Diyabetik retinopatide subklinik aterosklerozun bir göstergesi olarak monosit /HDL oranı

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.

Anahtar Kelimeler:

Diyabetik retinopati, subklinik ateroskleroz, monosit /HDL oranı

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

ABSTRACTAim: 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,

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