Correlations of serum hypoxia-inducible factor 1α, vascular endothelial growth factor, and stromal cell-derived factor-1 levels with microvascular injury in patients with proliferative diabetic retinopathy

Background Proliferative diabetic retinopathy (PDR) is characterized by pathological neovascularization and microvascular damage driven by hypoxia-related mechanisms. We aimed to explore the correlations of serum hypoxia-inducible factor 1α (HIF-1α), vascular endothelial growth factor (VEGF), and stromal cell-derived factor-1 (SDF-1) levels with microvascular injury in patients with proliferative diabetic retinopathy. Methods Subjects (150 in total) with type 2 diabetes mellitus and diabetic retinopathy (DR) who were treated at our hospital between January 2023 and June 2024 were assigned to a proliferative DR (PDR) group (n=82) and a non-proliferative DR (NPDR) group (n=68). Comparisons were carried out on the general data, microvascular endothelial function [circulating endothelial cells (CEC), endothelial progenitor cells (EPC), and circulating progenitor cells (CPC)], and serum HIF-1α, VEGF and SDF-1 between the two groups. Results High expressions of serum HIF-1α, VEGF, and SDF-1 were associated with an increased risk of PDR of 2.465, 3.132, and 2.592 times, respectively ( p <0.05). Serum HIF-1α, VEGF, and SDF-1 were independent influencing factors for PDR ( p <0.05). Areas under the curves (AUCs) of serum HIF-1α, VEGF, and SDF-1 for predicting PDR were 0.721, 0.762, and 0.748, respectively. A prediction model combining serum HIF-1α, VEGF, and SDF-1 was constructed: Log(P) = -0.251 + 0.271 × HIF-1α + 0.290 × VEGF + 0.277 × SDF-1. AUCs of the triple combination for PDR prediction was 0.869, significantly exceeding the predictive values of the three indicators alone (Z=3.246, 3.172, 3.231, p =0.002, <0.001, <0.001). Conclusions Serum HIF-1α, VEGF, and SDF-1 have significant correlations with microvascular injury in proliferative diabetic retinopathy patients, and their combination is highly valuable for the early identification of high-risk patients.