The Relationship Between Epicardial Adipose And Type 2 Diabetic Retinopathy

Background and Purpose:In recent years,the incidence of Type 2 Diabetes Mellitus(T2DM)has gradually increased,and the incidence of Diabetic Retinopathy(DR)as its complication has increased,and the increased prevalence of DR and its risk factors have attracted increasing attention.Studies have shown that epicardial adipose tissue(EAT)plays an important role in the progression of diabetes,EAT can produce a variety of anti-inflammatory factors.Inflammation plays an important role in the occurrence and progression of DR.Monocyte to High Density Lipoprotein Cholesterol Ratio(MHR)is a new inflammatory marker.There are few studies on the relationship between EAT and MHR and DR.Therefore,the aim of this study was to investigate the association between epicardial adipose tissue volume,MHR and DR in patients with T2DM and the independent risk factors for DR,as well as to provide new ideas for the prevention and treatment of DR in clinical practice.Method:A total of 271 patients with type 2 diabetes,including 146 males and 125 females,were included in the study.The subjects were divided into a diabetes without retinopathy group and a diabetic retinopathy group,according to the 2002international clinical grading criteria for diabetic retinopathy.133 patients in the diabetes without retinopathy group and 138 patients in the diabetic retinopathy group were included.General clinical data of all patients were collected:age,gender,course of diabetes,systolic blood pressure,diastolic blood pressure,height,weight,history of diabetes nephropathy,history of hypertension,serum creatinine(Scr),total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),fasting blood glucose(FPG),urinary microalbumin/creatinine ratio(UACR),fasting C-peptide(FCP),Glycosylated hemoglobin(Hb A1c),monocyte count and epicardial adipose tissue volume of subjects were measured,and BMI and MHR were calculated.The data were statistically analysed to compare the differences in indicators between groups and to identify potential risk factors for DR in patients with T2DM.Results:1.The differences in gender,diastolic blood pressure and BMI between the 2groups were not statistically significant(P>0.05).Age,course of diabetes,systolic blood pressure,prevalence of diabetic nephropathy and prevalence of hypertension were significantly higher in the diabetic retinopathy group than in the diabetes without retinopathy group,with statistically significant differences(P<0.05).2.FCP was significantly lower in the diabetic retinopathy group than that in the diabetes without retinopathy group,and the difference was statistically significant(P<0.001);HLD-C was significantly lower in the diabetic retinopathy group than that in the diabetes without retinopathy group,and the difference was statistically significant(P<0.05);UACR,monocyte count and MHR were significantly higher in the diabetic retinopathy group than that in the diabetes without retinopathy group,and the difference was statistically significant(P<0.001).There was no statistically significant difference in Hb A1c,FPG,TG,TC,LDL-C and Scr between the two groups(P>0.05).3.The volume level of epicardial adipose tissue in diabetic retinopathy group was significantly higher than that in diabetes without retinopathy group,and the difference was statistically significant(P<0.001).4.According to the interquartile level of the volume of epicardial adipose tissue of all enrolled patients,they were divided into Q1 group(epicardial adipose tissue volume<99.68cm~3),Q2 group(99.68cm~3<epicardial adipose tissue volume<122.42cm~3),Q3 group(122.42cm~3<epicardial adipose tissue volume<154.33cm~3),Q4 group(epicardial adipose tissue volume>154.33cm~3)to conduct a trend test.The results showed that the prevalence of DR was 39.7%in the Q1 group,44.1%in the Q2 group,48.5%in the Q3 group,and 71.6%in the Q4 group.As the level of epicardial adipose tissue volume increased,the prevalence of DR increased,and the difference was statistically significant(P=0.001).5.Patients were divided into diabetes without retinopathy group and diabetic retinopathy group as dependent variables according to whether they had combined diabetes retinopathy,and age,FCP,epicardial adipose tissue volume,UACR,course of diabetes and hypertension were included in the binary logistic regression analysis as independent variables.The results showed that an increase in epicardial adipose tissue volume would increase the risk of DR with statistical significance(OR=1.017,95%confidence interval 1.009-1.025,P<0.001),a smaller FCP would increase the risk of DR with statistical significance(OR=0.778,95%confidence interval0.65-0.932,P=0.006),a longer course of diabetes,the higher the risk of DR,statistically significant(OR=1.053,95%confidence interval 1.007-1.100,P=0.022),the higher the risk of DR in patients with hypertension compared to those without hypertension,statistically significant(OR=1.947,95%confidence interval1.085-3.494,P=0.025).It is suggested that in patients with type 2 diabetes,decreased FCP,prolonged duration of diabetes,elevated EAT volume,and a history of hypertension are independent risk factors for DR.Conclusion:1.The volume of epicardial adipose tissue and the ratio of monocyte to high-density lipoprotein cholesterol in type 2 diabetes patients with diabetes retinopathy were significantly higher than those in type 2 diabetes patients without retinopathy,and the risk of DR increased with higher EAT volume.2.Decreased FCP,prolonged course of diabetes,increased EAT volume,and a history of hypertension were independent risk factors for DR.