原发性急性闭角型青光眼患者房水VEGF-A、GAS6、SPP1与小梁切除术预后的关系

Relationship between aqueous humor levels of VEGF-A, GAS6, and SPP1 and prognosis after trabeculectomy in patients with acute primary angle-closure glaucoma

摘要:

目的 探讨原发性急性闭角型青光眼（APACG）患者房水血管内皮生长因子A（VEGF-A）、生长停滞特异性蛋白6（GAS6）、分泌型磷蛋白1（SPP1）与小梁切除术预后的关系。方法 选取2022年7月—2024年1月邯郸市第一医院88例（88眼）行小梁切除术的APACG患者为研究对象，依据术后疗效分为手术成功组（67例，67眼）与手术失败组（21例，21眼）。采用酶联免疫吸附试验检测APACG患者房水VEGF-A、GAS6、SPP1水平。采用多因素一般Logistic回归模型分析APACG患者小梁切除术失败的影响因素。绘制受试者工作特征（ROC）曲线分析房水VEGF-A、GAS6、SPP1预测APACG患者小梁切除术失败的价值。结果 手术失败组的VEGF-A、GAS6、SPP1水平均高于手术成功组（P <0.05）。手术成功组与手术失败组的性别构成、年龄、发病时间、体质量指数、吸烟史、糖尿病史、高血压史、术前青光眼用药种类、术前眼压、眼别、结膜瓣类型、可调节缝合线应用、术后1个月滤过泡保持率、术后降眼压用药种类比较，差异均无统计学意义（P >0.05）。多因素一般Logistic回归分析结果显示，VEGF-A水平高［O^R =1.018（95% CI：1.004，1.033）］、GAS6水平高［O^R =1.004（95% CI：1.001，1.008）］、SPP1水平高［O^R =1.270（95% CI：1.086，1.484）］均为APACG患者小梁切除术失败的危险因素（P <0.05）。ROC曲线分析结果表明，VEGF-A、GAS6、SPP1联合预测的敏感性和特异性分别为76.2%（95% CI：0.528，0.918）和83.6%（95% CI：0.725，0.915），曲线下面积为0.859（95% CI：0.767，0.950）。结论 APACG患者房水VEGF-A、GAS6、SPP1与APACG患者小梁切除术预后密切相关。三者联合检测对预测APACG患者小梁切除术失败具有较高的临床价值。

Abstract:

Objective To explore the relationship between levels of vascular endothelial growth factor A (VEGF-A), growth arrest-specific 6 (GAS6), and secreted phosphoprotein 1 (SPP1) in the aqueous humor and the prognosis after trabeculectomy in patients with acute primary angle-closure glaucoma (APACG).Methods A total of 88 APACG patients (88 eyes) who underwent trabeculectomy in the Department of Ophthalmology, Handan First Hospital from July 2022 to January 2024 were enrolled as research subjects. According to postoperative efficacy, they were divided into a success group (67 cases, 67 eyes) and a failure group (21 cases, 21 eyes). Levels of VEGF-A, GAS6, and SPP1 in aqueous humor were detected by enzyme-linked immunosorbent assay (ELISA). Multivariate logistic regression analysis was used to identify influencing factors for trabeculectomy failure in APACG patients, and receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of aqueous humor VEGF-A, GAS6, and SPP1 levels for trabeculectomy failure.Results There were statistically significant differences in VEGF-A, GAS6, and SPP1 levels between the success and failure groups (P < 0.05); levels in the failure group were higher than those in the success group. No statistically significant differences were found between the two groups in gender composition, age, onset time, body mass index (BMI), smoking history, diabetes history, hypertension history, number of preoperative glaucoma medications, preoperative intraocular pressure, eye laterality, conjunctival flap type, application of adjustable sutures, 1-month postoperative bleb retention rate, or number of postoperative intraocular pressure-lowering medications (P > 0.05). Multivariate logistic regression analysis showed that high VEGF-A level [O^R = 1.018 (95% CI: 1.004, 1.033) ], high GAS6 level [O^R = 1.004 (95% CI: 1.001, 1.008) ], and high SPP1 level [O^R = 1.270 (95% CI: 1.086, 1.484) ] were all risk factors for trabeculectomy failure in APACG patients (P < 0.05). ROC curve analysis indicated that the combination of VEGF-A, GAS6, and SPP1 for prediction yielded a sensitivity of 76.2% (95% CI: 0.528, 0.918) and specificity of 83.6% (95% CI: 0.725, 0.915), and area under the curve was 0.859（95% CI：0.767，0.950）.Conclusion Levels of VEGF-A, GAS6, and SPP1 in aqueous humor are closely related to the prognosis after trabeculectomy in APACG patients. Combined detection of these markers has high clinical value for predicting trabeculectomy failure.