRNA XIST, SIRT1, and their combination for DR. Multivariate Logistic regression analysis was performed to investigate the factors affecting the occurrence of DR in T2DM patients.

RESULTS: Compared with the control group, the levels of serum lncRNA XIST and SIRT1 in the non-DR group and DR group were successively decreased(all P<0.05). The levels of serum lncRNA XIST and SIRT1 were positively correlated in DR patients(r=0.639, P<0.05). ROC analysis showed that the area under the curve(AUC)for predicting DR by combining serum lncRNA XIST and SIRT1 was 0.940, which was higher than the AUC by serum lncRNA XIST and SIRT1 alone(0.855, 0.875). Logistic regression analysis showed that lncRNA XIST(OR=0.752)and SIRT1(OR=0.694)were influencing factors for the occurrence of DR(both P<0.01).

CONCLUSION: The serum levels of lncRNA XIST and SIRT1 are both lower in DR patients, and the combination of lncRNA XIST and SIRT1 has a better assessment capacity for the occurrence of DR.