方法：选取2014-04/2016-04收治的糖尿病视网膜病变患者150眼，根据荧光素眼底血管造影分为无视网膜病变组(50眼)，非增殖期视网膜病变(NPDR)组(50眼)和增殖期视网膜病变(PDR)组(50眼)，同时选取健康志愿者50眼作为对照组。分析对比四组之间NO、ET-1、ICAM-1和VEGF指标水平情况。

结果：ET-1、NO、VEGF、ICAM-1在PDR组数值最高，其次是NDR组、NPDR组，最后为对照组，经统计学分析，有显著性统计学差异(均P<0.01)； VEGF灵敏度和特异度均最高(0.97和0.80)，阳性/阴性预测值分别为0.89/0.94，阳性似然比/阴性似然比分别为4.83/0.04，Youden指数为0.76，ROC曲线面积0.83(P<0.01)，阈值237.82pg/mL； 其次是ET-1灵敏度和特异度(0.93和0.80)，阳性/阴性预测值分别为0.93/0.80，阳性似然比/阴性似然比分别为4.65/0.09，Youden指数为0.73，ROC曲线面积0.74(P<0.01)，阈值13.45ng/L； NO灵敏度和特异度(0.86和0.40)，阳性/阴性预测值分别为0.81/0.50，阳性似然比/阴性似然比分别为1.45/0.33，Youden指数为0.27，ROC曲线面积0.68(P <0.01)，阈值59.42μmol/L； ICAM-1灵敏度和特异度(0.87和0.36)，阳性/阴性预测值分别为0.80/0.47，阳性似然比/阴性似然比分别为1.35/0.23，Youden指数为0.23，ROC曲线面积0.64(P<0.01)，阈值250.23μg/L。

结论：DR早期阶段血管内皮功能已经开始变化，其中VEGF和ET-1对DR早期诊断具有重要的参考价值。

METHODS: Totally 150 patients with diabetic retinopathy from April 2014 to April 2016 were selected, divided into non-retinopathy group(50 cases)and non-proliferative retinopathy group(50 cases)and the proliferative retinopathy group(50 cases), accordinged to the fluorescein fundus angiography, and 50 healthy volunteers as control group. Four kinds of endothelial function indicators, NO, ET-1, ICAM -1 and VEGF levels, were compared among the four groups.

RESULTS: In PDR group, the levels of the four indicators were highest, then in NDR group, NPDR group, those in the control group was the lowest(all P<0.01). Sensitivity and specificity of VEGF were the best(0.97 and 0.80), the positive/negative predictive value were 0.89/0.94, positive likelihood ratio and negative likelihood ratio were 4.83/0.04, Youden index was 0.76, the ROC curve area was 0.83(P<0.01), the threshold was 237.82 pg/mL. Sensitivity and specificity of ET-1 were the second(0.93 and 0.80), the positive/negative predictive value were 0.93/0.80, positive likelihood ratio and negative likelihood ratio were 4.65/0.09 respectively, Youden index was 0.73, the ROC curve area was 0.74(P<0.01), the threshold was 13.45ng/L. Sensitivity and specificity of NO were 0.86 and 0.40, the positive/negative predictive value were 0.81/0.50, positive likelihood ratio and negative likelihood ratio were 1.45/0.33 respectively, Youden index was 0.27, the ROC curve area was 0.68(P<0.01), the threshold was 59.42μmol/L. Sensitivity and specific of ICAM-1 were 0.87 and 0.36, the positive/negative predictive value were 0.80/0.47, positive likelihood ratio and negative likelihood ratio were 1.35/0.23 respectively, Youden index was 0.23, the ROC curve area was 0.64(P<0.01), the threshold was 250.23μg/L.

CONCLUSION: At early stages of DR, vascular endothelial function has begun to change, in which VEGF and ET-1 has an important reference value for the early diagnosis of DR.