目的：探究非增殖型糖尿病视网膜病变(NPDR)和增殖型糖尿病视网膜病变(PDR)患者角膜生物力学参数及血清瘦素(Leptin)、细胞外超氧化物歧化酶(ecSOD)含量差异性。

方法：前瞻性研究。选择2020-05/ 2022-05我院收治的2型糖尿病(T2DM)合并糖尿病视网膜病变(DR)患者118例，按照病变程度分为NPDR组57例、PDR组61例，另选54例T2DM无视网膜病变患者和52例体检健康人群分别作为NDR组和对照组，所有参与研究者均选左眼入组。比较各组角膜生物力学参数\〖角膜中央厚度(CCT)，眼内压(IOP)，等效球镜度(SE)，第一次压平时间(A1T)，第一次压平长度(A1L)，最大形变幅度(DA)\〗及血清Leptin、ecSOD含量差异，多因素Logistic回归分析影响PDR发生的高危因素。

结果：PDR组、NPDR组患者CCT、IOP、A1T高于对照组和NDR组，DA低于对照组和NDR组(均P<0.05)，且PDR组CCT、IOP、A1T高于NPDR组(均P<0.05)； PDR组、NPDR组、NDR组血清Leptin、ecSOD水平均高于对照组(均P<0.05)； NPDR组和PDR组DM病程、CCT、IOP、A1T及血清Leptin、ecSOD含量有差异(均P<0.05)； 多因素Logistic回归分析显示，DM病程、CCT、IOP、A1T及血清Leptin、ecSOD含量是影响PDR发生的因素，DA是影响PDR发生的保护因素(均P<0.05)。

结论：PDR患者CCT、IOP及血清Leptin、ecSOD含量较NPDR患者明显增加，DA明显降低，且CCT、IOP、A1T、血清Leptin、ecSOD含量是影响PDR发生的高危因素，DA是影响PDR发生的保护因素。

METHODS: This article is a prospective study. A total of 118 patients with type 2 diabetes mellitus(T2DM)and diabetic retinopathy(DR)who were admitted to our hospital from May 2020 to May 2022 were selected, and they were divided into NPDR group(n=57)and PDR group(n=61)according to the degree of lesion. Another 54 patients with T2DM but no retinopathy and 52 healthy individuals were set as NDR group and control group. Then the differences in the corneal biomechanics measured with \〖central corneal thickness(CCT), intraocular pressure(IOP), spherical equivalent(SE), the first applanation time(A1T), the first applanation length(A1L), deformation amplitude(DA)\〗 and serum Leptin and ecSOD levels were analyzed, and multivariate Logistic regression analysis was conducted to analyze the high-risk factors affecting the occurrence of PDR.

RESULTS: The CCT, IOP and A1T in PDR and NPDR groups were higher than those in control and NDR groups, and DA was lower than those in control and NDR groups(all P<0.05), and the CCT, IOP and A1T in the PDR group were higher than those in the NPDR group(all P<0.05). The levels of serum Leptin and ecSOD in PDR group, NPDR group and NDR group were higher than those in the control group(all P<0.05). The course of DM, CCT, IOP, A1T, and serum Leptin and ecSOD levels between NPDR group and PDR group were statistically significant(all P<0.05). Multivariate Logistic regression analysis denoted that DM course, CCT, IOP, A1T, Leptin, and ecSOD are risk factors that affect the occurrence of PDR, while DA is a protective factor that affects the occurrence of PDR(all P<0.05).

CONCLUSION: CCT, IOP and levels of serum Leptin and ecSOD in PDR patients were significantly increased compared to those in the NPDR patients, while DA was significantly reduced. Furthermore, CCT, IOP, A1T and levels of serum Leptin and ecSOD were risk factors affecting the occurrence of PDR, while DA was a protective factor affecting the occurrence of the PDR.