Uğurlu Nagihan, Gerceker Sidika, Yülek Fatma, Ugurlu Burcak, Sarı Cenk, Baran Pervin, Çağil Nurullah
Ophthalmology Department, Yildirim Beyazit University Ankara Atatürk Training and Research Hospital, Turkey.
Intern Med. 2013;52(19):2173-8. doi: 10.2169/internalmedicine.52.8572. Epub 2012 Mar 1.
Endothelial dysfunction plays an important role in the development of diabetic retinopathy. The aim of this study was to evaluate endothelial dysfunction using different approaches in patients with type 1 diabete mellitus with early stages of diabetic retinopathy. For this purpose, we investigated the serum levels of cellular adhesion molecules, including intercellular adhesion molecule (ICAM-1), vascular cell adhesion molecule (VCAM-1) and endothelin-1 (ET-1), which have emerged as specific markers of endothelial dysfunction, and measured the flow-mediated dilatation (FMD), a noninvasive technique used to evaluate endothelial dysfunction.
The study group included 59 patients with type 1 diabetes mellitus (DM) and 30 age-matched healthy control subjects. The diabetic patients were divided into two groups according to the ophthalmoscopic findings: Group 1, composed of type 1 diabetic patients having no signs of diabetic retinopathy (DRP), and Group 2, composed of type 1 diabetic patients having findings of the early stages of nonproliferative diabetic retinopathy (NPDR).
The serum levels of ET-1 (fmol/mL), ICAM-1 (ng/mL) and VCAM-1 (ng/mL) were 8.52±0.699 vs. 478.39±46.22 vs. 728.64±35.081 in the patients without retinopathy, 8.91±1.354 vs. 451.79±48.262 vs. 863.59±62.37 in the diabetic patients with NPDR and 10.73±1.04 vs. 608.15±74.92 vs. 872.95±57.63 in the control group. There were no significant differences in the serum levels of the three molecules between the groups. The FMD values were 6.51±0.46% in the diabetic patients without retinopathy, 6.66±0.29% in the diabetic patients with NPDR and 6.68±0.51% in the control group. No significant differences were found between the groups.
The early stages of diabetic retinopathy cannot be considered in the evaluation of systemic markers of endothelial dysfunction.
内皮功能障碍在糖尿病视网膜病变的发展中起重要作用。本研究的目的是使用不同方法评估1型糖尿病且处于糖尿病视网膜病变早期阶段患者的内皮功能障碍。为此，我们研究了细胞黏附分子的血清水平，包括细胞间黏附分子（ICAM-1）、血管细胞黏附分子（VCAM-1）和内皮素-1（ET-1），这些已成为内皮功能障碍的特异性标志物，并测量了血流介导的血管舒张（FMD），这是一种用于评估内皮功能障碍的非侵入性技术。
研究组包括59例1型糖尿病患者和30例年龄匹配的健康对照者。糖尿病患者根据眼底镜检查结果分为两组：第1组由无糖尿病视网膜病变（DRP）体征的1型糖尿病患者组成，第2组由有非增殖性糖尿病视网膜病变（NPDR）早期表现的1型糖尿病患者组成。
无视网膜病变患者的ET-1（fmol/mL）、ICAM-1（ng/mL）和VCAM-1（ng/mL）血清水平分别为8.52±0.699、478.39±46.22、728.64±35.081；患有NPDR的糖尿病患者分别为8.91±1.354、451.79±48.262、863.59±62.37；对照组分别为10.73±1.04、608.15±74.92、872.95±57.63。三组间这三种分子的血清水平无显著差异。无视网膜病变的糖尿病患者的FMD值为6.51±0.46%，患有NPDR的糖尿病患者为6.66±0.29%，对照组为6.68±0.51%。组间未发现显著差异。
在评估内皮功能障碍的全身标志物时，不能考虑糖尿病视网膜病变的早期阶段。
