Analysis of peripheral blood biochemical parameters in diabetic retinopathy

Abstract

[한글]서론: 당뇨망막병증을 예측하는 말초혈액 생화학 표지자들의 임상적인 유용성을 평가하기 위하여, 당뇨 환자들을 대상으로 여러 종류의 생화학 표지자들의 혈청 혹은 혈장 농도를 측정하여 비교 평가하였다.방법; 총 98명의 당뇨 환자와 41명의 건강 성인을 대상으로 말초혈액의 생화학 표지자를 분석하였다. 당뇨환자군은 당뇨망막병증이 없는 38명과 당뇨망막병증이 있는 60명으로 구성되었으며, 당뇨망막병증 환자군은 다시 비증식성당뇨망막병증 51명과 증식성당뇨망막병증 9명으로 구성되었다. 나이와 당뇨 유병기간 및 혈중 glucose, BUN, creatinine, lactate dehydrogenase, total cholesterol, HDL-C (high density lipoprotein-cholesterol), LDL-C (low density lipoprotein-cholesterol), LDL 직경, triglyceride 그리고 싸이토카인 즉, IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), interferon-gamma (INF-γ), tumor necrosis factor-alpha (TNF-α), monocyte chemoattractant protein-1 (MCP-1)을 분석하였다.결과: 당뇨 유병기간 (P<0.001)은 당뇨망막병증이 있는 당뇨환자군에서 당뇨망막병증이 없는 당뇨환자군보다 유의하게 길었으며, glucose (P=0.001), total cholesterol (P=0.005) 그리고 LDL-C (P=0.025)은 보다 높았다. 경향성 분석에서 당뇨망막병증이 심할수록, 당뇨의 유병기간 (P for trend <0.001)은 길었으며, glucose (P for trend <0.001), BUN (P for trend=0.021), creatinine (P for trend =0.004), total cholesterol (P for trend=0.004), LDL-C (P for trend=0.023) 그리고 MCP-1 (P for trend=0.049)의 농도는 유의하게 상승하였다. 다중 로지스틱 회귀 분석시 당뇨망막병증의 유병에 관한 유의한 상대위험도를 보이는 항목은당뇨 유병기간 (OR=1.30; 95% CI, 1.14-1.48 per year), glucose(OR=1.01; 95% CI, 1.00-1.02 per 1 mg/dL), total cholesterol (OR=1.03; 95% CI, 1.01-1.05 per 1 mg/dL) 그리고 IL-1β (OR=1.92; 95% CI, 1.16-3.18 per 1 pg/mL)이었다. 증식성당뇨망막병증 환자에서는 비증식성당뇨망막병증 환자보다 당뇨 유병기간 (P=0.004)은 유의하게 더 길었고, IL-6 (P=0.002), TNF-α (P=0.012) 혈중 농도는 더 높았으며, 나이 (P=0.034)는 보다 더 적었고 LDL 직경 (P=0.003)은 더 짧았다.결론: 당뇨 유병기간은 당뇨환자에서 당뇨망막병증의 발병을 예측하는 중요한 위험인자로 판단되었으며 혈중 glucose, total cholesterol, 그리고 LDL-cholesterol 농도는 당뇨 환자에서 당뇨망막병증을 평가하는데 도움이 되며, IL-6, TNF-α 그리고 LDL 직경은 당뇨망막병증 환자에서 증식성당뇨망막병증을 예측하는데 또한 유용할 것으로 판단되었다.

[영문]Introduction: To evaluate the clinical usefulness of peripheral blood biochemicalparameters for the prediction of diabetic retinopathy (DR), peripheral blood levels of various biochemical parameters were measured in diabetes mellitus (DM) patients with or without diabetic retinopathy (DR).Materials and Methods: The peripheral blood samples were obtained from 98 DM patients and 41 healthy controls. There were 38 DM patients without DR and 60 with DR, and the DR cases were categorized as non-proliferative DR (NPDR) in 51 patients and proliferative DR (PDR) in 9 patients. Demographic profiles such as age and DM duration were analyzed. The biochemical profiles of the blood were analyzed for glucose, BUN, creatinine, lactate dehydrogenase, total cholesterol, triglyceride, high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C) and LDL diameter. In addition, various cytokines such as IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), interferon-gamma (INF-γ), tumor necrosis factor-alpha (TNF-α) and monocyte chemoattractant protein-1 (MCP-1) were also analyzed.Results: DM duration (P<0.001) was longer in DM patients with DR comparedto DM patients without DR. Glucose (P=0.001), total cholesterol (P=0.005) andLDL-C (P=0.025) were significantly higher in DM patients with DR than in DM patients without DR. In trend analysis, the severity of DR showed a significant positive correlation with DM duration (P<0.001), glucose (P<0.001), BUN (P=0.021), creatinine (P=0.004), total cholesterol (P=0.004), LDL-C (P=0.023) and MCP-1 (P=0.049). The independent risk factors associated with the presence of DR by multiple logistic regression analysis were DM duration (OR=1.30; 95% CI, 1.14-1.48 per year), glucose (OR=1.01; 95% CI, 1.00-1.02 per 1 mg/dL), total cholesterol (OR=1.03; 95% CI, 1.01-1.05 per 1 mg/dL) and IL-1β (OR=1.30; 95% CI, 1.14-1.48 per 1 pg/mL). DM duration (P=0.004) was longer than in DM patients with non-proliferative diabetic retinopathy (NPDR). IL-6 (P=0.002) and TNF-α (P=0.012) levels were higher in DM patients with PDR compared to those with NPDR. DM patients with PDR were younger than those with NPDR(P=0.034). And the LDL diameter (P=0.003) was smaller in DM patients with PDR compared to those with NPDR.Conclusions: DM duration seems to be an important risk factor in the prediction of diabetic retinopathy. The serum glucose, total cholesterol, and LDL-cholesterol levels may be useful in the evaluation for diabetic retinopathy in DM patients. In addition, levels of IL-6 and TNF-α, as well as LDL diameter may also be useful for the prediction of PDR in DM patients with diabetic retinopathy.