Katić Karla, Katić Josip, Kumrić Marko, Božić Joško, Tandara Leida, Šupe Domić Daniela, Bućan Kajo
Department of Ophthalmology, University Hospital of Split, 21000 Split, Croatia.
Department of Cardiology, University Hospital of Split, 21000 Split, Croatia.
Diagnostics (Basel). 2024 May 10;14(10):992. doi: 10.3390/diagnostics14100992.
The aim of this study was to establish whether multiple blood parameters might predict an early treatment response to intravitreal bevacizumab injections in patients with diabetic macular edema (DME). Seventy-eight patients with non-proliferative diabetic retinopathy (NPDR) and DME were included. The treatment response was evaluated with central macular thickness decrease and best corrected visual acuity increase one month after the last bevacizumab injection. Parameters of interest were the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), vitamin D, and apolipoprotein B to A-I ratio (ApoB/ApoA-I). The NLR (2.03 ± 0.70 vs. 2.80 ± 1.08; < 0.001), MLR (0.23 ± 0.06 vs. 0.28 ± 0.10; = 0.011), PLR (107.4 ± 37.3 vs. 135.8 ± 58.0; = 0.013), and SII (445.3 ± 166.3 vs. 675.3 ± 334.0; < 0.001) were significantly different between responder and non-responder groups. Receiver operator characteristics analysis showed the NLR (AUC 0.778; 95% CI 0.669-0.864), PLR (AUC 0.628; 95% CI 0.511-0.735), MLR (AUC 0.653; 95% CI 0.536-0.757), and SII (AUC 0.709; 95% CI 0.595-0.806) could be predictors of response to bevacizumab in patients with DME and NPDR. Patients with severe NPDR had a significantly higher ApoB/ApoA-I ratio (0.70 (0.57-0.87) vs. 0.61 (0.49-0.72), = 0.049) and lower vitamin D (52.45 (43.10-70.60) ng/mL vs. 40.05 (25.95-55.30) ng/mL, = 0.025). Alterations in the NLR, PLR, MLR, and SII seem to provide prognostic information regarding the response to bevacizumab in patients with DME, whilst vitamin D deficiency and the ApoB/ApoA-I ratio could contribute to better staging.
本研究的目的是确定多项血液参数是否可预测糖尿病性黄斑水肿（DME）患者玻璃体内注射贝伐单抗后的早期治疗反应。纳入了78例非增殖性糖尿病视网膜病变（NPDR）和DME患者。在最后一次注射贝伐单抗后1个月，通过中心黄斑厚度降低和最佳矫正视力提高来评估治疗反应。感兴趣的参数包括中性粒细胞与淋巴细胞比值（NLR）、单核细胞与淋巴细胞比值（MLR）、血小板与淋巴细胞比值（PLR）、全身免疫炎症指数（SII）、维生素D以及载脂蛋白B与A-I比值（ApoB/ApoA-I）。反应者组和无反应者组之间的NLR（2.03±0.70对2.80±1.08；<0.001）、MLR（0.23±0.06对0.28±0.10；=0.011）、PLR（107.4±37.3对135.8±58.0；=0.013）和SII（445.3±166.3对675.3±334.0；<0.001）存在显著差异。受试者工作特征分析显示，NLR（曲线下面积[AUC]0.778；95%置信区间[CI]0.669 - 0.864）、PLR（AUC 0.628；95% CI 0.511 - 0.735）、MLR（AUC 0.653；95% CI 0.536 - 0.757）和SII（AUC 0.709；95% CI 0.595 - 0.806）可能是DME和NPDR患者对贝伐单抗反应的预测指标。重度NPDR患者的ApoB/ApoA-I比值显著更高（0.70[0.57 - 0.87]对0.61[0.49 - 0.72]，=0.049），维生素D水平更低（52.45[43.10 - 70.60]ng/mL对40.05[25.95 - 55.30]ng/mL，=0.025）。NLR、PLR、MLR和SII的变化似乎可为DME患者对贝伐单抗的反应提供预后信息，而维生素D缺乏和ApoB/ApoA-I比值可能有助于更好地进行分期。
