关键词:

糖尿病视网膜病变, NLRP3, 视力障碍, 神经纤维

Abstract:

Objective　To investigate the expression of NLRP3 in peripheral blood monocytes in patients with diabetic retinopathy (DR) and its correlation with visual impairment. Methods　A retrospective analysis was conducted on 152 patients with type 2 diabetes who were treated at Xianyang First People's Hospital from January 2022 to March 2024. Among them, 94 were male (61.84%) and 58 were female (38.16%), with an average age of (55.02±5.36) years and a diabetes duration of (14.06±3.78) years. Based on the severity of DR, patients were divided into no DR (NDR) group (36 cases), non-proliferative DR (NPDR) group (68 cases), and proliferative DR (PDR) group (48 cases). The expression of NLRP3 mRNA in peripheral blood mononuclear cells was detected using reverse transcription polymerase chain reaction (RT-PCR), and serum levels of interleukin (IL)-1β and IL-18 were measured using enzyme-linked immunosorbent assay (ELISA). Visual impairment was assessed using the CV-5000S autorefractor and Humphrey visual field analyzer. Corneal and retinal nerve fiber metrics were evaluated using the Spectralis OCT and HRT3-RCM laser confocal microscopy. The severity of visual impairment, corneal nerve fiber metrics [nerve fiber length (NFL), corneal nerve fiber density (NFD), corneal nerve fiber branching density (NFB)], and retinal nerve fiber metrics [retinal nerve fiber layer (RNFL) thickness, foveal avascular zone (FAZ) area, superficial capillary layer (SCL) blood flow density, and deep capillary layer (DCL) blood flow density] were compared among the groups. Statistical comparisons were made using χ², t tests, SNK-q tests, and one-way analysis of variance. Results　The NLRP3 mRNA, IL-1β, IL-18 levels, and the proportion of severe visual impairment in the NDR group were 0.90±0.14, (20.03±4.01) ng/L, (76.96±22.85) ng/L, and 5.56% (2/36), respectively. In the NPDR group, these values were 1.19±0.13, (27.15±3.69) ng/L, (112.05±20.76) ng/L, and 25.00% (17/68). In the PDR group, they were 1.59±0.23, (36.02±3.71) ng/L, (136.20±18.95) ng/L, and 54.17% (26/48), all showing a gradual increase (all P<0.05). NFL, NFD, NFB, RNFL thickness, SCL, and DCL metrics gradually declined in the NDR, NPDR, and PDR groups, while FAZ values [(0.34±0.07, 0.40±0.09, 0.46±0.08) mm²] gradually increased, with all differences being statistically significant (all P<0.05). Spearman correlation analysis showed that NLRP3 was positively correlated with the severity of visual impairment (r=0.493, P<0.001). Conclusion　The expression level of NLRP3 in peripheral blood monocytes increased with the severity of DR and it was positively correlated with the severity of visual impairment in DR patients.

Key words:

Diabetic retinopathy, NLRP3, Visual impairment, Nerve fibers