Архив офтальмологии Украины Том 13, №3, 2025

Актуальність. Нейронспецифічна енолаза (NSE) є маркером нейронально-гліального ушкодження. Її локальне вимірювання у внутрішньоочній рідині (ВОР) може відображати градієнт тяжкості діабетичної ретинопатії (ДР) та підсилювати стратифікацію ризику. Мета дослідження: встановити вміст NSE у ВОР та її зв’язок із тяжкістю ДР. Матеріали та методи. Обстежено 110 пацієнтів із цукровим діабетом (ЦД) 2-го типу, яких розподілили на групи за стадією ДР відповідно до Міжнародної класифікації (2003): 1-ша — без ретинопатії (ДР0; 15 очей), 2-га — з початковою непроліферативною ДР (НПДР1; 40 очей), 3-тя — з помірною НПДР (НПДР2; 25 очей), 4-та — з тяжкою НПДР (НПДР3; 12 очей); 5-та — з проліферативною ДР (ПДР; 18 очей). До контрольної групи залучено 25 осіб відповідного віку та статі, які не мали ЦД і ДР. У ВОР, що була отримана під час операції факоемульсифікації катаракти, визначали вміст NSE (мг/мл). Для статистичного аналізу результатів використано пакет EZR v.1.54 (Австрія). Результати. Вік груп був зіставний (p = 0,108), тривалість ЦД зростала зі стадією ДР (p < 0,001). Вміст NSE у ВОР підвищувався від контролю до ПДР (p < 0,001), медіани (мг/мл): контроль — 4,07 (3,42–4,70), ДР0 — 4,66 (4,28–6,23), НПДР1 — 12,28 (10,2–15,4), НПДР2 — 19,20 (16,4–26,9), НПДР3 — 47,63 (42,3–51,6), ПДР — 59,19 (45,6–65,1). Багатокласові межі (мг/мл): < 8,63 (ДР0); 8,63–20,0 (НПДР1); 20,1–40,4 (НПДР2); 40,5–64,0 (НПДР3); > 64,0 (ПДР); для ПДР чутливість 27,8 %, специфічність 100 %; інтегральна точність 0,64 (95% ДІ: 0,56–0,73). Бінаризація (легка/помірна = НПДР1 + НПДР2; тяжка = НПДР3 + ПДР) з порогами 8,27–40,45 та > 40,45 мг/мл забезпечила чутливість/специфічність: 90,8 %/94,3 % (легка/помірна) і 86,7 %/98,1 % (тяжка); інтегральна точність 0,844 (95% ДІ: 0,772–0,901). Висновки. NSE у ВОР відображає градієнт тяжкості ДР і надає клас-специфічні та бінарні пороги для практичної стратифікації (логіка rule-out/rule-in для тяжких форм). Для подальшого впровадження методу потрібна зовнішня валідація.

Background. Neuron-specific enolase (NSE) is a mar­ker of neuronal-glial injury. Its local measurement in the intrao­cular fluid (IOF) may reflect the gradient of diabetic retinopathy (DR) severity and enhance risk stratification. The purpose of the study was to determine NSE levels in the IOF and their association with DR severity. Materials and methods. We examined 110 patients with type 2 diabetes mellitus who were divided into five groups by the International Clinical Diabetic Reti­nopathy (2003) classification: group 1 — no retinopathy (DR0; 15 eyes), group 2 — mild non-proliferative DR (NPDR1; 40 eyes), group 3 — moderate NPDR (NPDR2; 25 eyes), group 4 — severe NPDR (NPDR3; 12 eyes), group 5 — proliferative DR (PDR; 18 eyes). The control group included 25 age- and sex-matched individuals without diabetes/DR. In the IOF obtained during phacoemulsification, NSE concentration (mg/mL) was measured. Statistical analysis was performed with EZR v1.54 (Austria). Results. Age was comparable across groups (p = 0.108), while diabetes duration increased with DR stage (p < 0.001). NSE levels in the IOF rose from control to PDR (p < 0.001), medians (mg/mL): control — 4.07 (3.42–4.70), DR0 — 4.66 (4.28–6.23), NPDR1 — 12.28 (10.2–15.4), NPDR2 — 19.20 (16.4–26.9), NPDR3 — 47.63 (42.3–51.6), PDR — 59.19 (45.6–65.1). Multiclass cut-offs (mg/mL): < 8.63 (DR0); 8.63–20.0 (NPDR1); 20.1–40.4 (NPDR2); 40.5–64.0 (NPDR3); > 64.0 (PDR). For PDR, sensiti­vity was 27.8 %, specificity was 100 %; overall accuracy was 0.64 (95% confidence interval: 0.56–0.73). Binary classification (mild/mode­rate = NPDR1 + NPDR2; severe = NPDR3 + PDR) with thresholds 8.27–40.45 and > 40.45 mg/mL yielded sensitivity/specificity of 90.8 %/94.3 % (mild/moderate) and 86.7 %/98.1 % (severe); overall accuracy was 0.844 (95% confidence interval: 0.772–0.901). Conclusions. NSE levels in the IOF reflect the DR severity gradient and provide stage-specific and binary thresholds for practical stratification (a rule-out/rule-in logic for severe forms). External validation is required for broader implementation.

діабетична ретинопатія; цукровий діабет 2-го типу; нейронспецифічна енолаза; біомаркери; внутрішньоочна рідина; прогресування захворювання

diabetic retinopathy; type 2 diabetes mellitus; neuron-specific enolase; biomarkers; intraocular fluid; disease progression

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