Clinical Study Of Myeloperoxidase And Integrin Family In Type 2 Diabetic Mellitus And Its Retinopathy

Objective This a retrospective study that analyzes the serum myeloperoxidase(MPO),integrin family,oxidative stress and other clinical data in patients with type 2 diabetes mellitus(T2DM).Comparing the differences of these indexes in T2 DM patients with or without diabetic retinopathy(DR),and exploring their clinical significance in DR,so as to find serological indexes for predicting the risk for DR and finding new treatments of DR.Methods There are 146 patients with T2 DM contained in this study who treated in the Department of Endocrinology in the affiliated Hospital of Inner Mongolia Medical University.After all cases were examined with non-mydriatic fundus camera,59 cases and 87 cases were included in diabetic retinopathy(DR)group and non-diabetic retinopathy(NDR)group respectively.According to the clinical manifestations of DR,DR group was divided into nonproliferative diabetic retinopathy(NPDR)group and proliferativediabetic retinopathy(PDR)group,35 cases and 24 cases were included in NPDR group and PDR group respectively.Serum MPO,reactive oxygen species(ROS),malondialdehyde(MDA),integrin αIIb(ITGαIIb),integrinαVβ3(ITGαVβ3),integrin αVβ5(ITGαVβ5)and integrin αVβ6(ITGαVβ6)were tested by enzyme linked immunosorbent assay(ELISA).All clinical indexes were compared between DR and NDR group,NPDR and PDR group.Analyzing the risk factors for DR and PDR,and the value of risk factors on predicting the risk for DR and PDR.Results(1)Comparison of clinical indexes: the course of disease,MPO,MDA,ITGαIIb,ITGαVβ3,ITGαVβ5,neutrophil ratio(NEUT%),neutrophil to lymphocyte ratio(NLR),high sensitivity C reactive protein(hs-CRP),red blood cell volume distribution width(RDW),glycosylated hemoglobin(Hb A1c)and total cholesterol(TC)in DR group were higher than those in NDR group,hematocrit(HCT)in DR group was lower than that in NDR group,the difference was statistically significant(P<0.05).NEUT%,hs-CRP,RDW and TC in PDR group were higher than those in NPDR group.The difference was statistically significant(P<0.05).(2)Multivariate Logistic regression analysis: the course of disease(OR=1.142,P=0.001),MPO(OR=1.016,P=0.016),ITGαVβ3(OR=1.228,P=0.013),ITGαVβ5(OR=1.191,P=0.000),hs-CRP(OR=1.536,P=0.000),RDW(OR=8.766,P=0.000)were risk factors for DR;hs-CRP(OR=1.303,P=0.011),RDW(OR=7.914,P=0.001)were risk factors for PDR.(3)ROC analysis: the course of disease,MPO,ITGαVβ3 and ITGαVβ5 have low accuracy in predicting the risk for DR,hs-CRP and RDW have certain accuracy in predicting the risk for both DR and PDR.(4)Correlation analysis: MPO was positively correlated with ROS(r=0.376,P=0.000),NEUT%(r=0.234,P=0.005)and NLR(r=0.273,P=0.001).Conclusion(1)MPO is a risk factor for DR in patients with T2 DM,and the level of serum MPO in patients with T2 DM is positively correlated with oxidative stress and inflammation;MPO participates in DR by magnifying oxidative stress injury and promoting adhesion and aggregation of inflammatory cells,and MPO may be a new mechanism of connecting oxidative stress and inflammation in microvascular injury.(2)The serum levels of ITGαIIb,ITGαVβ3 and ITGαVβ5 were increased in patients with T2 DM complicated with DR,both ITGαVβ3 and ITGαVβ5 were risk factors for DR.Integrin participates in DR by increasing retinal microvascular permeability,promoting neovascularization and mediating platelet aggregation.(3)RDW and hs-CRP are not only the risk factors for T2 DM patients with DR and PDR,but also have certain accuracy in predicting the risk of DR and PDR.On account of RDW and hs-CRP are available and inexpensive,they have good clinical and economic value in evaluating the risk and progression of DR.