Endothelial dysfunction and low-grade inflammation and the progression of retinopathy in Type 2 diabetes
Endothelial dysfunction and low-grade inflammation and the progression of retinopathy in Type 2 diabetes
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DOI：
10.1111/j.1464-5491.2007.02217.x
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发表时间：
2007-09-01
影响因子：
3.5
通讯作者：
Stehouwer, C. D. A.
中科院分区：
文献类型：
--
作者：
Spijkerman, A. M. W.;Gall, M.-A.;Stehouwer, C. D. A.
Aims To study whether microalbuminuria，endothelial dysfunction and low-grade inflammation are associated with the presence and progression of diabetic retinopathy.Methods参加糖尿病门诊的2型糖尿病患者（n = 328）随访10年，并在过去的7年中每年检查一次。通过直接眼底镜检查（基线）和双视野60度眼底照相（随访）评估瞳孔扩大后的视网膜病变。尿白蛋白排泄，内皮功能的标志物（血管性血友病因子，组织型纤溶酶原激活剂，可溶性E-选择素（sE-选择素），可溶性血管细胞粘附分子1）和炎症活动（C-反应蛋白和纤维蛋白原）进行了determined.Results视网膜病变的患病率为33.8%。基线时的中位糖尿病病程为7年（四分位距2-12年）。基线尿白蛋白排泄和糖化血红蛋白（HbA（1c））的最高三分位数与视网膜病变的患病率相关：比值比（OR）95%置信区间（CI）分别为2.80（1.44-5.46）和2.19（1.11-4.32）。188例患者发生视网膜病变进展。基线sE-选择素的第二和第三个三分位数与视网膜病变进展相关[1.44（1.04-2.01）和1.61（1.19-2.18）]，但与HbA无关（1c）。其他标志物均与视网膜病变的存在或进展无显著相关性。高基线HbA（1c）与视网膜病变的进展显著相关：1.65（1.21-2.25）.结论在糖尿病门诊就诊的2型糖尿病患者中，有一些证据表明内皮功能障碍在视网膜病变的进展中起作用。我们无法证明低度炎症的作用。我们的研究强调了血糖控制在视网膜病变发展和进展中的重要性。
Aims To study whether microalbuminuria, endothelial dysfunction and low-grade inflammation are associated with the presence and progression of diabetic retinopathy.Methods Patients with Type 2 diabetes (n = 328) attending a diabetes clinic were followed for 10 years and examined annually during the last 7 years. Retinopathy was assessed after pupillary dilatation by direct ophthalmoscopy (baseline) and two-field 60 degrees fundus photography (follow-up). Urinary albumin excretion, and markers of endothelial function (von Willebrand factor, tissue-type plasminogen activator, soluble E-selectin (sE-selectin), and soluble vascular cell adhesion molecule 1) and inflammatory activity (C-reactive protein and fibrinogen) were determined.Results The prevalence of retinopathy was 33.8%. The median diabetes duration at baseline was 7 years (interquartile range 2-12 years). The highest tertiles of baseline urinary albumin excretion and glycated haemoglobin (HbA(1c)) were associated with prevalent retinopathy: odds ratio (OR) 95% confidence interval (CI) 2.80 (1.44-5.46) and 2.19 (1.11-4.32), respectively. Progression of retinopathy occurred in 188 patients. The second and third tertiles of baseline sE-selectin were associated with progression of retinopathy [1.44 (1.04-2.01) and 1.61 (1.19-2.18)] but not independently of HbA(1c). None of the other markers was significantly associated with the presence or progression of retinopathy. High baseline HbA(1c) was significantly associated with progression of retinopathy: 1.65 (1.21-2.25).Conclusion In this population of patients with Type 2 diabetes who attended a diabetes clinic, there was some evidence for a role of endothelial dysfunction in the progression of retinopathy. We could not demonstrate a role for low-grade inflammation. Our study emphasizes the importance of glycaemic control in the development and progression of retinopathy.