目的：探讨分析糖尿病(DM)新生血管性青光眼(NVG)患者血清烟酰胺腺嘌呤二核苷酸磷酸氧化酶4(NOX4)、基质金属蛋白酶(MMP)-2表达及其临床意义。

方法：选取2020年6月至2023年6月邯郸市眼科医院(邯郸市第三医院)收治的161例DM并发NVG患者纳入研究组进行前瞻性研究； 根据研究组患者小梁切除术术后1 a是否出现并发症，将研究组患者分为预后良好组(n=90)和预后不良组(n=71)。同期选择本院虹膜无新生血管的慢性闭角型青光眼患者161例为对照组。ELISA法检测血清NOX4、MMP-2表达水平； 绘制ROC曲线评估NOX4、MMP-2对DM并发NVG的诊断价值及术后并发症预测价值； 采用Pearson法分析NOX4、MMP-2与血管内皮生长因子(VEGF)、白细胞介素-6(IL-6)的相关性； 采用多因素Logistic分析研究组患者出现术后并发症的影响因素。

结果：研究组和对照组患者一般资料具有可比性。与对照组相比，研究组患者血清NOX4、MMP-2、VEGF、IL-6的表达水平显著性升高(P<0.001)。经Pearson法分析，血清NOX4、MMP-2水平与VEGF、IL-6水平呈显著正相关(P<0.001)。经ROC曲线分析，NOX4、MMP-2二者联合诊断DM并发NVG患者的AUC优于NOX4(Z=3.341，P<0.05)、MMP-2(Z=2.788，P<0.05)分别诊断DM并发NVG患者的AUC。预后不良组患者的DM病程、眼压>21 mmHg人数占比、以及NOX4、MMP-2、VEGF、IL-6表达水平均高于预后良好组(P<0.001)。DM病程、眼压>21 mmHg、NOX4、MMP-2、VEGF、IL-6水平均为DM并发NVG患者预后不良的危险因素(P<0.001)。经ROC曲线分析，NOX4、MMP-2二者联合预测DM并发NVG患者出现术后并发症的AUC优于NOX4(Z=3.727，P<0.05)、MMP-2(Z=2.219，P<0.05)分别预测的AUC。

结论：NOX4、MMP-2在DM并发NVG患者血清中上调表达，二者联合检测对DM并发NVG患者早期诊断及预后具有较大的临床价值。

METHODS: A prospective study was conducted on 161 patients with DM complicated with NVG admitted to Handan City Eye Hospital(The Third Hospital of Handan)from June 2020 to June 2023. Based on whether complications occurred 1 a after trabeculectomy in the study group patients, they were divided into a group with good prognosis(n=90)and a group with poor prognosis(n=71). During the same period, 161 patients with chronic angle-closure glaucoma without iris neovascularization were selected as the control group. ELISA method was applied to detect the expression levels of serum NOX4 and MMP-2. ROC curve was plotted to evaluate the diagnostic value and postoperative complication prediction value of NOX4 and MMP-2 in patients with DM complicated with NVG. Pearson method was applied to analyze the correlation of NOX4 and MMP-2 with vascular endothelial growth factor(VEGF)and interleukin-6(IL-6). Multivariate Logistic regression was applied to analyze the influencing factors of postoperative complications in the study group.

RESULTS:The general information of the study group and control group of patients is comparable. Compared with the control group, the expression levels of serum NOX4, MMP-2, VEGF, and IL-6 in the study group were significantly increased(P<0.001). According to Pearson analysis, serum NOX4 and MMP-2 levels significantly positively correlated with VEGF and IL-6 levels, respectively(P<0.001). According to ROC curve, the AUC of NOX4 combined with MMP-2 in the diagnosis of DM complicated with NVG was better than that of individual diagnosis of NOX4(Z=3.341, P<0.05)and MMP-2(Z=2.788, P<0.05). The duration of DM, the proportion of people with intraocular pressure >21 mmHg, and the expression levels of NOX4, MMP-2, VEGF, and IL-6 in the poor prognosis group were all higher than those in the good prognosis group(P<0.001). The duration of DM, intraocular pressure >21 mmHg, the levels of NOX4, MMP-2, VEGF, and IL-6 were all risk factors for poor prognosis in DM patients with NVG(P<0.001). According to ROC curve, the combined prediction of NOX4 and MMP-2 for postoperative complications in patients with DM complicated by NVG was superior to the AUC predicted by NOX4(Z=3.727, P<0.05)and MMP-2(Z=2.219, P<0.05), respectively.

CONCLUSION:NOX4 and MMP-2 are upregulated in the serum of patients with DM complicated by NVG. Combined detection of these two markers holds significant clinical value for the early diagnosis and prognosis of patients with DM complicated by NVG.