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中华眼科医学杂志(电子版)

中华眼科医学杂志(电子版) ›› 2026, Vol. 16 ›› Issue (02) : 77 -84. doi: 10.3877/cma.j.issn.2095-2007.2026.02.003

论著

高度近视眼与糖尿病视网膜病变共同病理机制蛋白质组学关联性的临床与实验研究
罗若宁1,2, 李敏3, 张洁1,2, 上官燕玉1,2, 陈丽4, 朱彦鸣1, 许闻洋1, 毕燕龙1,2, 李冰1,2,†()   
  1. 1200065　上海，同济大学附属同济医院眼科
    2200331　上海，同济大学视觉科学与转化研究中心
    3200127　上海交通大学医学院附属仁济医院眼科
    4200090　上海，同济大学附属杨浦医院眼科
  • 收稿日期:2025-12-20 出版日期:2026-04-28
  • 通信作者: 李冰
  • 基金资助:
    上海市自然科学基金项目(19ZR1450500); 中华国际医学交流基金项目(Z-2017-26-2402); 上海市同济医院临床研究培育项目(ITJ（QN）2405)

The proteomics associations in the common pathological mechanisms between high myopia and diabetic retinopathy

Ruoning Luo1,2, Min Li3, Jie Zhang1,2, Yanyu Shangguan1,2, Li Chen4, Yanming Zhu1, Wenyang Xu1, Yanlong Bi1,2, Bing Li1,2,†()   

  1. 1Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
    2Tongji University Center for Vision Science and Translational Research, Shanghai 200331, China
    3Department of Ophthalmology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
    4Department of Ophthalmology, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, China
  • Received:2025-12-20 Published:2026-04-28
  • Corresponding author: Bing Li
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引用本文：

罗若宁, 李敏, 张洁, 上官燕玉, 陈丽, 朱彦鸣, 许闻洋, 毕燕龙, 李冰. 高度近视眼与糖尿病视网膜病变共同病理机制蛋白质组学关联性的临床与实验研究[J/OL]. 中华眼科医学杂志(电子版), 2026, 16(02): 77-84.

Ruoning Luo, Min Li, Jie Zhang, Yanyu Shangguan, Li Chen, Yanming Zhu, Wenyang Xu, Yanlong Bi, Bing Li. The proteomics associations in the common pathological mechanisms between high myopia and diabetic retinopathy[J/OL]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2026, 16(02): 77-84.

目的

探讨高度近视眼(HM)与糖尿病视网膜病变(DR)发生风险呈负相关的分子机制。

方法

选取2019年3月至10月于同济大学附属杨浦医院眼科就诊的18例患者作为研究对象。其中，男性10例，女性8例；年龄64~77岁，平均年龄(70.1±4.3)岁。收集HM患者6例、增殖性糖尿病视网膜病变(PDR)患者6例及对照受试者6例血液样本，提取并鉴定血浆细胞外囊泡，采用蛋白定量和非标记液相色谱串联质谱分析，得到差异表达蛋白。使用基因注释功能富集、京都基因及基因组百科全书通路富集等生物信息学分析方法分析差异表达蛋白的功能。构建形觉剥夺性近视小鼠模型及DR小鼠模型，并用蛋白质免疫印迹法对关键差异蛋白进行组间验证。

结果

HM者、增殖性糖尿病视网膜病变(PDR)者及对照受试者共检测到血浆细胞外囊泡蛋白质852种。相对对照受试者，HM和PDR者血浆细胞外囊泡标本中分别发现16种特异性蛋白和6种特异性蛋白，共有蛋白700种。差异表达蛋白25项。HM者相对对照受试者有75种差异表达蛋白，包括20种上调蛋白和55种下调蛋白。差异蛋白主要富集在免疫应答及细胞外基质相关通路。其中，关键蛋白E3泛素蛋白连接酶Itchy同源物(ITCH)在HM组中表达上调，PDR者中表达下调。HM者相对对照组受试者和PDR者差异蛋白的蛋白质-蛋白质相互作用网络中分别有46个节点和69个节点，320个边界和676个边界。该趋势与动物模型的巩膜组织表达相一致。

结论

HM者对于DR的发生与发展具有潜在抑制作用，ITCH可能通过调控炎症通路和视网膜血管生成参与此过程。ITCH在两种疾病中的差异性表达及潜在机制路径解释了HM伴糖尿病患者发生DR程度轻和风险低的临床现象。

关键词: 高度近视眼, 糖尿病视网膜病变, E3泛素-蛋白连接酶, 细胞外囊泡, 蛋白质组学
Objective

The aim of this study is to investigate the specific molecular mechanism of high myopia (HM) is correlated with a lower risk of diabetic retinopathy (DR).

Methods

A total of 18 patients who visited the Department of Ophthalmology, Yangpu Hospital Affiliated to Tongji University from March to October 2019 were enrolled as study subjects, including 10 males and 8 females with a mean age of (70.1±4.3) years (ranging from 64 to 77 years). Blood samples were collected from 6 patients with HM, 6 patients with proliferative diabetic retinopathy (PDR), and 6 control subjects. Extracellular vesicles were isolated and characterized, then proteomic analysis was performed using liquid chromatography-tandem mass spectrometry with label-free quantification. Bioinformatics methods, including Gene Ontology functional enrichment and Kyoto Encyclopedia of Genes and Genomes pathway enrichment, were applied to analyze the functions of the differentially expressed proteins. Additionally, a form-deprivation myopia mouse model and a DR mouse model were established, and key proteins were validated by Western blot.

Results

A total of 852 proteins of extracellular vesicles were identified in the proteomic data. Compared with control subjects, 16 specific proteins were identified in plasma extracellular vesicle specimens from HM patients and 6 specific proteins from PDR patients, with 700 common proteins. A total of 25 differentially expressed proteins were found. Compared with control subjects, HM patients had 75 differentially expressed proteins, including 20 up-regulated proteins and 55 down-regulated proteins. These proteins were mainly enriched in immune response and extracellular matrix-related pathways. Among them, the key protein E3 ubiquitin-protein ligase Itchy homolog (ITCH) was up-regulated in the HM group and down-regulated in the PDR group. The protein-protein interaction network of differential proteins in HM patients compared with control subjects contained 46 nodes and 320 edges. The differential proteins in HM patients compared with PDR patients contained 69 nodes and 676 edges in the protein-protein interaction network. A consistent expression trend occurred in scleral tissues of animal models.

Conclusions

HM may potentially inhibit the occurrence and progression of DR, and ITCH is likely involved in this process by regulating inflammatory pathways and retinal angiogenesis. The differential expression of ITCH in the two diseases and its underlying mechanistic pathways provide a new perspective for explaining the clinical observation that diabetic patients with HM tend to have milder DR and a lower risk of its progression.

Key words: High myopia, Diabetic retinopathy, E3 ubiquitin-protein ligase, Extracellular vesicles, Proteomics
图1　三组受试者血浆细胞外囊泡的蛋白质组学分析　图1A示三组受试者血浆细胞外囊泡共有蛋白及特异蛋白数量；图1B示25种差异表达蛋白热图；图1C示HM相对对照组受试者差异表达蛋白火山图　 图2　HM者相对对照组受试者差异表达蛋白的基因本体数据库富集生物学过程分析　 图3　HM组与PDR差异表达蛋白的基因本体数据库富集细胞组分分析　 图4　表达蛋白的京都基因与基因组百科全书富集分析　图4A示HM者相对对照组受试者表达上调的差异蛋白；1~20分别代表酒精中毒、癌症中的转录失调、志贺菌病、系统性红斑狼疮、中性粒细胞外陷阱的形成、癌症中的蛋白聚糖、癌症中的微小核糖核酸、p53信号通路、核因子κB信号通路、膀胱癌、糖胺聚糖生、物合成-硫酸软骨素/硫酸皮肤素、糖胺聚糖生物合成-硫酸乙酰肝素/肝素甘露糖型0-聚糖生物合成、沙门氏菌感染、轴突导向、紧密连接、Notch信号通路、肿瘤坏死因子信号通路及泛素介导的蛋白水解；图4B示高度近视眼组与PDR组表达下调的差异蛋白　1~20分别代表补体和凝血级联反应、非洲锥虫病、胆固醇代谢、百日咳、金黄色葡萄球菌感染、神经退行性疾病通路-多种疾病、炎症介质对瞬时受体电位通道的调控、血管平滑肌收缩、过氧化物酶体增殖物激活受体信号通路、糖酵解/糖异生、细胞黏附分子、催产素信号通路、安非他明成瘾、磷脂酰肌醇信号系统、黑色素生成、昼夜节律同步、钙信号通路、促性腺激素释放激素信号通路、嗅觉转导及光转导　 图5　HM组与PDR组之间主要差异表达蛋白质的蛋白质-蛋白质相互作用图　 图6　动物模型造模及蛋白验证的结果图　图6A示DR组小鼠视网膜苏木精-伊红染色结果；图6B示近视组小鼠4周等效球镜度光度变化；图6C示小鼠模型巩膜组织ITCH蛋白印迹表达水平　注：HM，高度近视眼；PDR，增殖性糖尿病视网膜病变；ITCH，E3泛素蛋白连接酶
表1 高度近视眼者相对对照组受试者血浆细胞外囊泡排名前10位的差异表达
蛋白分类 Uniprot ID 蛋白英文缩写 蛋白英文全称 蛋白中文全称 差异倍数 上调/下调
蛋白质泛素化 Q96J02 ITCH E3 ubiquitin-protein ligase Itchy homolog E3泛素蛋白连接酶Itchy同源物 4.0 上调
脱氧核糖核酸结合 Q8IXZ2 ZC3H3 Zinc finger CCCH domain-containing protein 3 含锌指3半胱氨酸＋组氨酸结构域蛋白3 7.2 上调
  P29374 ARID4A AT-rich interactive domain-containing protein 4A 富含AT互作结构域蛋白4A 4.2 上调
  P68431 H3C1 Histone H3.1 组蛋白H3.1 3.9 上调
  Q71DI3 H3C15 Histone H3.2 组蛋白H3.2 3.8 上调
  Q16695 H3-4 Histone H3.1t 组蛋白H3.1t 3.7 上调
  P84243 H3-3A Histone H3.3 组蛋白H3.3 3.6 上调
  P17041 ZNF32 Zinc finger protein 32 锌指蛋白32 8.3 下调
  O75446 SAP30 Histone deacetylase complex subunit SAP30 组蛋白去乙酰化酶复合物亚基Sin3相关多肽 8.2 下调
核糖核酸结合 O95793 STAU1 Double-stranded RNA-binding protein Staufen homolog 1 双链核糖核酸结合蛋白Staufen同源物1 3.7 上调
酶 Q6GTS8 PM20D1 N-fatty-acyl-amino acid synthase/hydrolase PM20D1 N-脂肪酰基氨基酸合成酶/水解酶含肽酶M20域1 3.6 上调
  P03952 KLKB1 Plasma kallikrein 血浆激肽释放酶 8.5 下调
受体 Q9UEW3 MARCO Macrophage receptor MARCO 具有胶原结构的巨噬细胞受体 7.0 下调
  Q96JA4 MS4A14 Membrane-spanning 4-domains subfamily A member 14 跨膜4结构域亚家族A成员14 3.6 上调
免疫介导 A0A075B6J1 IGLV5-37 Immunoglobulin lambda variable 5-37 免疫球蛋白λ可变区5-37 9.5 下调
  P0C0L4 C4A Complement C4-A 补体C4-A 8.8 下调
蛋白质结合调节 P18206 VCL Vinculin 黏着斑蛋白 8.2 下调
  P20742 PZP Pregnancy zone protein 妊娠区带蛋白 7.4 下调
  P08519 LPA Apolipoprotein(a) 载脂蛋白(a) 7.0 下调
其他 Q9HDC9 APMAP Adipocyte plasma membrane-associated protein 脂肪细胞质膜相关蛋白 8.4 下调
表2 高度近视眼组与增殖性糖尿病视网膜病变组血浆细胞外囊泡排名前10位的差异表达蛋白
蛋白分类 Uniprot ID 蛋白英文缩写 蛋白英文全称 蛋白中文全称 差异倍数 上调/下调
脱氧核糖核酸结合 Q16695 H3-4 Histone H3.1t 组蛋白H3.1t 7.6 上调
  Q71DI3 H3C15 Histone H3.2 组蛋白H3.2 7.5 上调
  P84243 H3-3A Histone H3.3 组蛋白H3.3 7.4 上调
  P68431 H3C1 Histone H3.1 组蛋白H3.1 7.3 上调
分子运输 P52732 KIF11 Kinesin-like protein KIF11 甲状腺激素受体相互作用蛋白5 5.7 上调
  P69905 HBA1 Hemoglobin subunit alpha 血红蛋白α亚基 10.9 下调
蛋白质结合调节 O14950 MYL12B Myosin regulatory light chain 12B 肌球蛋白调节轻链12B 5.5 上调
  P19105 MYL12A Myosin regulatory light chain 12A 肌球蛋白调节轻链12A 5.2 上调
  Q13790 APOF Apolipoprotein F 载脂蛋白F 14.0 下调
  P35908 KRT2 Keratin，type II cytoskeletal 2 epidermal Ⅱ型细胞角蛋白2(表皮型) 9.9 下调
细胞凋亡调控 Q96KQ4 PPP1R13B Apoptosis-stimulating of p53 protein 1 p53凋亡刺激蛋白1 5.0 上调
核糖核酸结合 P50914 RPL14 Large ribosomal subunit protein eL14 大核糖体亚基蛋白延伸因子复合物14 4.5 上调
凝血 P02679 FGG Fibrinogen gamma chain 纤维蛋白原γ链 12.3 下调
  P03952 KLKB1 Plasma kallikrein 血浆激肽释放酶 8.2 下调
酶 Q13093 PLA2G7 Platelet-activating factor acetylhydrolase 血小板活化因子乙酰水解酶 7.6 下调
  Q4FZB7 KMT5B Histone-lysine N-methyltrans-ferase KMT5B 组蛋白赖氨酸N-甲基转移酶5B 7.5 下调
  Q9UHG3 PCYOX1 Prenylcysteine oxidase 1 异戊二烯半胱氨酸氧化酶1 7.3 下调
蛋白质泛素化 P18206 VCL Vinculin 黏着斑蛋白 7.5 下调
免疫介导 P01859 IGHG2 Immunoglobulin heavy constant gamma 2 免疫球蛋白重链恒定区γ2 7.4 下调
其他 Q5SW79 CEP170 Centrosomal protein of 170 kDa 170 kDa中心体蛋白 7.7 上调
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