2型糖尿病伴干眼症病人血清和泪液分泌型卷曲相关蛋白 5、脂肪酸结合蛋白 4水平与病情严重程度的相关性

目的 分析分泌型卷曲相关蛋白5(SFRP-5)、脂肪酸结合蛋白4(FABP4)在2型糖尿病（T2DM）伴干眼症病人血清和泪液中的表达及其与病情严重程度的相关性。方法 选取2020年12月至2021年12月唐山市眼科医院收治的T2DM病人145例，其中单纯T2DM病人84例168眼（T2DM组），伴干眼症病人61例122眼（T2DM伴干眼症组），另选取同期该院体检健康者50例100眼作为对照组。T2DM伴干眼症病人又分为轻度组（29例）、中度组（17例）、重度组（15例）。利用酶联免疫吸附法测定所有受试者血清和泪液中SFRP-5、FABP4水平；相关性分析采用Pearson法或Spearman法；logistic回归分析影响T2DM病人干眼症发生的因素。结果 T2DM伴干眼症组、T2DM组血清和泪液SFRP-5水平均低于对照组（106.09±8.37、135.72±9.26比158.34±9.45,28.85±5.13、58.27±6.14比45.18±5.92）,T2DM伴干眼症组低于T2DM组（P<0.05）;T2DM伴干眼症组、T2DM组血清和泪液FABP4水平均高于对照组（...

Correlation of serum and tear SFRP-5 and FABP4 levels with disease severity in patients with type 2 diabetes mellitus and dry eye disease

Objective To analyze the expression of secreted frizzled-related protein 5 (SFRP-5) and fatty acid-binding protein 4(FABP4) in the serum and tear fluid of patients with type 2 diabetes mellitus (T2DM) accompanied by dry eye disease and their correla-tion with the severity of the disease.Methods From December 2020 to December 2021, 145 T2DM patients admitted to Tangshan EyeHospital were selected, including 168 patients with simple T2DM (T2DM group), 61 patients with dry eye (T2DM with dry eye group),and 50 patients of healthy people who had medical checkups during the same period as the control group. T2DM patients with dry eyewere divided into mild group (29 cases), moderate group (17 cases) and severe group (15 cases). The levels of SFRP-5 and FABP4 in se- rum and tear fluid were measured by enzyme-linked immunosorbent assay. The Pearson method or Spearman method was used for corre-lation analysis. Logistic regression analysis was used to analyze the factors influencing the occurrence of dry eye in T2DM patients.Re- sults The levels of SFRP-5 in serum and tear fluid were lower in the T2DM with dry eye group and the T2DM group than in the con-trol group (106.09±8.37, 135.72±9.26 vs. 158.34±9.45; 28.85±5.13, 58.27±6.14 vs. 45.18±5.92) and lower in the T2DM with dry eye group than in the T2DM group (P<0.05). The levels of FABP4 in serum and tear fluid in T2DM with dry eye group and T2DM groupwere higher than those in the control group (70.63±6.59, 58.27±6.14 vs. 45.18±5.92; 15.91±3.76, 10.28±3.58 vs. 7.72±3.29) and were higher in the T2DM with dry eye group than in the T2DM group (P<0.05). The serum and tear fluid SFRP-5 levels (68.29±7.15, 95.54±8.34 vs. 131.82±9.02; 12.83±4.62, 24.72±5.49 vs. 39.56±5.18), tear film rupture time (BUT) and tear secretion test (SIT) in the severeand moderate groups were lower than those in the mild group, and those in the severe group were lower than the moderate group (P< 0.05). The serum and tear FABP4 levels (84.56±6.83, 73.18±6.94 vs. 61.93±6.27; 25.64±4.19, 17.15±3.86 vs. 10.16±3.47) and ocularsurface disease index (OSDI) score in the severe and moderate groups were higher than those in the mild group, and those in the severegroup were higher than those in the moderate group (P<0.05). There was a positive correlation between serum and tear fluid SFRP-5 lev- els, and a positive correlation between serum and tear fluid FABP4 levels in patients with T2DM with dry eye (P<0.05). The serum and tear fluid SFRP-5 levels in T2DM patients with dry eye were negatively correlated with the OSDI scores and positively correlated withthe BUT and the SIT (P<0.05). Both serum and tear fluid FABP4 levels were positively correlated with OSDI scores and negatively cor-related with BUT and SIT scores (P<0.05). Serum and tear fluid SFRP-5 levels were independent protective factors affecting the occur-rence of dry eye in T2DM patients, while serum and tear fluid FABP4 levels were independent risk factors (P<0.05). Conclusion SFRP-5 was lowly expressed at low levels, and FABP4 was highly expressed in both the serum and tear fluid of patients with T2DMwith dry eye, both of which are closely related to the severity of the disease.