目的：探讨房水中白细胞介素-6(IL-6)、IL-2水平与原发性开角型青光眼(POAG)患者视神经损伤严重程度的关系，并构建POAG患者视神经损伤严重程度的决策树模型。

方法：前瞻性研究，选取2021-05/2023-10医院收治的107例107眼POAG患者进行研究，根据患者平均缺损值(MD)判断视神经损伤程度并分为轻度、中度、重度三组。比较不同严重程度视神经损伤患者一般资料，房水中IL-6、IL-2水平。分析房水中IL-6、IL-2水平与POAG患者视神经损伤严重程度的相关性，采用多因素Logistic回归分析检验POAG患者视神经损伤严重程度的影响因素，基于影响因素构建决策树模型。

结果：重度组患者中合并高血压占比、患眼眼压、双眼眼压差均高于轻度、中度组，房水中IL-6、IL-2水平显著低于轻度、中度组(均P<0.05)。POAG患者房水中IL-6、IL-2水平与视神经损伤严重程度呈负相关(r=-0.361、-0.358，均P<0.001)。合并高血压、眼压、双眼眼压差、房水中IL-6、IL-2水平是POAG患者视神经损伤严重程度的影响因素(均P<0.05)。基于上述影响因素构建决策树模型，共筛选出房水中IL-6、IL-2水平和合并高血压3个解释变量，其中房水中IL-2水平是最重要的根节点变量，也是最为重要的预测因子。该决策树模型的AUC为0.710(95%CI：0.599-0.820，P=0.001)，敏感性为0.581、特异性为0.737，约登指数为0.318，预测价值高。

结论：房水中IL-6、IL-2水平与POAG患者视神经损伤严重程度具有显著相关性，基于合并高血压、眼压、双眼眼压差、房水中IL-6、IL-2水平构建的决策树模型对POAG患者视神经损伤程度具有较高的评估价值。

METHODS: A prospective study was conducted on 107 patients(107 eyes)with POAG who were admitted to the hospital from May 2021 to October 2023. According to the mean defect(MD)value, the degree of optic nerve injury was judged and divided into three groups: mild, moderate and severe. The general data, IL-6 and IL-2 levels in aqueous humor of patients with different severity of optic nerve injury were compared, and the correlation between the levels of IL-6 and IL-2 in aqueous humor and the severity of optic nerve injury in POAG patients was analyzed. Multivariate Logistic regression analysis was used to test the influencing factors of the severity of optic nerve injury in POAG patients, and the decision tree model was constructed based on influencing factors.

RESULTS: The proportion of patients with hypertension, intraocular pressure and binocular intraocular pressure difference in the severe group was higher than that in the mild and moderate groups, and the levels of IL-6 and IL-2 in the aqueous humor were significantly lower than those in the mild and moderate groups(all P<0.05). The levels of IL-6 and IL-2 in aqueous humor of POAG patients were negatively correlated with the severity of optic nerve injury(r=-0.361, -0.358, all P<0.001). Hypertension, intraocular pressure, binocular intraocular pressure difference, IL-6 and IL-2 levels in aqueous humor were independent factors affecting the degree of optic nerve injury in POAG patients(all P<0.05). Based on the above factors, a decision tree model was constructed, and three explanatory variables of IL-6, IL-2 levels in aqueous humor and hypertension were screened out. Among them, IL-2 level in aqueous humor was the most important root node variable and the most important predictor. The AUC of the decision tree model was 0.710(95% CI: 0.599-0.820, P=0.001), the sensitivity was 0.581, the specificity was 0.737, and the Youden index was 0.318, with a high predictive value.

CONCLUSION: The levels of IL-6 and IL-2 in aqueous humor were significantly correlated with the severity of optic nerve injury in POAG patients. The decision tree model based on hypertension, intraocular pressure, binocular intraocular pressure difference, IL-6 and IL-2 levels in aqueous humor has a high evaluation value for the severity of optic nerve injury in POAG patients.