Yin Jie, Chen Juan, Chen Yuanyuan
Department of Ophthalmology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China.
Front Nutr. 2025 Jan 14;11:1490340. doi: 10.3389/fnut.2024.1490340. eCollection 2024.
This study aimed to explore the association between the ratio of 4-pyridoxine (4-PA) to pyridoxal 5'-phosphate (PLP) (4-PA/PLP) and diabetic retinopathy (DR) and further assess the mediating effect of Endothelial Activation and Stress Index (EASIX) on the association between 4-PA/PLP and DR.
In this cross-sectional study, 1,698 patients with diabetes from the National Health and Nutrition Examination Survey were included. According to the median, 4-PA/PLP was categorized into a high-level group (≥0.89) and a low-level group (<0.89). As the EASIX had a skewed distribution, it was log-transformed before analysis. Weighted logistic regression models were used to investigate the association of 4-PA/PLP with EASIX and DR and the mediating effect of EASIX on the association between 4-PA/PLP and DR. The distribution-of-product method was adopted to assess the mediating effect. Subgroup analysis was performed based on the age and duration of diabetes.
A total of 362 diabetic patients were classified as having DR. After adjusting for all covariates, a higher level of 4-PA/PLP was associated with an increased level of log EASIX [odds ratio (OR) = 1.56, 95% confidence interval (CI): 1.06-2.30]. A higher ratio of 4-PA/PLP was associated with increased odds of DR compared to the reference group with lower levels of 4-PA/PLP (OR = 1.94, 95%CI: 1.40-2.67). In addition, we found that log EASIX may play a mediating role in the 4-PA/PLP and DR, with a 95% CI of distribution of product of 0.31 (95% CI: 0.02-0.67). The proportion of mediation was 69.06%. The mediating effect of log EASIX was also observed in individuals with diabetes who were aged≥60 years (proportion of mediation: 50.63%) or had a duration of diabetes ≥10 years (proportion of mediation: 71.83%).
This study found a positive association between high levels of 4-PA/PLP and an increased risk of DR, with the relationship being partially mediated by log EASIX.
本研究旨在探讨4-吡哆醇（4-PA）与5'-磷酸吡哆醛（PLP）的比值（4-PA/PLP）与糖尿病视网膜病变（DR）之间的关联，并进一步评估内皮激活与应激指数（EASIX）在4-PA/PLP与DR关联中的中介作用。
在这项横断面研究中，纳入了来自美国国家健康与营养检查调查的1698例糖尿病患者。根据中位数，将4-PA/PLP分为高水平组（≥0.89）和低水平组（<0.89）。由于EASIX呈偏态分布，在分析前对其进行对数转换。采用加权逻辑回归模型研究4-PA/PLP与EASIX和DR的关联以及EASIX在4-PA/PLP与DR关联中的中介作用。采用乘积分布法评估中介作用。根据年龄和糖尿病病程进行亚组分析。
共有362例糖尿病患者被分类为患有DR。在调整所有协变量后，较高水平的4-PA/PLP与较高水平的对数EASIX相关[比值比（OR）=1.56，95%置信区间（CI）：1.06-2.30]。与4-PA/PLP水平较低的参考组相比，较高的4-PA/PLP比值与DR风险增加相关（OR=1.94，95%CI：1.40-2.67）。此外，我们发现对数EASIX可能在4-PA/PLP与DR之间起中介作用，乘积分布的95%CI为0.31（95%CI：0.02-0.67）。中介比例为69.06%。在年龄≥60岁（中介比例：50.63%）或糖尿病病程≥1年（中介比例：71.83%）的糖尿病患者中也观察到了对数EASIX的中介作用。
本研究发现高水平的4-PA/PLP与DR风险增加之间存在正相关，且这种关系部分由对数EASIX介导。
