血清胆红素水平与2型糖尿病视网膜病变的相关性

目的 探讨血清胆红素水平与糖尿病视网膜病变（DR）之间的关系。方法 选取2型糖尿病患者293例,依据眼底检查分为糖尿病无视网膜病变组（NDR）（n=146）、糖尿病视网膜病变组（DR）（n=147）,将DR组分为非增殖期糖尿病视网膜病变组（NPDR）（n=103）、增殖期糖尿病视网膜病变组（PDR）（n=44）。对NDR、NPDR、PDR 3组患者临床资料进行分析比较。依据总胆红素四分位数分为Q1、Q2、Q3、Q4组,分析总胆红素与DR患病率的关系。结果 与NDR组比较,NPDR组和PDR组中的病程、收缩压均升高（P＜0.05）,且PDR组中的病程、收缩压高于NPDR组（P＜0.05）。与NDR组比较,NPDR组和PDR组中总胆红素（TBIL）、直接胆红素（DBIL）、餐后2小时C 肽（2 h CP）均减低,且PDR组中TBIL、DBIL、间接胆红素（IBIL）、2 h CP低于NPDR组（P＜0.05）。与NDR组比较,PDR组中IBIL低于NDR组（P＜0.05）。与NDR组比较,NPDR组和PDR组中FPG、2 hPG、HbA1c、TC均升高,且PDR组中FPG、2 hPG、HbA1c、γ GGT高于NPDR组（P＜0.05）。与NDR组比较,PDR组中γ GGT高于NDR组（P＜0.05）。多元有序Logistic回归分析：TBIL、2 h CP是DR的保护性因素;病程、收缩压、FPG、2 hPG、HbA1c、γ GGT是DR的危险因素。不同TBIL水平DR的患病率存在差异,随着TBIL水平的升高,DR的患病率呈现下降趋势（P＜0.05）。结论 TBIL水平的降低与DR发病风险增加显著相关,可作为预测DM患者发生DR风险的潜在性生物标志物。对于血清胆红素偏低的患者,密切监测2 h CP水平以及加强监控管理血糖、HbA1c、SBP、γ GGT,对DR的预防具有重要意义。     

老年2型糖尿病患者BNP、HbA1c的变化与视网膜病变的关系

目的探讨血浆B型钠尿肽（BNP）、糖化血红蛋白（HbA1c）与2型糖尿病性视网膜病变（DR）的关系。方法分别应用Nycocard READER11分析仪及Dxpress德帕思心梗心力衰竭快速检测仪检测167例老年2型糖尿病患者[包括2型糖尿病无视网膜病变（NDR）患者65例、2型糖尿病伴非增生性视网膜病变（NPDR）患者59例、2型糖尿病伴增生性视网膜病变（PDR）患者43例]及50名无糖尿病及严重心血管疾病的老年人血浆HbA1c和BNP水平。分析各组间BNP、HbA1c水平变化及其与视网膜病变的关系。结果NPDR及PDR组HbA1c水平高于NDR组（P〈0．05）,且HbA1c水平越高,DR发生率越高（P〈0．01）。NPDR组BNP水平与NDR组比较无明显差异（P〉0．05）,而PDR组血浆BNP水平高于NDR组及NPDR组,并且随病变程度加重,其血浆浓度也增加（P〈0．01）。结论PDR患者BNP及HbA1c水平均较高,因此二者联合检测可以间接反映老年DR发生和发展的程度以及是否伴有其他糖尿病性并发症。     

中国人群中血糖波动与2型糖尿病视网膜病变关系的meta分析

目的 通过比较血糖波动在2型糖尿病伴视网膜病变（diabetic retinopathy, DR）与2型糖尿病不伴视网膜病变（non diabetic retinopathy, NDR）人群中的差异，探讨血糖波动与DR的关系。方法 全面检索数据库，纳入比较DR患者与NDR患者血糖波动的文献17篇，采用RevMan5.3软件和STATA12.0软件进行meta分析。结果 在纳入的17项研究中， DR组的平均血糖波动幅度（mean amplitude of glycemic excursion, MAGE）明显高于NDR组［加权均数差（weighted mean difference, WMD）及95%CI为2.12(1.66，2.58)，P＜0.01］。在纳入的9项研究中，非增殖期糖尿病视网膜病变（non proliferative diabetic retinopathy, NPDR）组的MAGE明显低于增殖期糖尿病视网膜病变（proliferative diabetic retinopathy, PDR）组［WMD及95%CI为-1.09(-1.42，-0.77)，P<0.01］。NPDR组的MAGE明显高于NDR组［WMD及95%CI为1.52（1.25，1.79），P<0.01］。结论 从NDR组到NPDR组再到PDR组，平均血糖波动幅度呈逐步增大趋势。     

血清C反应蛋白、铁蛋白与糖尿病视网膜病变严重程度关系的研究

目的探讨血清C反应蛋白（CRP）、血清铁蛋白（sF）水平和糖尿病视网膜病变（DR）严重程度的关系。方法随机选取住院的2型糖尿病患者60例,根据眼底检查结果分为无糖尿病视网膜病变组（M）R）21例、非增值期糖尿病视网膜病变组（NPDR）20例、增值期糖尿病视网膜病变组（PDR）19例。比较3组患者CRP、SF水平的关系。结果CRP、SF水平在NDR组、NPDR组、PDR组中逐渐升高,3者问比较差异有统计学意义（P〈0．05）。多因素有序logistic回归分析显示CRPSF是DR严重程度的独立危险因素。结论血清CRP、SF水平和DR严重程度密切相关,应重视早期监测血清CRP和SF。     

2型糖尿病患者尿白蛋白排泄量与视网膜病变的相关性研究

【目的】探讨2型糖尿病（T2DM ）患者尿白蛋白排泄量与视网膜病变（DR）的相关性。【方法】260例T2DM患者,依据尿白蛋白排泄量分为正常白蛋白尿组41例（NA组,24 h尿白蛋白＜30 mg）、微量白蛋白尿组118例（M A U组,24 h尿白蛋白30～300 m g ）和大量白蛋白尿组101例（C A U组,24 h尿白蛋白＞300 mg）。检测各组患者的24 h尿白蛋白定量并进行眼底检查,分析T2DM患者尿白蛋白排泄量与DR的相关性。【结果】NA组单纯性视网膜病变（NPDR）检出率为98．％,增殖性视网膜病变（PDR）检出率为48．％;MAU组NPDR检出率为43．2％,PDR检出率为16．1％;CAU 组 NPDR检出率为42．6％,PDR检出率为347．％;各组NPDR和PDR检出率比较差异有统计学意义（ P ＜00．5）;相关性分析结果显示,T2DM 患者尿白蛋白排泄量与DR检出率呈正相关（ P ＜00．5）。【结论】T2DM 患者尿白蛋白排泄量与DR的发生显著相关,两者可能存在共同的病理生理基础。     

血清及房水白细胞介素-6水平与糖尿病性视网膜病变的相关性

目的分析血清及房水中白细胞介素-6（interleukin-6,IL-6）水平与糖尿病性视网膜病变（diabetic retinopathy,DR）的相关性,探讨IL-6在DR发生、发展中的作用。方法60例2型糖尿病患者（实验组）,其中20例20眼无DR（non-DR,NDR）为NDR组,20例20眼非增生性DR（non-proliferative DR,NPDR）为NPDR组,20例20眼增生性DR（proliferative DR,PDR）为PDR组;健康老年性白内障患者20例20眼为对照组。采用电化学发光法检测各组血清及房水中IL-6水平,并进行比较。结果 NDR组、NPDR组、PDR组血清IL-6水平分别为（3.72±1.50）、（4.56±2.33）、（4.52±1.97）ng/L,对照组为（3.50±2.24）ng/L,实验组与对照组比较差异无统计学意义（F=1.430,P=0.240）;NDR组、NPDR组和PDR组房水IL-6水平分别为（128.42±32.22）、（205.15±25.15）、（1 618.00±42.66）ng/L,对照组为（115.80±29.97）ng/L,实验组与对照组比较差异有统计学意义（F=9 851.950,P=0.000）;NDR组房水IL-6水平与对照组比较差异无统计学意义（P〉0.05）,NPDR组与PDR组房水IL-6水平均高于对照组（P〈0.01）,且随眼部病情加重,有增高趋势（P〈0.01）。结论房水IL-6水平的表达与DR程度相关。     

3 404例2型糖尿病患者视网膜病变患病率及其相关因素分析

目的 分析2型糖尿病（T2DM）患者视网膜病变（DR）患病率及其相关因素。方法 对3 404例2型糖尿病住院患者进行回顾性研究，根据眼科会诊结果，将患者分为3组，其中非DR组（A组/NDR组）2 562例，DR非增殖期组（B组/NPDR组）716例，DR增殖期组（C组/PDR组）126例。得出DR的患病率，比较3组患者之间临床资料及临床指标的异同，及其与DR的相关性。结果 2型糖尿病患者DR患病率达24.7%，与甘油三酯（OR=1.110，P=0.000）、糖化血红蛋白（HbA1c）（OR=1.087，P=0.000）、血尿酸（OR=1.003，P=0.000）、病程（OR=1.002，P=0.000）相关。结论 2型糖尿病患者DR患病率为24.7%，高血脂、高血糖、高尿酸血症、病程长为DR的独立危险因素。早期发现糖尿病、早期治疗糖尿病、积极控制血糖血脂血尿酸，对于减少DR的发生及延缓DR的发展意义重大。     

高同型半胱氨酸血症与2型糖尿病视网膜病变的关系

目的 探讨2型糖尿病患者血浆同型半胱氨酸（homocysteine, Hcy）水平与糖尿病视网膜病变之间的关系. 方法 测定45例2型糖尿病（DM）患者及19例健康对照者（CON）血浆同型半胱氨酸水平,45例2型糖尿病患者分为糖尿病视网膜病变（DR）组（17例）与无视网膜病变（NDR）组（28例）,比较各组间血浆总Hcy的水平;再将17例DR组分为增殖期糖尿病视网膜病变（PDR）组（9例）和背景期糖尿病视网膜病变（BDR）组（8例）,比较两组间血浆总Hcy的水平. 结果 2型糖尿病患者中DR组的血浆总Hcy水平高于NDR组及CON组（P＜0.01）,NDR与CON组比较则无显著性差异.在DR组,PDR组的血浆总Hcy水平显著高于BDR组（P＜0.01）,以正常对照组的血浆Hcy均数＋2个标准差作为高Hcy血症的诊断标准,PDR组高Hcy血症的发生率高于BDR组（P＜0.05）. 结论 2型糖尿病患者伴有视网膜病变者血浆总Hcy水平升高,其中PDR组的血浆总Hcy又高于BDR组.血浆总Hcy水平升高,可能是2型糖尿病视网膜病变的危险因素之一.     

糖尿病视网膜病变患者血清胎球蛋白A水平的变化及其与CRP的相关性

目的探讨糖尿病视网膜病变(DR)患者血清胎球蛋白A(AHSG)水平的变化及其与C反应蛋白(CRP)的相关性。方法选取2型糖尿病(T2DM)患者115例,分为糖尿病无视网膜病变(NDR)组46例、非增生性糖尿病视网膜病变(NPDR)组37例、增生性糖尿病视网膜病变(PDR)组32例;另选取正常对照组40名。采用酶联免疫吸附试验(ELISA)测定血清AHSG与CRP水平。结果 NDR组、NPDR组及PDR组血清AHSG及CRP水平均高于正常对照组,组间比较及组内两两比较差异均有统计学意义(P0.05,P0.01)。T2DM患者的血清AHSG水平与CRP呈正相关(r=0.239,P0.05)。结论 AHSG水平升高与DR的病情严重程度有关,其可能通过促炎性效应参与DR的发生、发展。     

线粒体DNA 5178C/A多态性与2型糖尿病关系的研究

目的研究线粒体DNA5178C/A多态性与2型糖尿病(T2DM)及其并发症的关系。方法采用聚合酶链反应(PCR)与PCR产物直接测序的方法,对2型糖尿组(220例)及正常对照组(126例)进行基因分析。结果 5178C基因型与5178A基因型的T2DM患者在性别、发病年龄、体重指数、血糖、血脂等水平差异无统计学意义,但T2DM患者中5178C基因型并发视网膜病变的频率要高于5178A基因型(P0.05)。结论线粒体DNA5178C/A多态性可能与T2DM患者并发视网膜病变负相关。     

Antiatherogenic mitochondrial genotype in patients with type 2 diabetes

OBJECTIVE: To evaluate the significance of a longevity-associated mitochondrial genotype (Mt5178A) derived from a C --> A transversion at nucleotide position 5178 of mitochondrial DNA, which causes a Leu-to-Met substitution within the NADH dehydrogenase subunit 2 gene, in type 2 diabetic subjects. RESEARCH DESIGN AND METHODS: Mt5178 typing was done by polymerase chain reaction-restriction fragment-length polymorphism with the restriction enzyme AluI in 1,148 type 2 diabetic Japanese subjects, and the results were compared with the clinical characteristics. Then, the association of Mt5178 type with early atherosclerotic changes of the bilateral carotid arteries on ultrasonography was assessed in 412 diabetic subjects randomly selected from the original 1,148 type 2 diabetic subjects, while maintaining the same frequency of Mt5178A and Mt5178C. RESULTS: The frequency of Mt5178A in the type 2 diabetic subjects (454 of 1,148; 40%) was not different from that previously found in healthy blood donors (114 of 252; 45%). Clinical characteristics regarding diabetes were not significantly different between the Mt5178A group (n = 454) and the Mt5178C group (n = 694). However, the mean intima-media thickness (IMT) at six sites in the bilateral carotid arteries was significantly smaller in the Mrt5178A group than in the Mt5178C group (0.906 +/- 0.018 vs. 0.995 +/- 0.021 mm, mean +/- SEM, P = 0.022), and the Mt5178 type was significantly correlated with both the mean IMT and the presence of plaque on multiple regression analysis and discriminant analysis. CONCLUSIONS: The Mt5178A genotype may be unrelated to the etiology of type 2 diabetes. However, Mt5178A seems to have an antiatherogenic effect, at least in type 2 diabetic individuals.     

Diabetic Retinopathy and Microalbuminuria Can Predict Macroalbuminuria and Renal Function Decline in Japanese Type 2 Diabetic Patients: Japan Diabetes Complications Study

OBJECTIVE

To examine the interactive relationship between diabetic retinopathy (DR) and diabetic nephropathy (DN) in type 2 diabetic patients and to elucidate the role of DR and microalbuminuria on the onset of macroalbuminuria and renal function decline.

RESEARCH DESIGN AND METHODS

We explored the effects of DR and microalbuminuria on the progression of DN from normoalbuminuria and low microalbuminuria (<150 mg/gCr) to macroalbuminuria or renal function decline in the Japan Diabetes Complications Study (JDCS), which is a nationwide randomized controlled study of type 2 diabetic patients focusing on lifestyle modification. Patients were divided into four groups according to presence or absence of DR and MA: normoalbuminuria without DR [NA(DR−)] (n = 773), normoalbuminuria with DR [NA(DR+)] (n = 279), microalbuminuria without DR [MA(DR−)] (n = 277), and microalbuminuria with DR [MA(DR+)] (n = 146). Basal urinary albumin-to-creatinine ratio and DR status were determined at baseline and followed for a median of 8.0 years.

RESULTS

Annual incidence rates of macroalbuminuria were 1.6/1,000 person-years (9 incidences), 3.9/1,000 person-years (8 incidences), 18.4/1,000 person-years (34 incidences), and 22.1/1,000 person-years (22 incidences) in the four groups, respectively. Multivariate-adjusted hazard ratios of the progression to macroalbuminuria were 2.48 (95% CI 0.94–6.50; P = 0.07), 10.40 (4.91–22.03; P < 0.01), and 11.55 (5.24–25.45; P < 0.01) in NA(DR+), MA(DR−), and MA(DR+), respectively, in comparison with NA(DR−). Decline in estimated glomerular filtration rate (GFR) per year was two to three times faster in MA(DR+) (−1.92 mL/min/1.73 m²/year) than in the other groups.

CONCLUSIONS

In normo- and low microalbuminuric Japanese type 2 diabetic patients, presence of microalbuminuria at baseline was associated with higher risk of macroalbuminuria in 8 years. Patients with microalbuminuria and DR showed the fastest GFR decline. Albuminuria and DR should be considered as risk factors of renal prognosis in type 2 diabetic patients. An open sharing of information will benefit both ophthalmologists and diabetologists.Diabetic retinopathy (DR) and nephropathy (DN) are two major chronic microvascular complications in long-standing type 1 and type 2 diabetic patients. However, it is still unclear whether these 2 complications are related to or affect each other or whether both of them progress simultaneously after their onset, although many epidemiological studies have shown the coexistence of DR and DN (1,2). In fact, we sometimes see proteinuric diabetic patients without DR or normoalbuminuric patients with proliferative DR, which is the most advanced stage of DR. For example, it was shown that only 36% had no DR, while 53% had nonproliferative, 9% moderate to severe, and 2% severe DR in 285 normoalbuminuric Caucasian type 1 diabetic patients (3). In addition, there was marked discordance between DR and DN, especially in normoalbuminuria or low-level microalbuminuria, while advanced renal histological severity has been related to advanced DR severity in Caucasian type 1 diabetic patients (4). On the other hand, diabetic patients treated by diabetologists sometime miss their visits to ophthalmologists; therefore, the relationships or detailed clinical courses of DR and DN can hardly be analyzed in most clinical sites.All over the world, DN is a major cause of end-stage renal disease, which requires renal replacement therapy such as hemodialysis or renal transplantation (5,6). In Japan, the number of patients requiring renal replacement therapy has increased threefold in the last 15 years. Therefore, it is absolutely necessary to stop the progression of DN and to find biomarkers or easily available factors that represent the exact clinical course or prognosis of DN. However, it is not exactly known what factors affect an increase of urinary albumin excretion (UAE) or glomerular filtration rate (GFR) decline, which are typical clinical changes in DN.Microalbuminuria is well known as a risk factor resulting in macroalbuminuria in type 1 and type 2 diabetic patients (7–9). In addition, some Caucasian type 2 diabetic patients with microalbuminuria showed rapid decline of GFR, although it was unclear whether these patients had more frequent DR compared with the patients without rapid GFR decline (10). On the other hand, DR was shown to be a risk factor of microalbuminuria and macroalbuminuria (2,11). In addition, proliferative DR was shown to be a predictor of macroalbuminuria in Caucasian type 1 diabetic patients (13), but this association has not been investigated in Asian populations. Although DR and glomerulosclerosis seemed to be parallel to progress using the investigation of serial renal biopsy specimens (14) when the blood glucose control was fair to poor, detailed interaction between two complications are still obscure in a large number of patients. Whether DR can predict renal functional decline in type 1 and type 2 diabetic patients remains to be clarified.The Japan Diabetes Complications Study (JDCS) is a nationwide randomized controlled study of type 2 diabetic patients focusing on lifestyle modification (15,16). We have reported the extremely low transition rate from normoalbuminuria and low microalbuminuria in this Japanese cohort (9), as well as incidence and progression rates of DR that were also lower than in Caucasian populations (15). In addition, we have also shown that the incidence and progression rate of DR were lower than those in Caucasian populations and that glycemic control, duration of diabetes, and systolic blood pressure (SBP) were related to DR in the JDCS cohort (17). Here, we elucidated the relationships between DN and DR, and the risk factors of the UAE increase and GFR decline according to the presence or absence of microalbuminuria or DR in the JDCS cohort.     

25-羟维生素D、脂蛋白相关磷脂酶A2与糖尿病视网膜病变的相关性:单中心回顾性研究

  目的  探讨25-羟维生素D[25-hydroxy vitamin D, 25(OH)D]、脂蛋白相关磷脂酶A2(lipoprotein-associated phospholipase A2, LP-PLA2)与糖尿病视网膜病变(diabetic retinopathy, DR)的相关性。  方法  回顾性收集并分析2014年5月至2017年1月沧州市中心医院内分泌科收治的2型糖尿病患者的临床资料,根据眼底摄片结果,分为糖尿病不伴视网膜病变组(no DR, NDR)组,背景期糖尿病伴视网膜病变(background DR, BDR)组和增殖期糖尿病伴视网膜病变(proliferative DR, PDR)组,选取同期于本院进行体检的健康人作为对照组。比较4组相关生化指标水平,采用Pearson相关分析及多元Logistic回归分析DR的相关及独立危险因素。  结果  共340例符合纳入和排除标准的2型糖尿病患者入选本研究,其中NDR组125例、BDR组118例、PDR组97例, 对照组100例。4组间的性别、年龄、体质量指数、收缩压、舒张压、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、空腹血糖差异无统计学意义(P均＞0.05);NDR组、BDR组、PDR组的病程逐渐增长(P=0.003),NDR组、BDR组、PDR组糖化血红蛋白A1C(glycated hemoglobin A1c, HbA1c)、糖化白蛋白(glycated albumin, GA)、血清胱抑素C(serum cystatin C, Cys-C)、LP-PLA2均显著高于健康对照组, 25(OH)D显著低于健康对照组(P均＜0.05);NDR、BDR、PDR组间两两比较,HbA1c、GA、Cys-C、LP-PLA2、25(OH)D差异亦有统计学意义(P均＜0.05)。Pearson相关分析显示,病程、HbA1c、GA、Cys-C及LP-PLA2与DR呈正相关(P均=0.000),25(OH)D与DR呈负相关(P=0.000)。多元Logistic回归分析显示,病程、HbA1c、Cys-C、LP-PLA2、25(OH)D与DR及其严重程度均独立相关(P均＜0.05)。  结论  25(OH)D 、LP-PLA2水平与DR的发生、发展密切相关,25(OH)D是其保护因素,而LP-PLA2是其危险因素。     

2型糖尿病患者糖尿病视网膜病变检出率及其相关危险因素分析

目的：探讨2型糖尿病患者糖尿病视网膜病变（DR）的发生率及相关危险因素。方法：收集448例2型糖尿病患者的眼底检查情况及其他临床资料,根据眼底检查结果将患者分为糖尿病无视网膜病变（NDR）及糖尿病视网膜病变（DR）组,比较可能诱发DR的危险因素。结果：112例患者合并DR占总数的25．0％。年龄、糖尿病病程、收缩压、尿素氮、肌酐、尿微量白蛋白以及高血压、脑梗死合并率两组之间的差异有统计学意义。Logistic回归糖尿病病程、尿微量白蛋白是DR发生的独立危险因素。结论：我院住院2型糖尿病患者中25．0％合并DR,糖尿病病程、尿微量白蛋白是DR独立的危险因素。     

Diabetic retinopathy predicts all-cause mortality and cardiovascular events in both type 1 and 2 diabetes: meta-analysis of observational studies

OBJECTIVE

The prognostic significance of diabetic retinopathy (DR) for death and cardiovascular (CV) outcomes is debated. We investigated the association of DR with all-cause mortality and CV events in patients with diabetes by a systematic review and meta-analysis.

RESEARCH DESIGN AND METHODS

The electronic databases Medline and Embase were searched for cohort studies that evaluated DR in type 2 or type 1 diabetic patients and reported total mortality and/or fatal and nonfatal CV events, including myocardial infarction, angina pectoris, coronary artery bypass graft, ischemic changes on a conventional 12-lead electrocardiogram, transient ischemic attack, nonfatal stroke, or lower leg amputation. Data extraction was performed by two reviewers independently. Pooled effect estimates were obtained by using random-effects meta-analysis.

RESULTS

The analysis included 20 studies that fulfilled the inclusion criteria, providing data from 19,234 patients. In patients with type 2 diabetes (n = 14,896), the presence of any degree of DR increased the chance for all-cause mortality and/or CV events by 2.34 (95% CI 1.96–2.80) compared with patients without DR. In patients with type 1 diabetes (n = 4,438), the corresponding odds ratio was 4.10 (1.50–11.18). These associations remained after adjusting for traditional CV risk factors. DR was also predictive of all-cause mortality in type 2 diabetes (odds ratio 2.41 [1.87–3.10]) and type 1 diabetes (3.65 [1.05–12.66]).

CONCLUSIONS

The presence of DR was associated with an increased risk of all-cause mortality and CV events in both type 2 and type 1 diabetic patients.Diabetic retinopathy (DR) is a common chronic microvascular diabetes complication. Approximately 29% of U.S. adults with type 2 diabetes have DR (1), whereas DR will develop in 95% of type 1 diabetic individuals during their lifetime (2). DR has been associated with increased all-cause and cardiovascular (CV) mortality risk in both type 2 and type 1 diabetes (3–7). Associations with DR have been more extensively evaluated in type 2 diabetes, whereas studies in type 1 diabetes are scarce.Considering these data, identification of DR could possibly add to the diabetic patient’s CV risk stratification. Furthermore, the fundus examination is inexpensive and is routinely performed for the screening of chronic diabetes complications. Therefore, it is worthwhile to comprehensively review data on the predictive role of DR. The aim of the current study was to investigate the association of DR with all-cause mortality and CV events (fatal and nonfatal) in type 2 and type 1 diabetic patients by a systematic review and meta-analysis of cohort studies.     

糖尿病微血管病变与血清同型半胱氨酸、氧化应激反应的相关性

目的 探讨糖尿病微血管病变患者血清同型半胱氨酸与氧化应激反应的相关性.方法 测定80名健康人(对照组),100例无微血管病变2型糖尿病患者(DM组)、100例合并糖尿病肾病2型糖尿病患者(DN组)及100例合并DR2型糖尿病患者(DR组)血清同型半胱氨酸(Hcy)、丙二醛(MDA)、超氧化物歧化酶(SOD)及还原型谷胱甘肽(GSH)浓度.结果 DM组、DN组、DR组Hcy浓度分别为(98.86±21.46)、(198.95±19.35)、(138.65±15.25)ng/L,MDA浓度分别为(17.49±1.64)、(28.89±2.14)、(22.47±1.86)nmol/L,均明显高于对照组(62.48±15.36)ng/L,(11.86±0.48)nmol/L)(F值分别为7.95、6.89,P均＜0.01);DN组及DR组均较DM组明显升高(P均＜0.01),DM组、DN组、DR组血清SOD浓度分别为(107.80±15.62)、(79.86±14.63)、(89.34±12.75)mg/L,GSH浓度分别为(179.26±25.81)、(143.36±21.75)、(156.96±19.35)mg/L,均低于正常对照组(128.32±19.21)mg/L,(237.38±27.31)mg/L(F值分别为7.89、8.76,P均＜0.01);DN组及DR组均较DM组低(P均＜0.01);同时DN组又低于DR组(P＜0.01);血清Hcy与MDA浓度呈正相关(r=0.79,P＜0.05),与SOD、GSH浓度均呈负相关(r值分别为-0.71、-0.78,P均＜0.05).结论 糖尿病微血管病变患者血清同型半胱氨酸浓度升高,氧化应激反应增强,氧化应激与血清同型半胱氨酸浓度升高有关,血清同型半胱氨酸浓度升高,氧化应激促进糖尿病微血管病变发生发展.     

2型糖尿病视网膜病患者血清C反应蛋白与肿瘤坏死因子α的检测及其意义

目的：探讨血清炎症因子C反应蛋白（CRP）与肿瘤坏死因子α（TNFα）在2型糖尿病视网膜病变（DR）中的变化。方法：2型糖尿病（DM）患者98例，其中2型DM无视网膜病变38例（DM组），背景型视网膜病变32例（DR1组），增殖型糖尿病视网膜病变（DR2）组28例，健康对照（NC）组30例，用酶联免疫吸附法测定血清CRP与TNFα水平。结果：DM组血清CRP（54．9±29．8）mg／L，TNFα（159．0±76．0）mg／L，均较健康对照组升高（P〈0．05），DR1、DR2两组的血清CRP、TNFα均较NC组及DM组升高（P〈0．01），DR2组的血清CRP均较DR1组升高（P〈0．05）。结论：CRP及TNFα在2型DM及DR的发生、发展中起重要作用。     

环氧化酶-2基因启动子区-765G/C多态性与糖尿病视网膜病变的相关性研究

目的探讨环氧化酶-2（COX-2）基因启动子区-765G/C多态性与糖尿病视网膜病变（DR）的相关性。方法采用聚合酶链反应-限制性片段长度多态性方法,在中国昆明地区汉族人群中,对121例2型糖尿病变伴视网膜病变者（DR）,44例2型糖尿病非视网膜病变者,100例健康对照者的COX-2基因-765G/C多态性进行检测;比较分析各组间基因型频率、等位基因频率及相关临床资料。结果 （1）各组间的基因型频率和等位基因频率无统计学意义。（2）糖尿病病程、糖化血红蛋白（HbA1c）%水平是糖尿病视网膜病变发生的危险因素。结论昆明地区汉族人群中,COX-2基因-765G/C多态性与DR无相关关系;糖尿病病程和HbA1c%水平影响2型糖尿病患者DR的发生。     

人类巨细胞病毒与2型糖尿病视网膜病变关系的研究

目的:探讨人类巨细胞病毒(human cytomegalovirus,HCMV)感染与2型糖尿病视网膜病变(diabetic retinopathy,DR)的关系。方法:采用聚合酶链反应(chain reaction technique,PCR)技术分别检测2型糖尿病(T2DM)患者86例(单纯T2DM组40例、DR组46例)以及对照组30例外周血中的HCMV-DNA,放射免疫法测定血浆内皮素(endothelin,ET)。结果:DR组HCMV-DNA检测阳性率(65%)明显高于单纯T2DM组(35%)和对照组(13%,P<0.01),DR组ET含量与单纯T2DM组和对照组比较差异也有显著性。结论:HCMV感染与DR的发生发展有关,HCMV感染可能加重DR。     

The Relationship Between Diabetic Retinopathy and Cognitive Impairment

OBJECTIVE

Recent studies have shown an increased risk for cognitive impairment and dementia in patients with diabetes. An association between diabetic retinopathy (DR) and retinal microvasculature disease and cognitive impairment has been reported as potential evidence for a microvascular component to the cognitive impairment. It was hypothesized that severity of DR would be associated with cognitive impairment in individuals with type 2 diabetes.

RESEARCH DESIGN AND METHODS

Three hundred eighty patients with type 2 diabetes were recruited from a population-based eye screening program and grouped by severity of DR as follows: no/mild DR (n = 252) and proliferative diabetic retinopathy (PDR) (n = 128). Each participant underwent psychosocial assessment; depression screening; ophthalmic and physical examination, including blood assays; and cognitive assessment with the Addenbrooke''s Cognitive Examination-Revised (ACE-R), Mini-Mental State Examination (MMSE), and the Mini-Cog. General linear modeling was used to examine severity of DR and cognitive impairment, adjusting for confounders.

RESULTS

Severity of DR demonstrated an inverse relationship with cognitive impairment (fully adjusted R² = 0.415, P < 0.001). Ethnicity contributed most to the variance observed (16%) followed by education (7.3%) and retinopathy status (6.8%). The no/mild DR group had lower cognitive impairment scores on ACE-R (adjusted mean ± SE 77.0 ± 1.9) compared with the PDR group (82.5 ± 2.2, P < 0.001). The MMSE cutoff scores showed that 12% of the no/mild DR group (n = 31) had positive screening results for dementia or significant cognitive impairment compared with 5% in the PDR group (n = 6).

CONCLUSIONS

Patients with minimal DR demonstrated more cognitive impairment than those with advanced DR. Therefore, the increased prevalence of cognitive impairment in diabetes may be associated with factors other than evident retinal microvascular disease.The prevalence of both type 2 diabetes and dementia has increased significantly over the past 2 decades. These parallel increases may be explained by a common metabolic pathology because type 2 diabetes is an independent risk factor for the development of Alzheimer disease (1,2). Diabetes has also been associated with cognitive impairment, which is defined as the degree of cognitive dysfunction that exists between normal aging and dementia. Cognitive impairment, even when mild, is a predictor for the development of dementia and Alzheimer disease (3). Therefore, identifying the disease processes that link diabetes and cognitive impairment could be important for identifying patients at risk for dementia and for the development of preventive interventions in the diabetes population.One current area of inquiry is the relationship between the severity of microvascular changes in the retina and cognitive impairment (4,5). Several groups have explored the association of diabetic retinopathy (DR) with cognitive impairment, showing conflicting results. Roberts et al. (6) found that if DR was present, the risk of mild cognitive impairment was more than doubled (odds ratio 2.36). A systematic review of six studies reported an increased risk (odds ratio 2.0) of cognitive impairment in patients with DR and type 1 and type 2 diabetes (7). Another recent systematic review of studies in type 2 diabetes alone also reported an association between cognitive impairment and DR, although only in older male patients or patients with established macrovascular disease (8). This review highlighted that case assignment in the reviewed studies was poor, with only a small number of patients having severe DR (n = 47). In the absence of studies comparing levels of DR, it is not possible to distinguish whether DR is just an associated risk factor for cognitive impairment or whether progression of DR is associated with increased cognitive decline. The later scenario would suggest a common pathology. A further limitation of previous studies is that they did not fully adjust for cardiovascular disease, which has been associated with increased cognitive impairment (9). In one study, the sample comprised patients who had a coronary artery bypass (10).Therefore, the present study was designed to test whether severity of DR is associated with higher levels of cognitive impairment in patients with type 2 diabetes. It included a far greater number of patients with more severe DR than previously studied so that it would be possible to observe differences in cognitive performance between patients with milder and patients with more severe DR.