Study On The Correlation Between Diabetic Retinopathy And Diabetic Nephropathy And Its Key Influencing Factors

Chapter 1.Risk factors and protective factors of diabetic retinopathyPurpose:To explore the influencing factors in the progression of diabetic retinopathy(DR)and to analyze whether cataract surgery and high myopia are independent influencing factors during the progression.Methods:In this study,1063 eyes of 1063 diabetic patients who participated in ophthalmic consultation in Guangdong Provincial People’s Hospital from September 2016 to February 2020 were included.The data of general condition,biochemical index and ocular examination results were collected,and the multivariate regression model was used for statistical analysis.Results:Based on the data of the enrolled population,multiple regression analysis showed that the risk factor for diabetic retinopathy was at older age(odds ratio(OR):1.026,95%confidence interval(CI):1.012-1.042;p<0.001),longer diabetes course(OR:1.164,95%CI:1.090-1.708;p=0.007),with a history of hypertension(OR:2.189,95%CI:1.504-3.175;p=0.008),higher serum creatinine value(OR:1.009,95%CI;1.005-1.013;p<0.001),eye risk factor was cataract surgery(OR:2.106,95%CI:1.5075.273;p=0.001),while the protective factor for DR was high myopia(OR:0.274,95%CI:0.170-0.442;p<0.001).As DR progressed,the protective effect of high myopia became stronger(mild NPDR,OR=0.4613,p=0.003;moderate NPDR,OR=0.217,p=0.003;severe NPDR,OR=0.221,p=0.008;PDR,OR=0.125,p=0.001).In contrast,cataract surgery was an increasingly significant risk factor(mild NPDR,OR=1.595,p=0.258;moderate NPDR,OR=3.955,p=0.005;severe NPDR,OR=6.836,p<0.001;PDR,OR=9.756,p<0.001).Conclusion:The risk factors for DR were older age,history of hypertension,high serum creatinine value,and history of cataract surgery.The protective factors for DR Were high myopia.Among them,the role of high myopia as a protective factor became more and more obvious with the progress of DR;The influence of cataract surgery as a risk factor in the progression of DR Is increasingly significant.Chapter 2.Study on the correlation between diabetic retinopathy and diabetic nephropathyPurpose:To analyze the correlation between DR stage and diabetic nephropathy grade after correcting the risk factors and protective factors explored in Chapter 1,and to explore the reasons for the asynchronous progression between DR and diabetic nephropathy.Methods:Based on the data of 1063 patients included in Chapter 1,subgroup analysis was used to divide the samples into four groups,including high myopia group,cataract operation group,both groups and neither group.The correlation between DR and diabetic nephropathy was analyzed in different subgroups.Partial correlation analysis was used to verify the results.Results:DR was most strongly associated with diabetic nephropathy in group with neither high myopia nor a history of cataract surgery(DR stage and eGFR,r=0.366,p<0.001;DR stage and UACR,r=0.521,p<0.001),which was supported by partial correlation analysis(DR stage and eGFR,r=0.374,p<0.001;DR stage and UACR,r=0.531,p<0.001).Conclusions:By correcting for high myopia and cataract surgery,there shows a higher correlation between DR and diabetic nephropathy,thus partially explaining the reason for the asynchronous progress of them.Chapter 3.Mechanism of high myopia on diabetic retinopathyPurpose:To explore the influence mechanism of high myopia on diabetic retinopathy and the possible influence pathway.Method:The genes of DR and high myopia were obtained based on the open database of GWAS(Genome-wide association studies,GWAS).Characteristic parameter operation was carried out on the obtained genes through protein-protein interation(PPI)to analyze their topological characteristics.After the intersection,genes between DR and high myopia were identified by Venn diagram method,the possible regulatory pathways were identified by kegg network enrichment analysis.Results:It was found that KCNQ5 and INSR in high myopia pathway played a negative role in the regulation of DR.KCNQ5 limited the progress of DR by affecting energy metabolism.INSR prevents the progression of DR by regulating insulin sensitivity and controlling blood sugar levels in the body.Conclusion:The KCNQ5 and INSR pathways in high myopia are negatively correlated with the regulation of DR Progression.This result explains the protective effect of high myopia on DR progression in Chapter 1,indicating that patients with high myopia are less likely to develop PDT than patients without high myopia.