国际眼科纵览 ›› 2026, Vol. 50 ›› Issue (1): 47-53.doi: 10.3760/cma.i.cn115500-20251128-26107

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脂代谢相关复合指标在致盲性眼病诊断中的作用

张金金 张铭志   

  1. 汕头大学·香港中文大学联合汕头国际眼科中心,广东汕头 515041
  • 收稿日期:2025-11-28 出版日期:2026-02-22 发布日期:2026-02-22
  • 通讯作者: 张铭志,Email:zmz@jsiec.org
  • 基金资助:
    国家自然科学基金(82171044)

The role of lipid metabolism-related composite indicators in the diagnosis of blinding eye diseases

Zhang Jinjin, Zhang Mingzhi   

  1. Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou Guangdong 515041, China
  • Received:2025-11-28 Online:2026-02-22 Published:2026-02-22
  • Contact: Zhang Mingzhi, Email: zmz@jsiec.org
  • Supported by:
    National Natural Science Foundation of China (82171044)

摘要: 脂代谢相关复合指标通过整合基础血脂及相关参数,能更灵敏地量化机体胰岛素抵抗、氧化应激及血管内皮功能状态,弥补了单一血脂指标的局限性。在致盲性眼病中,此类指标展现出独特的病理提示价值:甘油三酯-葡萄糖指数作为胰岛素抵抗的替代标志物,与糖尿病视网膜病变的严重程度及微血管损伤呈正相关;载脂蛋白B/非高密度脂蛋白胆固醇(apolipoprotein B/non-high-density lipoprotein cholesterol,ApoB/non-HDL-C)比值反映脂质异位沉积与局部炎症,有助于预警新生血管性年龄相关性黄斑变性;Non-HDL-C升高提示青光眼视神经及其微环境的脂质代谢异常;总胆固醇/高密度脂蛋白胆固醇比值则在非动脉炎性缺血性视神经病变中表现出优异的诊断效能,与视力预后关联。尽管目前面临缺乏统一诊断阈值、因果机制待阐明等挑战,基于复合指标的风险评估体系正成为推动眼科疾病早期诊断、分层筛查与精准防治的重要工具。

关键词: 脂代谢, 复合指标, 疾病风险

Abstract: Lipid metabolism-related composite indicators, by integrating basic blood lipid parameters and relevant variables, offer a more sensitive quantification of systemic insulin resistance, oxidative stress, and endothelial function, thereby overcoming the limitations associated with single lipid parameters. In the context of blinding ocular diseases, these indicators demonstrate distinct pathological implications. The triglyceride-glucose (TyG) index, functioning as a surrogate marker for insulin resistance, is positively correlated with the severity of diabetic retinopathy and the extent of microvascular injury. The apolipoprotein B/non-high-density lipoprotein cholesterol (ApoB/non-HDL-C) ratio, reflecting ectopic lipid deposition and local inflammation, aids in predicting the risk of neovascular age-related macular degeneration. Elevated non-HDL-C levels indicate lipid metabolic dysregulation within the optic nerve and its microenvironment in glaucoma. And the total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) ratio exhibits superior diagnostic efficacy and a significant association with visual prognosis in non-arteritic anterior ischemic optic neuropathy. Despite current challenges such as the lack of unified diagnostic thresholds and the need to further elucidate causal mechanisms, risk assessment systems based on these composite indices are emerging as pivotal tools for facilitating early diagnosis, stratified screening, and precise prevention and treatment of ophthalmic diseases.

Key words: Lipid metabolism, Composite indicators, Disease risk