Архив офтальмологии Украины Том 14, №2, 2026

Актуальність. Активація ендотелію, взаємодія лейкоцитів та ендотелію є центральними подіями за діабетичної ретинопатії (ДР) і можуть лежати в основі діабетичної макулопатії (ДМП). Сироваткові маркери стратифікації макулярного ризику вивчені недостатньо. Мета: оцінити сироваткові рівні L-селектину (LS) та E-селектину (ES) як незалежні предиктори несприятливого розвитку й перебігу діабетичної ретинопатії при цукровому діабеті 2-го типу. Матеріали та методи. Базовий перехресний аналіз включав 136 пацієнтів із цукровим діабетом 2-го типу та ДР. ДМП оцінювали як наявну/відсутню (+/–); кінцевими точками оптичної когерентної томографії були центральні товщина (ЦТС) та об’єм сітківки (ЦОС). LS та ES вимірювали за допомогою імуноферментного методу. Лінійна й логістична регресія (на +10 нг/мл) були скориговані за віком, тривалістю діабету, систолічним артеріальним тиском та стадією ДР; дискримінацію порогів оцінювали в ROC-аналізі. Результати. ДМП відмічено в 42,6 % пацієнтів (58/136). LS та ES у групі DMP+ були вищими, ніж у групі DMP– (p < 0,001). Після коригування обидва біомаркери незалежно асоціювалися з вищими ЦТС та ЦОС (p < 0,001) та прогнозованою ДМП (LS: відношення шансів 4,14; ES: відношення шансів 5,92 на кожні 10 нг/мл, p < 0,001). Дискримінація була відмінною (показник AUC становив 0,900 для LS і 0,902 для ES); оптимальними пороговими значеннями були LS ≥ 49,0 нг/мл та ES ≥ 55,9 нг/мл. Для суворо визначеного діабетичного макулярного набряку асоціації послаблювалися після коригування на стадію ДР. Висновки. LS та ES є сильними незалежними предикторами ДМП та гірших структурних результатів оптичної когерентної томографії при ДР і можуть підтримувати прагматичну стратифікацію ризику.

Background. Endothelial activation and leukocyte-endothelium interactions are central to diabetic retinopathy (DR) and may underlie diabetic maculopathy (DMP). Serum markers for macular risk stratification remain limited. Aim of the study was to evaluate serum L- (LS) and E-selectins (ES) as independent predictors of the adverse development and course of diabetic retinopathy in type 2 diabetes mellitus. Materials and methods. Baseline cross-sectional analysis included 136 patients with type 2 diabetes and DR. DMP was assessed as present/absent (+/–); optical coherence tomography endpoints were central retinal thickness (CRT) and volume (CRV). LS and ES were measured by enzyme-linked immunosorbent assay. Linear and logistic regression (per +10 ng/mL) were adjusted for age, diabetes duration, systolic blood pressure, and DR stage; ROC analysis assessed discrimination. Results. DMP was present in 42.6 % of patients (58/136). LS and ES were higher in DMP+ than in DMP– (p < 0.001). After adjustment, both biomarkers were independently associated with higher CRT and CRV (p < 0.001) and predicted DMP (LS: odds ratio 4.14; ES: odds ratio 5.92 per +10 ng/mL; p < 0.001). Discrimination was excellent (AUC 0.900 for LS; 0.902 for ES); optimal cutoffs were LS ≥ 49.0 ng/mL and ES ≥ 55.9 ng/mL. For strictly defined diabetic macular edema, associations attenuated after adjustment for DR stage. Conclusions. LS and ES are strong independent predictors of DMP and worse optical coherence tomography structural outcomes in DR and may support pragmatic risk stratification.

цукровий діабет 2-го типу; діабетична ретинопатія; макулярний набряк; томографія; селектини; L-селектин; E-селектин; біомаркери

type 2 diabetes; diabetic retinopathy; macular edema; tomography; selectins; L-selectin; E-selectin; biomarkers

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