Levels of Serum Periostin,Metrnl,IL-35 and HbA1c in Patients with Preclinical Diabetic Retinopathy and Their Clinical Significance

YANG Hao; XIAO Yu; LIU Zilin; XIAO Ziyun

doi:10.3969/j.issn.1002-3429.2025.12.010

Abstract：Objective To explore the levels of serum Periostin,Metrnl,interleukin-35(IL-35),and glycated hemo-globin(HbA1c)in patients with preclinical diabetic retinopathy(PCDR)and their clinical significance.Methods A total of 118 patients with PCDR admitted from July 2020 to July 2023 were selected as the PCDR group,and another 118 patients with simple type 2 diabetes mellitus(T2DM)admitted during the same period were selected as the non-PCDR group.The general data and serum Periostin,Metrnl,IL-35 and HbA1c levels of the two groups were compared.The correlations between Peri-ostin,Metrnl,IL-35,HbA1c and optical coherence tomography angiography(OCTA)and visual electrophysiological exam-ination parameters of PCDR patients were analyzed.The follow-up lasted 18 months.According to the presence or absence of diabetic retinopathy(DR),the patients were divided into the DR Group and the non-DR group.The levels of Periostin,Metrnl,IL-35,and HbA1c in the DR Group and the non-DR group were compared.The receiver operating characteristic(ROC)curve was used to evaluate the early warning value of Periostin,Metrnl,IL-35 and HbA1c for the occurrence of DR In patients with PCDR.Results Superficial vascular density,deep vascular density,and the P1 amplitude of multifocal electroretinogram(mfERG)in the PCDR group was lower than that of the non-PCDR group,and the area of foveal avascular zone(FAZ)and the number of non-perfusion areas in the fovea were higher than those in the non-PCDR group(P<0.01).The Periostin and HbA1c in the PCDR group were both higher than those in the non-PCDR group,while the Metrnl and IL-35 were lower than those in the non-PCDR group(P<0.01).In patients with PCDR,Periostin and HbA1c were positively correlated with the area of FAZ and the number of non-perfusion areas,and negatively correlated with superficial vascular density,deep vascular density and the amplitude of mfERG P1(P<0.01).Metrnl and IL-35 were negatively correlated with the area of FAZ and the number of non-perfusion areas,and positively correlated with superficial vascular density,deep vascular density and the amplitude of mfERG P1(P<0.01).All 118 patients completed an 18-month follow-up.A total of 21 patients progressed to DR and were in-cluded in the DR group.Among them,97 patients who did not progress to DR were included in the non-DR group.The Perios-tin and HbA1c in the DR group were higher than those in the non-DR group,while the Metrnl and IL-35 were lower than those in the non-DR group(P<0.01).The ROC curve showed that the area under the curve(AUC)of Periostin,Metrnl,IL-35,and HbA1c for predicting the occurrence of DR In PCDR patients was 0.772,0.821,0.806,and 0.804,respectively,and the AUC of combined prediction of the four indicators was 0.904.The AUC of the combined prediction was higher than that predicted by each indicator alone,and the sensitivity and specificity were 83.90%and 84.75%respectively.Conclusion In patients with PCDR,the levels of Periostin and HbA1c increase,while the levels of Metrnl and IL-35 decrease.Moreover,Periostin,Metrnl,IL-35,and HbA1c are related to superficial vascular density,deep vascular density,FAZ area,the number of non-perfusion ar-eas,and the amplitude of mfERG P1.Their levels are helpful for the early warning of the occurrence of DR in PCDR patients.