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目的 探究联合检测血管紧张素Ⅱ（AngⅡ）、内皮素、一氧化氮对2型糖尿病隐匿型糖尿病视神经病变（DON）的诊断价值。方法 回顾性分析2020年4月至2024年4月收治的500例2型糖尿病患者临床资料，根据有无隐匿型DON发生分为DON组（n=44）与非DON组（n=456）。比较两组基线资料及AngⅡ、内皮素、一氧化氮水平，采用多因素logistic回归分析2型糖尿病隐匿型DON发生的影响因素，采用受试者工作特征曲线、临床影响曲线、决策曲线分别评价AngⅡ、内皮素、一氧化氮联合诊断2型糖尿病隐匿型DON的价值、实际符合率及临床效用。结果 DON组患者糖尿病病程长于非DON组，空腹血糖、糖化血红蛋白、AngⅡ、内皮素水平高于非DON组，一氧化氮水平低于非DON组（P<0.01）；多因素logistic回归分析显示，AngⅡ、内皮素、一氧化氮均为2型糖尿病隐匿型DON发生的影响因素（P<0.01）;AngⅡ、内皮素、一氧化氮诊断2型糖尿病隐匿型DON的曲线下面积分别为0.843、0.777、0.835;AngⅡ、内皮素、一氧化氮联合诊断2型糖尿病隐匿型DON的曲线下面积最大，为0.939，敏感度、特异度分别为84.09%、90.57%;AngⅡ、内皮素、一氧化氮联合诊断2型糖尿病隐匿型DON的结果与实际情况符合率较高，且AngⅡ、内皮素、一氧化氮联合诊断具有明显正向净获益，临床效用良好。结论 2型糖尿病隐匿型DON患者AngⅡ、内皮素、一氧化氮水平异常，可作为其诊断因子，且三者联合诊断价值更高，可为临床早期监测隐匿型DON发生提供依据。
Abstract：Objective To explore the diagnostic value of combined detection of angiotensin Ⅱ(Ang Ⅱ), endothelin, and nitric oxide for latent diabetic optic neuropathy(DON) in patients with type 2 diabetes mellitus(T2DM). Methods Clinical data of 500 patients with T2DM admitted from April 2020 to April 2024 were retrospectively analyzed. Patients were divided into the DON group(n=44) and the non-DON group(n=456) based on the presence or absence of latent DON. The baseline data and levels of Ang Ⅱ, endothelin, and nitric oxide were compared between the two groups. Multivariate logistic regression analysis was used to identify the influencing factors of latent DON occurrence. Receiver operating characteristic(ROC) curves, clinical impact curves, and decision curves were employed to evaluate the efficacy, actual concordance rate, and clinical utility of the combined detection of AngⅡ,endothelin, and nitric oxide in the diagnosis of latent DON. Results Patients in the DON group had a longer duration of diabetes than those in the non-DON group, with higher levels of fasting blood glucose, glycosylated hemoglobin, AngⅡ, and endothelin, and lower levels of nitric oxide than the non-DON group(P<0.01). Multivariate logistic regression analysis showed that AngⅡ, endothelin, and nitric oxide were all influencing factors for the occurrence of latent DON(P<0.01). The area under the ROC curve(AUC) of AngⅡ,endothelin, and nitric oxide in the diagnosis of latent DON was 0.843, 0.777, and 0.835, respectively, indicating a certain diagnostic efficacy. The combination of Ang Ⅱ, endothelin, and nitric oxide had the largest AUC for diagnosing latent DON, at 0.939, with a sensitivity of 84.09% and a specificity of 90.57%. The results of the combination of Ang Ⅱ, endothelin, and nitric oxide in diagnosing latent DON had a high concordance rate with the actual situation, and the combination of Ang Ⅱ, endothelin, and nitric oxide had a significant positive net benefit, demonstrating good clinical efficacy. Conclusion Conclusion Patients with latent DON exhibit abnormal levels of AngⅡ, endothelin, and nitric oxide, which can serve as diagnostic markers. The combined detection of these three markers enhances diagnostic efficacy and provides a basis for early clinical monitoring of DON occurrence.
[1]张素雅,王菁.电生理视觉诱发电位检测联合血清脂肪特异性丝氨酸蛋白酶抑制剂表达在糖尿病视神经病变中的诊断价值[J].中国医药导报,2023,20(36):104-107.
[2] XUAN W, MOOTHEDATHU A A, MENG T, et al. 3D engineering for optic neuropathy treatment[J].Drug Discov Today,2021,26(1):181-188.
[3]孟倩丽,张良,谢洁.几种糖尿病相关眼病的诊断治疗规范[J].眼科新进展,2022,42(4):253-261.
[4] DEáK K, FEJES I, JANáKY M, et al. Further evidence for the utility of electrophysiological methods for the detection of subclinical stage retinal and optic nerve involvement in diabetes[J].Med Princ Pract, 2016,25(3):282-285.
[5] CHHABLANI J, SHARMA A, GOUD A, et al.Neurodegeneration in type 2 diabetes:evidence from spectraldomain optical coherence tomography[J].Invest Ophthalmol Vis Sci, 2015,56(11):6333-6338.
[6] SIMóR, SIMó-SERVAT O, BOGDANOV P, et al. Diabetic retinopathy:role of neurodegeneration and therapeutic perspectives[J].Asia Pac J Ophthalmol(Phila), 2022,11(2):160-167.
[7] SORRENTINO F S, MATTEINI S, BONIFAZZI C, et al. Diabetic retinopathy and endothelin system:microangiopathy versus endothelial dysfunction[J].Eye(Lond), 2018,32(7):1157-1163.
[8] CHOU C C, PAN S Y, SHEEN Y J, et al. Association between semaglutide and nonarteritic anterior ischemic optic neuropathy:a multinational population-based study[J].Ophthalmology,2025,132(4):381-388.
[9] JOUSSEN A M, RICCI F, PARIS L P, et al. Angiopoietin/Tie2signalling and its role in retinal and choroidal vascular diseases:a review of preclinical data[J].Eye(Lond), 2021,35(5):1305-1316.
[10] GUO Y, CHENG X, HUANG C, et al. Frataxin loss promotes angiotensinⅡ-induced endothelial-to-mesenchymal transition[J].J Am Heart Assoc, 2024,13(15):e034316.
[11] SHIHOYA W, SANO F K, NUREKI O. Structural insights into endothelin receptor signalling[J].J Biochem, 2023,174(4):317-325.
[12] KODATI B, STANKOWSKA D L, KRISHNAMOORTHY V R, et al. Involvement of c-Jun N-terminal kinase 2(JNK2)in Endothelin-1(ET-1)mediated neurodegeneration of retinal ganglion cells[J].Invest Ophthalmol Vis Sci, 2021,62(6):13.
[13] WALTON D M, MINTON S D, COOK A D. The potential of transdermal nitric oxide treatment for diabetic peripheral neuropathy and diabetic foot ulcers[J].Diabetes Metab Syndr,2019,13(5):3053-3056.
[14]宗志峰,蒋磊,张晓芳.循环内皮素、一氧化氮水平与糖尿病视神经病变的相关性研究[J].中国糖尿病杂志,2022,30(8):579-583.
[15]中华医学会糖尿病学分会.中国2型糖尿病防治指南（2020年版）[J].中华糖尿病杂志,2021,13(4):315-409.
[16]中华医学会眼科学分会神经眼科学组.中国糖尿病视神经病变诊断和治疗专家共识（2022年）[J].中华眼科杂志,2022,58(6):405-411.
[17] GRAUSLUND J, TAHA A A, MOLANDER L D, et al. Onceweekly semaglutide doubles the five-year risk of nonarteritic anterior ischemic optic neuropathy in a Danish cohort of 424,152persons with type 2 diabetes[J].Int J Retina Vitreous, 2024,10(1):97.
[18]郜会龙,丁来标,王丽霞,等.三七皂苷R1通过miR-181/IL-8/TLR4通路调控糖尿病性视神经病变的机制研究[J].中国中医眼科杂志,2023,33(11):1014-1020,1034.
[19]李波,王启常.无糖尿病视网膜病变的糖尿病性视神经病变患病率调查[J].检验医学与临床,2017,14(17):2515-2517,2520.
[20] YANG S, LIU R, XIN Z, et al. Plasma metabolomics identifies key metabolites and improves prediction of diabetic retinopathy:development and validation across multinational cohorts[J].Ophthalmology, 2024,131(12):1436-1446.
[21] KEMCHOKNATEE P, TANGON D, SRISOMBUT T. Risk factors of developing non-arteric ischemic optic neuropathy in patients with type 2 diabetes mellitus:a single-center retrospective cohort study[J].Int J Ophthalmol, 2025,18(2):290-296.
[22] POLLREISZ A, DESISSAIRE S, SEDOVA A, et al. Early identification of retinal neuropathy in subclinical diabetic eyes by reduced birefringence of the peripapillary retinal nerve fiber layer[J].Invest Ophthalmol Vis Sci, 2021,62(4):24.
[23] WEI Q, LIN S M, XU S H, et al. Graph theoretical analysis and independent component analysis of diabetic optic neuropathy:a resting-state functional magnetic resonance imaging study[J].CNS Neurosci Ther, 2024,30(3):e14579.
[24] NICOLòM, FERRO DESIDERI L, VAGGE A, et al. Faricimab:an investigational agent targeting the Tie-2/angiopoietin pathway and VEGF-A for the treatment of retinal diseases[J].Expert Opin Investig Drugs, 2021,30(3):193-200.
[25] AUGOUSTIDES J G. Commentary:angiotensinⅡ:expanding the rescue options for vasoplegia[J].J Thorac Cardiovasc Surg,2022,163(4):1417-1418.
[26] NáDASY G L, BALLA A, D?RNYEI G, et al. Direct Vascular Effects of AngiotensinⅡ(a systematic short review)[J].Int J Mol Sci, 2024,26(1):113.
[27]何晓婕,潘俊如,靖俊,等.血清钙、PGI2、AngⅡ在妊娠高血压眼底病变预测及病情评估中的应用评价[J].中国优生与遗传杂志,2022,30(8):1401-1405.
[28] WU B W, WU M S, LIU Y, et al. SIRT1-mediated deacetylation of NF-κB inhibits the MLCK/MLC2 pathway and the expression of ET-1, thus alleviating the development of coronary artery spasm[J].Am J Physiol Heart Circ Physiol, 2021,320(1):H458-H468.
[29] KOSACKA M, BRZECKA A. Endothelin-1 and LOX-1 as markers of endothelial dysfunction in obstructive sleep apnea patients[J].Int J Environ Res Public Health, 2021,18(3):1319.
[30]郭九春,吕静.Klotho、ET-1在新生血管性青光眼患者中表达及临床意义[J].中国中医眼科杂志,2022,32(1):12-17.
[31] EMPITU M A, RINASTITI P, KADARISWANTININGSIH I N.Targeting endothelin signaling in podocyte injury and diabetic nephropathy-diabetic kidney disease[J].J Nephrol, 2025,38(1):49-60.
[32]陈宁宁,赵铭.糖尿病性白内障晶状体上皮细胞中MMP-9、ET-1的表达水平及其临床意义[J].医学临床研究,2022,39(7):1018-1021,1025.
[33]康亚娥,高永强.前列地尔联合雷珠单抗治疗糖尿病视网膜病变的疗效及对眼部血流动力学的影响[J].检验医学与临床,2023,20(16):2400-2403,2407.
[34] SCHMITT S I, BIELMEIER C B, BRAUNGER B M. New insights into endothelin signaling and its diverse roles in the retina[J].Adv Exp Med Biol, 2019,1185:519-523.
[35]王娟,向小红,吕红彬.糖尿病视网膜病变中一氧化氮与氧化应激的相关性[J].中华实验眼科杂志,2022,40(11):1095-1099.
[36]郭娴吟,曹征,陈硕,等.单纯糖尿病性视神经病变与糖化血红蛋白、一氧化氮和超氧化物歧化酶的相关性探讨[J].海南医学,2014,25(7):1017-1019.
基本信息:
DOI：
中图分类号:R774.6;R587.2
引用信息:
[1]宗志峰,康丽利,张钢等.血管紧张素Ⅱ、内皮素、一氧化氮联合诊断2型糖尿病隐匿型糖尿病视神经病变的价值分析[J].临床误诊误治,2025,38(11):30-34.
基金信息:
河北省2020年度医学科学研究课题（20200430）