目的：评估血清环氧合酶-2(COX-2)、晚期糖基化终产物受体(RAGE)对2型糖尿病(T2DM)患者发生糖尿病视网膜病变(DR)的诊断价值。方法：以2022年1月至2024年8月于本科室就诊的T2DM发生DR的患者118例118眼为DR组，未发生DR的T2DM患者75例75眼为T2DM组，另选取同期体检健康成人50例50眼为对照组。酶联免疫法检测血清COX-2、RAGE水平并进行比较； Logistic回归分析影响T2DM患者发生DR的因素； 受试者工作特征曲线(ROC)评估血清COX-2、RAGE诊断T2DM患者发生DR的价值。结果：与对照组及T2DM组相比，DR组患者血清COX-2、RAGE水平显著升高，且T2DM组高于对照组(均P<0.05)； 相较于T2DM组患者，DR组患者T2DM病程较长，糖化血红蛋白及空腹血糖升高，高血压史占比增多(均P<0.05)； T2DM病程长、有高血压史以及糖化血红蛋白、COX-2、RAGE水平升高是T2DM患者发生DR的危险因素(均P<0.05)； 血清COX-2、RAGE及二者联合诊断T2DM患者发生DR的AUC分别为0.828、0.819、0.907，联合诊断优于单独检测(Z二者联合-COX-2=3.220，P=0.001； Z二者联合-RAGE=2.734，P=0.006)。结论：T2DM发生DR患者血清COX-2、RAGE水平显著升高，其作为血清学指标诊断T2DM患者发生DR有较高的临床应用价值。

AIM: To evaluate the diagnostic value of serum cyclooxygenase-2(COX-2)and receptor for advanced glycation end products(RAGE)for diabetic retinopathy(DR)in type 2 diabetes mellitus(T2DM)patients.METHODS:From January 2022 to August 2024, 118 T2DM patients(118 eyes)with DR who visited our department were taken as DR group, while 75 T2DM patients(75 eyes)without DR were included as T2DM group. Another 50 healthy adults(50 eyes)who underwent physical checkups were included as the control group. Enzyme-linked immunosorbent assay was applied to detect and compare serum levels of COX-2 and RAGE. Logistic regression was applied to explore the factors that affected the occurrence of DR in T2DM patients. The receiver operating characteristic(ROC)curve was applied to evaluate the value of serum COX-2 and RAGE in diagnosing DR in T2DM patients.RESULTS:For the control group and T2DM group, the serum COX-2 and RAGE in the DR group were obviously higher, and with the T2DM group being higher than the control group(all P<0.05). Compared with the T2DM group, the DR group had a longer duration of T2DM, higher glycosylated hemoglobin and fasting blood glucose, and a higher proportion of hypertension history(all P<0.05). Long duration of T2DM, hypertension history, and elevated levels of glycosylated hemoglobin, COX-2, and RAGE were risk factors for DR in T2DM patients(all P<0.05). The AUC of serum COX-2, RAGE, and their combined diagnosis for DR in T2DM patients was 0.828, 0.819, and 0.907, respectively. The combined diagnosis was superior to the individual detection(Zcombination-COX-2=3.220, P=0.001; Zcombination-RAGE=2.734, P=0.006).CONCLUSION:Serum COX-2 and RAGE are obviously elevated in T2DM with DR, and they have high clinical application value for diagnosing T2DM patients with DR.

齐齐哈尔市科技计划创新激励项目(No.CSFGG-2023003)