New Predictive Factors of Diabetic Maculopathy Development in Diabetes Mellitus Type 2

Abstract

Relevance. In diabetes mellitus (DM), a cascade of pathological reactions unfolds in the vascular endothelium with the formation of endothelial dysfunction (EDF). Its main factors are endothelium hormone – endothelin-1 (ET1), nitric oxide (NO), endothelial NO-synthase (eNOS), and also tumor necrosis factor-α (TNFα). But the unexplored question remains whether EDFs can be used as prognostic markers for the development of diabetic maculopathy.
 Objective: to find out the prognostic value of EDF factors in the development of diabetic maculopathy (DM) in type 2 diabetes.
 Material and methods. This study included 152 patients (304 eyes) with type 2 diabetes, which were divided into groups according to the degree of diabetic retinopathy (DR): 1st – initial non-proliferative DR, 2nd – moderate or severe non-proliferative DR and 3rd – proliferative DR. DM was determined by the presence of specific diabetic retinal changes in the macular area according to the International Clinical Gravity Scale of the American Academy of Ophthalmology (2002). The control group consisted of 95 people. The content of ET1, eNOS and TNFα was determined by ELISA; the content of the final NO metabolites (NOx) was determined spectrophotometrically. Statistical data processing was performed using Statistica 10 (StatSoft, Inc., USA).
 Results. With the progression of DR, there was an increase in the frequency and severity level of DM (p=2.0e-06), which was accompanied by an increase in the blood levels ET1 (3.7-4.7 times), NOx (1.4-1.5 times) and TNFα (4.2-6.5 times), with a progressive decrease in the level of eNOS (P<0.01). Multifactorial logistic regression analysis (GLZ package; StatSoft, Inc., USA) showed that pathogenetic factors for the DM development were multiple increase in blood levels of ET1 and TNFα, which was confirmed by building a logistic regression model with satisfactory results of adequacy (p=0.039).
 Conclusions. This study confirmed the significant role of EDF in type 2 diabetes and proved the prognostic value of ET1 and TNFα blood levels for the development of DM.