Correlations of serum stromal cell-derived factor-1, chemokine receptor 7 and vascular density in the optic disc area with clinical stages in patients with normal-tension glaucoma
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摘要:目的
探讨正常眼压性青光眼(NTG)患者血清基质细胞衍生因子-1(SDF-1)、趋化因子受体7(CXCR7)及视盘区血管密度与临床分期的相关性。
方法选取157例NTG患者为NTG组，根据不同临床分期分为Ⅰ期组(n=29)、Ⅱ期组(n=88)和Ⅲ期组(n=40); 另选取56例同期健康体检者为对照组。比较NTG组与对照组血清SDF-1、CXCR7水平; 分析不同临床分期患者视盘区血管密度变化; 采用多因素Logistic回归分析探讨NTG的危险因素。
结果与对照组比较, NTG组血清SDF-1、CXCR7水平升高，差异有统计学意义(P < 0.05)。与对照组比较, NTG组患者大血管密度、毛细血管密度、全区域血管密度降低，无血管区密度升高，差异有统计学意义(P < 0.05); Ⅱ期组、Ⅲ期组毛细血管密度、全区域血管密度低于Ⅰ期组，无血管区密度高于Ⅰ期组，差异有统计学意义(P < 0.05)。大血管密度(r=-0.503, P=0.006)、毛细血管密度(r=-0.546, P < 0.001)、全区域血管密度(r=-0.553, P < 0.001)与临床分期呈负相关，无血管区密度与临床分期呈正相关(r=0.521, P=0.002)。NTG组高血压、饮酒史、青光眼家族史以及血清SDF-1高水平、CXCR7高水平患者比率高于对照组，差异有统计学意义(P < 0.05)。多因素Logistic回归分析显示，高血压、青光眼家族史、饮酒史以及高血清SDF-1、CXCR7水平是NTG发生的危险因素(P < 0.05)。
结论NTG患者血清SDF-1、CXCR7水平显著升高，大血管密度、毛细血管密度、全区域血管密度与患者临床分期呈负相关，无血管区密度与临床分期呈正相关。血清SDF-1、CXCR7可作为NTG诊断和临床分期的有效参考指标。
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关键词:
- 正常眼压性青光眼 /
- 血清基质细胞衍生因子-1 /
- 趋化因子受体7 /
- 视盘区血管密度 /
- 临床分期
Abstract:ObjectiveTo investigate the correlations of serum stromal cell-derived factor-1 (SDF-1), chemokine receptor 7 (CXCR7) and vascular density in the optic disc area with clinical stages in patients with normal-tension glaucoma (NTG).
MethodsA total of 157 patients with NTG were included in the NTG group and divided into stage Ⅰ group (n=29), stage Ⅱ group (n=88), and stage Ⅲ group (n=40) based on different clinical stages; additionally, 56 healthy individuals with physical examinations in the same period were selected as control group. Serum SDF-1 and CXCR7 levels were compared between the NTG group and the control group; changes in vascular density in the optic disc area among patients with different clinical stages were analyzed; the multivariate Logistic regression analysis was conducted to explore the risk factors for NTG.
ResultsCompared with the control group, the NTG group had significantly increased serum levels of SDF-1 and CXCR7 (P < 0.05). Compared with the control group, patients in the NTG group showed significantly decreased densities of large vessels, capillaries, and the entire area, as well as significantly increased density of avascular areas (P < 0.05). The densities of capillaries and the entire area were significantly lower in the stage Ⅱ group and stage Ⅲ group than the stage Ⅰ group, while the density of avascular areas was significantly higher (P < 0.05). The densities of large vessels (r=-0.503, P=0.006), capillaries (r=-0.546, P < 0.001), and the entire area (r=-0.553, P < 0.001) were negatively significantly correlated with clinical stages, while the density of avascular area was positively significantly correlated with clinical stages (r=0.521, P=0.002). The proportions of patients with hypertension, history of alcohol consumption, family history of glaucoma, and high serum levels of SDF-1 and CXCR7 in the NTG group were significantly higher than those in the control group (P < 0.05). Multivariate Logistic regression analysis revealed that hypertension, family history of glaucoma, history of alcohol consumption, and high serum levels of SDF-1 and CXCR7 were risk factors for NTG (P < 0.05).
ConclusionsPatients with NTG have significantly increased serum levels of SDF-1 and CXCR7. The densities of large vessels, capillaries, and the entire area are negatively correlated with clinical stages, while the density of avascular areas is positively correlated with clinical stages. Serum levels of SDF-1 and CXCR7 can serve as effective reference indicators for the diagnosis and clinical staging of NTG.
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表 1 健康体检者和不同临床分期患者视盘区血管密度参数比较（x±s）
% 组别 n 大血管密度 毛细血管密度 全区域血管密度 无血管区密度 对照组 56 34.66±7.92 34.92±6.76 71.04±8.23 11.12±2.44 Ⅰ期组 29 28.28±5.24* 24.86±3.68* 55.87±5.38* 15.75±4.08* Ⅱ期组 88 28.98±5.86* 18.88±6.06*# 43.87±5.85*# 19.01±5.08*# Ⅲ期组 40 29.01±5.91* 16.39±4.01*#△ 40.73±8.32*#△ 22.02±4.98*#△ 与对照组比较，*P < 0.05;与Ⅰ期组比较，#P < 0.05;与Ⅱ期组比较，△P < 0.05。 
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表 2 对照组与NTG组临床特征比较（x±s）[n(%)]
临床特征 分类 对照组(n=56) NTG组(n=157) χ2/t P 年龄 ≤60岁 20(35.71) 56(35.67) 1.336 0.103 >60岁 36(64.29) 101(64.33) 性别 男 29(51.79) 80(50.96) 0.682 0.597 女 27(48.21) 77(49.04) 高血压 有 21(37.50) 98(62.42) 10.397 0.002 无 35(62.50) 59(37.58) 青光眼家族史 有 10(17.86) 126(80.25) 8.999 < 0.001 无 46(82.14) 31(19.75) 糖尿病 有 18(32.14) 52(33.12) 0.397 0.739 无 38(67.86) 105(66.88) 吸烟史 有 16(28.57) 45(28.66) 0.684 0.422 无 40(71.43) 112(71.34) 饮酒史 有 15(26.79) 117(74.52) 8.655 0.002 无 41(73.21) 40(25.48) 收缩压/mmHg 128.96±14.26 128.55±13.21 0.678 0.462 舒张压/mmHg 83.64±8.58 84.06±8.73 0.849 0.267 心率/(次/min) 72.98±10.66 72.64±11.68 0.332 0.855 眼压/mmHg 15.39±1.59 15.79±1.77 0.648 0.497 SDF-1 ≥3.45 ng/mL 9(16.07) 123(78.34) 9.315 < 0.001 < 3.45 ng/mL 47(83.93) 34(21.66) CXCR7 ≥2.40 pg/mL 10(17.86) 129(82.17) 9.006 < 0.001 < 2.40 pg/mL 46(82.14) 28(17.83) 1 mmHg=0.133 kPa。SDF-1:基质细胞衍生因子-1;CXCR7:趋化因子受体7。
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表 3 NTG的多因素Logistic回归分析赋值
自变量 变量说明 赋值情况 高血压 分类变量 是=1, 否=0 青光眼家族史 分类变量 是=1, 否=0 饮酒史 分类变量 是=1, 否=0 SDF-1 分类变量 ≥3.45 ng/mL=1, < 3.45 ng/mL=0 CXCR7 分类变量 ≥2.40 pg/mL=1, < 2.40 pg/mL=0
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表 4 NTG的多因素Logistic回归分析
因素 β 标准误 Wald P OR 95%CI 高血压 3.468 1.422 8.789 < 0.001 2.432 1.984~3.668 青光眼家族史 4.007 2.128 8.846 < 0.001 2.867 2.198~3.661 饮酒史 0.187 0.106 7.494 0.028 1.364 1.001~1.889 SDF-1 1.588 0.385 8.649 < 0.001 0.613 0.225~1.135 CXCR7 0.886 0.613 9.680 < 0.001 1.368 1.006~3.458
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