Diyabetik retinopatide subklinik aterosklerozun bir göstergesi olarak monosit /HDL oranı

Year 2020, Volume: 3 Issue: 2, 109 - 114, 19.03.2020

Seyfullah Kan , Adnan Karaibrahimoğlu

https://doi.org/10.32322/jhsm.640710

Abstract

Amaç:
Diyabetik
retinopatisi olan hastalarda kardiyovasküler hastalıkların artan sıklığı
bilinmektedir. MHO (Monosit/HDL oranı), kardiyovasküler ve serebrovasküler
hastalıklarla ilişkisi yeni saptanmış bir belirteçtir. Bu çalışmanın amacı
aşikar kardiyovasküler hastalık bulgusu olmayan diyabetik retinopatisi olan
hastalarda subklinik ateroskleroz risk göstergesi karotis intima media
kalınlığı (KİMK) ile MHO ilşkisini araştırmaktır.

Gereç
ve Yöntem: Aşikar kardiyovasküler hastalığı olmayan 106 diyabetik
hasta ve 35 yaş, cinsiyet ve BMI (Body mass index) ile uyumlu sağlıklı kontrol
alındı. Hastalar proliferatif diyabetik retinopati (PDR , n=30),
nonproliferatif diyabetik retinopati ( NPDR, n=35), retinopati olmayan diyabet
hastaları (n=41) ve kontrol grubu (n=35) olmak üzere dört gruba ayrıldı.
Anthropometric, biyokimyasal parametreler ve KİMK ölçüldü. MHO ile KİMK
arasındaki ilşkiyi değerlendirmek için korelasyon ve regresyon analizi yapıldı.

Bulgular:
MHO değerleri
gruplar arasında anlamlı farklılığa sahip ve PDR grubunda anlamlı düzeyde daha
yüksekti ( p < ,001). Ateroskleroz
göstergesi olan KİMK gruplar arasında anlamlı farklılık gösterdi ( p < ,001). KİMK değeri PDR grubunda
anlamlı düzeyde yüksek iken diğer gruplarda birbirine yakın değerler ölçüldü
(Tablo 1). PDR grubunda MHO ile KİMK arasında önemli düzeyde anlamlı korelasyon
bulundu ( r=0,96; p < ,001). Binary logistic regression analizinde MHO’nin KİMK
üzerine anlamlı etkisi bulunmaktaydı [ β=0,206, (%95 CI : 1,004-1,505), P=0,046
] (Table 3).

Sonuç: Bu çalışma, yüksek MHO’nın diyabetik
retinopatisi olan hastalarda subklinik kardiyovasküler riski belirlemede
non-invaziv, basit ve maliyeti düşük bir marker olarak kullanılabileceğini
göstermektedir. Diabetik retinopatide MHO ve KİMK arasındaki ilişkiyi inceleyen
literatürdeki ilk çalışma olan bu çalışma, aşikar kardiyovasküler hastalık
bulgusu olmayan diyabetik hastalardaki kardiak riski erken belirlemede fayda
sağlayabilir.

Keywords

Diyabetik retinopati, subklinik ateroskleroz, monosit /HDL oranı

Monocyte to HDL ratio as an indicator of subclinical atherosclerosis in diabetic retinopathy

Abstract

ABSTRACT

Aim: Incidence of cardiovascular
diseases is gradually increasing in patients with diabetic retinopathy (DR).
MHR (Monocyte/HDL ratio), is a novel marker related with cardiovascular and
cerebrovascular diseases. The aim of this study was to investigate the
relationship between a subclinical atherosclerosis marker, carotid intima media
thickness (CIMT), and MHR in diabetic retinopathy patients without an apparent
cardiovascular disease. 

Material
and Method: 106 diabetic patients without an apparent
cardiovascular disease and 35 healthy controls matched for age, gender and body
mass index (BMI) were included in this study. 
The patients were separeted into four groups which were proliferative
diabetic retinopahy (PDR , n=30), nonproliferative diabetic retinopathy (NPDR,
n=35), diabetic patients without retinopathy (n=41) and control group (n=35).
Anthropometric, biochemical parameteres and CIMT were measured. Correlation and
regression analysis were done to assess the relation between MHR and CIMT.

Results:
MHR was
significantly different between
groups and significantly higher in PDR group (p < .001). CIMT, a marker for atherosclerosis, significantly
differed between groups (p <
.001). CIMT levels were significantly higher in PDR while similar values were
found in other than groups. In PDR group, a significant correlation was found
between MHR and CIMT ( r=0.96; p < .001). According to binary logistic regression analysis,
MHR had a significant effect on CIMT [ β=0.206, (%95 CI : 1.004-1.505), P=0.046
].

Conclusion: This study showed that  in patients with diabetic retinopathy, high
levels of MHR which is a non-invasive, simple and inexpensive marker, might be
useful for determination of subclinical cardiovascular risk. This study which
is the first in literature that investigated the relation between MHR and CIMT
in diabetic retinopathy might have a benefit on early detection of cardiac risk
in diabetic patients without an apparent cardiovascular disease.

Keywords

Diabetic retinopathy, subclinical atherosclerosis, monocyte to HDL ratio

References

• 1. Canpolat U, Çetin EH, Cetin S, Aydin S, Akboga MK, Yayla C, et al. Association of Monocyte-to-HDL Cholesterol Ratio with Slow Coronary Flow is Linked to Systemic Inflammation. Clin Appl Thromb 2016; 22(5): 476–82.
• 2. Kanbay M, Solak Y, Unal HU, Kurt YG, Gok M, Cetinkaya H, et al. Monocyte count/HDL cholesterol ratio and cardiovascular events in patients with chronic kidney disease. Int Urol Nephrol 2014; 46(8): 1619–25.
• 3. Wei X, Chen F, Huang J, He P, Wei Y, Tan N. Novel Risk Biomarker for Infective Endocarditis Patients With Normal Left Ventricular Ejection Fraction　― Monocyte to High-Density Lipoprotein Cholesterol Ratio ―. Circ J 2018; 82(1): 283–8.
• 4. Nambi V, Chambless L, Folsom AR, He M, Hu Y, Mosley T, et al. Carotid intima-media thickness and presence or absence of plaque improves prediction of coronary heart disease risk: the ARIC (Atherosclerosis Risk In Communities) study. J Am Coll Cardiol 2010; 55(15): 1600–7.
• 5. Wu Y, He J, Sun X, Zhao Y-M, Lou H-Y, Ji X, et al. Carotid atherosclerosis and its relationship to coronary heart disease and stroke risk in patients with type 2 diabetes mellitus. Medicine (Baltimore) 2017; 96(39): e8151.
• 6. Carbonell M, Castelblanco E, Valldeperas X, Betriu À, Traveset A, Granado-Casas M, et al. Diabetic retinopathy is associated with the presence and burden of subclinical carotid atherosclerosis in type 1 diabetes. Cardiovasc Diabetol 2018; 17(1): 66.
• 7. Brownlee M. The pathobiology of diabetic complications: a unifying mechanism. Diabetes 2005; 54(6): 1615–25.
• 8. Goldberg RB. Cytokine and cytokine-like inflammation markers, endothelial dysfunction, and imbalanced coagulation in development of diabetes and its complications. J Clin Endocrinol Metab 2009; 94(9): 3171–82.
• 9. Wong TY, Klein R, Sharrett AR, Duncan BB, Couper DJ, Tielsch JM, et al. Retinal Arteriolar Narrowing and Risk of Coronary Heart Disease in Men and Women. JAMA 2002; 287(9): 1153–9.
• 10. Huang Y, Chen Y, Xu M, Gu W, Bi Y, Li X, et al. Low-grade albuminuria is associated with carotid intima-media thickness in Chinese type 2 diabetic patients. J Clin Endocrinol Metab 2010; 95(11): 5122–8.
• 11. Cheung N, Wang JJ, Klein R, Couper DJ, Sharrett AR, Wong TY. Diabetic Retinopathy and the Risk of Coronary Heart Disease: The Atherosclerosis Risk in Communities Study. Diabetes Care 2007; 30(7): 1742–6.
• 12. Son J-W, Jang E-H, Kim M-K, Kim IT, Roh YJ, Baek K-H, et al. Diabetic retinopathy is associated with subclinical atherosclerosis in newly diagnosed type 2 diabetes mellitus. Diabetes Res Clin Pract 2011; 91(2): 253–9.
• 13. Rema M, Mohan V, Deepa R, Ravikumar R, Chennai Urban Rural Epidemiology Study-2. Association of Carotid Intima-Media Thickness and Arterial Stiffness With Diabetic Retinopathy: The Chennai Urban Rural Epidemiology Study (CURES-2). Diabetes Care 2004; 27(8): 1962–7.
• 14. Li L-X, Zhao C-C, Ren Y, Tu Y-F, Lu J-X, Wu X, et al. Prevalence and clinical characteristics of carotid atherosclerosis in newly diagnosed patients with ketosis-onset diabetes: a cross-sectional study. Cardiovasc Diabetol 2013; 12(1): 18.
• 15. Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR, et al. Which White Blood Cell Subtypes Predict Increased Cardiovascular Risk? J Am Coll Cardiol 2005; 45(10): 1638–43.
• 16. Akyel A, Yayla Ç, Erat M, Çimen T, Doğan M, Açıkel S, et al. Neutrophil-to-lymphocyte ratio predicts hemodynamic significance of coronary artery stenosis. Anatol J Cardiol 2015; 15(12): 1002–7.
• 17. Oylumlu M, Yildiz A, Oylumlu M, Yuksel M, Polat N, Bilik MZ, et al. Platelet-to-lymphocyte ratio is a predictor of in-hospital mortality patients with acute coronary syndrome. Anadolu Kardiyol Dergisi/The Anatol J Cardiol 2015; 15(4): 277–83.
• 18. Yue S, Zhang J, Wu J, Teng W, Liu L, Chen L. Use of the Monocyte-to-Lymphocyte Ratio to Predict Diabetic Retinopathy. Int J Environ Res Public Health 2015; 12(8): 10009–19.
• 19. Bolayir A, Gokce SF, Cigdem B, Bolayir HA, Yildiz OK, Bolayir E, et al. Monocyte/high-density lipoprotein ratio predicts the mortality in ischemic stroke patients. Neurol Neurochir Pol 2018; 52(2): 150–5.
• 20. Ucar FM. A potential marker of bare metal stent restenosis: monocyte count - to- HDL cholesterol ratio. BMC Cardiovasc Disord 2016; 16(1): 186.
• 21. Ancuta P, Wang J, Gabuzda D. CD16+ monocytes produce IL-6, CCL2, and matrix metalloproteinase-9 upon interaction with CX3CL1-expressing endothelial cells. J Leukoc Biol 2006; 80(5): 1156–64.
• 22. Tong PC, Lee K-F, So W-Y, Ng MH, Chan W-B, Lo MK, et al. White blood cell count is associated with macro- and microvascular complications in chinese patients with type 2 diabetes. Diabetes Care 2004; 27(1): 216–22.
• 23. Matsumura T, Taketa K, Motoshima H, Senokuchi T, Ishii N, Kinoshita H, et al. Association between circulating leukocyte subtype counts and carotid intima-media thickness in Japanese subjects with type 2 diabetes. Cardiovasc Diabetol 2013; 12(1): 177.
• 24. Murphy AJ, Woollard KJ. High-density lipoprotein: a potent inhibitor of inflammation. Clin Exp Pharmacol Physiol 2010; 37(7): 710–8.
• 25. Acikgoz N, Kurtoğlu E, Yagmur J, Kapicioglu Y, Cansel M, Ermis N. Elevated Monocyte to High-Density Lipoprotein Cholesterol Ratio and Endothelial Dysfunction in Behçet Disease. Angiology 2018; 69(1): 65–70.
• 26. Mirza E, Oltulu R, Katipoğlu Z, Mirza GD, Özkağnıcı A. Monocyte/HDL Ratio and Lymphocyte/Monocyte Ratio in Patients with Pseudoexfoliation Syndrome. Ocul Immunol Inflamm 2018; 1–5.
• 27. Şatırtav G, Mirza E, Oltulu R, Mirza GD, Kerimoğlu H. Assessment of Monocyte/HDL Ratio in Branch Retinal Vein Occlusion. Ocul Immunol Inflamm 2019; 1–5.
• 28. Sönmez O, Ertaş G, Bacaksız A, Tasal A, Erdoğan E, Asoğlu E, et al. Relation of neutrophil-to-lymphocyte ratio with the presence and complexity of coronary artery disease: an observational study. Anadolu Kardiyol Derg 2013; 13(7): 662–7.
• 29. Hartnett ME, Stratton RD, Browne RW, Rosner BA, Lanham RJ, Armstrong D. Serum markers of oxidative stress and severity of diabetic retinopathy. Diabetes Care 2000; 23(2): 234–40.
• 30. Celermajer DS, Sorensen KE, Gooch VM, Spiegelhalter DJ, Miller OI, Sullivan ID, et al. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet 1992; 340(8828): 1111–5.