目的：探讨2型糖尿病(DM)患者血清分泌型卷曲蛋白-4(SFRP-4)、壳多糖3样蛋白1(CHI3L1)水平与糖尿病视网膜病变(DR)的相关性。

方法：前瞻性研究。选取2018-10/2023-10本院收治的DR患者103例为DR组，其中DR早期39例，DR中期42例，DR晚期22例； 选取单纯2型糖尿病患者98例为DM组，同期选取健康体检者101例为对照组。收集各组受试者基线资料及临床指标。采用酶联免疫吸附(ELISA)法检测血清SFRP-4、CHI3L1水平。

结果：DR组患者血清SFRP-4、CHI3L1水平及TG、LDL-C、HbA1C、FPG、HOMA-IR均高于DM组和对照组(均P<0.05)； DM组患者血清SFRP-4、CHI3L1水平及TG、LDL-C、HbA1C、FPG、HOMA-IR均高于对照组(均P<0.05)。DR晚期患者病程、TG、LDL-C、HbA1C、FPG、HOMA-IR、SFRP-4、CHI3L1均高于DR中期、DR早期(均P<0.05)。DR患者血清SFRP-4、CHI3L1水平与病程、TG、LDL-C、HbA1C、FPG、HOMA-IR、DR分期均呈正相关(均P<0.05)。血清SFRP-4、CHI3L1及联合诊断DR的曲线下面积(AUC)分别为0.809、0.801、0.898。血清SFRP-4、CHI3L1水平是影响DR发生的危险因素(P<0.05)。

结论：血清SFRP-4、CHI3L1水平与2型糖尿病患者DR关系密切，二者水平升高提示患者发生DR的风险较高。

METHODS: Prospective study. A total of 103 DR patients who admitted to our hospital from October 2018 to October 2023 were selected as DR group, including 39 cases of early DR, 42 cases of mid DR, and 22 cases of late DR; 98 patients with simple type 2 diabetes were selected as DM group, 101 healthy individuals were selected as the control group, and baseline data and clinical indicators were collected. Enzyme linked immunosorbent assay(ELISA)was applied to detect serum levels of SFRP-4 and CHI3L1.

RESULTS: The levels of serum SFRP-4, CHI3L1, triglyceride(TG), low-density lipoprotein cholesterol(LDL-C), glycated hemoglobin(HbA1C), fasting plasma glucose(FPG), homeostasis model assessment of insulin resistance(HOMA-IR)in the DR group were higher than those in the DM group and the control group(all P<0.05); the serum levels of SFRP-4, CHI3L1, TG, LDL-C, HbA1C, FPG, HOMA-IR in the DM group were higher than those of the control group(all P<0.05). The course of disease, TG, LDL-C, HbA1C, FPG, HOMA-IR, SFRP-4, and CHI3L1 of late stage of DR were higher than those in the middle and early stages of DR(all P<0.05). The serum levels of SFRP-4 and CHI3L1 in DR patients were positively correlated with disease course, TG, LDL-C, HbA1C, FPG, HOMA-IR and DR staging(all P<0.05). The area under the curve(AUC)of serum SFRP-4, CHI3L1, and combined diagnostic DR was 0.809, 0.801, and 0.898, respectively. SFRP-4 and CHI3L1 were independent risk factors of DR(P<0.05).

CONCLUSION: The levels of serum SFRP-4 and CHI3L1 are closely related to DR in patients with type 2 diabetes. The higher levels of SFRP-4 and CHI3L1 suggested that patients have a higher risk of DR.