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Бездетко П. А., Ильина Е. Н., Аджадж С. М. Корреляция между диабетической ретинопатией и липидным спектром при различных значениях гликозили
28.05.2014, 17:24

Резюме
Бездітко П.А., Ільїна Є.М., Аджадж С.М. Кореляція між діабетичною ретинопатією і ліпідним спектром з різними значеннями глікозильованого гемоглобіну сироватки крові у хворих на цукровий діабет 2 типу.
143 хворих на цукровий діабет 2 типу та НПДР спостерігались протягом року. Проводилися: статична периметрія Хамфрі, оптична когерентна томографія, флюоресцентна ангіографія. Вивчався кореляційний зв’язок між показниками ліпідного спектру і діабетичною ретинопатію, а саме, коефіцієнтом світлочутливості сітківки (MD), кількістю локальних дефектів у полі зору, товщиною і обсягом центральної сітківки. Встановлена значуща кореляція, яка посилюється при підвищенні рівня глікозильованого гемоглобіну. При компенсації глікозильованого гемоглобіну спостерігається стабілізація прогресування НПДР; при субкомпенсації рівня ГГ початкова НПДР прогресує в розвинену і прямий кореляційний зв’язок посилюється в 1,2 рази; при декомпенсації ГГ відбувається прогресування початкової НПДР у важку з посиленням прямого кореляційного зв’язку у 1, 4 рази протягом року.
Ключові слова: ліпідний спектр, гліколізований гемоглобін, непролиферативная діабетична ретинопатія, коефіцієнт кореляції.
Резюме
Бездетко П. А., Ильина Е. Н., Аджадж С. М. Корреляция между диабетической ретинопатией и липидным спектром при различных значениях гликозилированного гемоглобина сыворотки крови у больных сахарным диабетом 2 типа.
143 больных сахарным диабетом 2 типа и непролиферативной диабетической ретинопатией наблюдались в течение года. Проводились: статическая периметрия Хамфри, оптическая когерентная томография, флюоресцентная ангиография. Изучалась корреляционная связь между показателями липидного спектра и диабетической ретинопатией, а именно, коэффициентом светочувствительности сетчатки (MD), количеством локальных дефектов в поле зрения, толщиной и объёмом центральной сетчатки. Установлена значимая корреляция, которая усиливается при повышении уровня гликозилированного гемоглобина. При компенсации гликозилированного гемоглобина наблюдается стабилизация прогрессирования НПДР; при субкомпенсации уровня ГГ начальная НПДР прогрессирует в развитую и прямая корреляционная связь усиливается в 1,2 раза; при декомпенсации ГГ происходит прогрессирование начальной НПДР в тяжёлую с усилением прямой корреляционной связи в 1,4 раза в течение года.
Ключевые слова: липидный спектр, гликозилированный гемоглобин, непролиферативная диабетическая ретинопатия, коэффициент корреляции.
Summary
Bezdetko P.A., Ilyina Y.N., Ajaj S.M. Сorrelation between diabetic retinopathy and lipids with different levels of glycated hemoglobin in patients with diabetes mellitus type 2.
143 patients with nonproliferative diabetic retinopathy in diabetes mellitus type 2 were observed within one year. The static Humphrey perimetry, optical coherence tomography, fluorescein angiography were done. We studied the correlation between lipid profile and diabetic retinopathy: mean deviation (MD), quantity of local defects in vision field, average thickness and volume of the central retina. It was significant correlation, which increased with an increasing level of glycosylated hemoglobin. Diabetic retinopathy with normal level of glycosylated hemoglobin was stabilized. Diabetic retinopathy with subcompensated level of glycosylated hemoglobin progressed to next stage and correlation increased in 1.2 times. DR with decompensated level of glycosylated hemoglobin progressed to most severe stage with correlation increasing in 1.4 times.
Key words: lipids, glycated hemoglobin, nonproliferative diabetic retinopathy, correlation.

Рецензент: д.мед.н., проф. А.М. Петруня

УДК 617.735-002-02:616.379-008.64:616.15-074

Харьковский национальный медицинский университет

проспект Ленина, 4, Харьков, 61022,Украина 

Kharkiv National Medical University,

4 Lenin Avenue, Kharkiv,61022,Ukraine

oko_66@mail.ru

Introduction. Diabetes mellitus (DM) - a severe disorder of metaolism. There are about 180 million of patients with diabetes mellitus are in the world, and more than 360 million will be in 2030 [1-3]. The mortality among patients with diabetes mellitus are in 2-4 times more than in people without disorders of carbohydrate metabolism. Depending on the type and duration of diabetes in 30-90% of patients the diabetic retinopathy (DR) develop - the main cause of disability in persons of working age [3, 4].

Increasing of level of cholesterol is detected in 84% of patients with diabetes mellitus type 2 and in 16% of patients with diabetes mellitus type 1 [5]. High blood levels of cholesterol and glucose lead to diabetic retinopathy [6-9].

Glycosylated hemoglobin is the biochemical parameter of DM control [3]. It pathological high level is defined as one of the independent factors of hypoxia - the main component of the pathogenesis of DR [4-6].

The study of correlation between the level of lipids and progression of nonproliferative diabetic retinopathy in patients with diabetes mellitus type 2 with different values ​​of glycated hemoglobin is actual.

So, the aim of the work was to study the correlation between diabetic retinopathy and lipids in patients with diabetes mellitus type 2.

Materials and methods

143 patients with nonproliferative diabetic retinopathy in diabetes mellitus type 2 at age from 41 to 70 were observed within one year. According to the classification of the American Diabetes Association (2002), all patients were diagnosed with nonproliferative diabetic retinopathy (NPDR). 73 of them with the initial stage (A) and presence of single microaneurysms and hemorrhages in the fundus. In 70 patients developed the stage (B) with the presence of microaneurysms, deep flame shaped hemorrhages in more than 2 quadrants.

The average duration of diabetes in patients with initial stage (A) of NPDR was 6,4 ± 1,4 years, in patients with stage (B) of NPDR was 6,8 ± 1,4 years.

Patients were divided into groups depending on the level of glycosylated hemoglobin. Data presented in table 1. (Table number 1)

There are visometry, tonometry, biomicroscopy, gonioscopy, oftalmoskopy, perimetry, fluorescein angiography, optical coherent tomography, electrophysiological studies were done. The level of blood sugar, glycosylated hemoglobin, lipid profile (The overall cholesterol (TC), triglycerides (TG), lipoproteins, high density lipoproteins (HDL), low density lipoproteins (LDL) very low density lipoproteins (VLDL), liver function tests were laboratory determined. All patients were regulary checked by an endocrinologist, cardiologist and surgeon and received angioprotektory and antioxidants treatments every 6 month.

The correlation between the level of glycosylated hemoglobin and mean deviation of sensitivity of retina, the number of local defects in the visual field, with p<5%, average thickness and volume of central retina, lipids was calculated. Estimated correlation coefficient, the conclusions were based on the level of statistical significance according to the classification of private correlations that takes into account the sample size [10].

Results and discussion

At the initial stage (A) of nonproliferative diabetic retinopathy and compensated level of glycosylated hemoglobin (GH) the level of lipids were normal within one year. Significant correlation was determined:

1) between GH and: cholesterol (r = 0,38, p = 0.033), VLDL (r = 0,43, p = 0.041);

2) between MD and: cholesterol (r = 0,48, for p = 0.029), triglycerides (TG) (r = 0,35, p = 0.036 at).

3) between LD and: total cholesterol (r = 0,33, p = 0.036), LDL cholesterol (r = 0,44, p = 0.029), HDL (r = -0,43, p = 0.032);

4) between average thikness of central retinal and: TG (r = 0,46, p = 0.024), cholesterol (r = 0,34, p = 0.028), VLDL (r = 0,35, p = 0.031), HDL cholesterol (r = - 0,36, p = 0.032).

When level of glycosylated hemoglobin was subcompensated, the mixed dyslipidemia was developed. The data presented in Table 2. (Table number 2)

It identifies significant correlation:

1) between GH and: VLDL (r = 0,38, p = 0,032), cholesterol (r = - 0,39, p = 0.031);

2) between MD and: cholesterol (r = 0,34, p = 0.026 at), VLDL (r = 0,42, p = 0.029), triglycerides (r = 0,29, p = 0.031), HDL cholesterol (r = - 0,43, at p = 0.033).

3) between average thickness of central retina and: TG (r = 0,42, p = 0.029).

Patients with primary nonproliferative diabetic retinopathy, and decompensated level of glycosylated hemoglobin showed progression of DR with increasing of lipids level. The data presented in Table 3. (Table number 3)

Significant correlation was determined:

1) between GH and: total cholesterol (r = 0,55, p = 0.028), VLDL (r = 0,50, p = 0.01), triglycerides (r = 0,49, p = 0.027), HDL (r = - 0,36, p = 0.027);

2) between MD and: VLDL (r = 0,38, p = 0.032), total cholesterol (r = 0,5, p = 0.023);

3) between the number of local defects visual field and: LDL cholesterol (r = 0,32, p = 0.034 in), HDL cholesterol (r = - 0,64, p = 0.029);

4) between the average thickness of the central retina and: LDL cholesterol (r = 0,50, p = 0.029), cholesterol (r = -0,45, p = 0.029);

5) between the volume of central retina and: VLDL (r = 0,45, p = 0.034 in), HDL (r = - 0,57, p = 0.021).

When monitoring patients with stage B of NPDR and normal level of glycosylated hemoglobin were observed all parameters were stabilized with significant correlation between them.

So, between GH and: LDL cholesterol (r = 0,34, p = 0.036), HDL cholesterol (r = 0,41, p = 0.032). Between MD and: LDL cholesterol (r = 0,31, p = 0.024). Between the number of local defects in the visual field and: HDL cholesterol (r = -0,41, p = 0.029), total cholesterol (r = 0,30, p = 0.031). Between average thickness of central retina and: VLDL (r = 0,31, p = 0.029), total cholesterol (r = 0,39, p = 0.035). Between volume of the central retina and: LDL cholesterol (r = 0,36, p = 0.027), VLDL (r = 0,50, p = 0.041), HDL cholesterol (r = - 0,41, p = 0.035).

In patients with stage B of NPDR and subcompensated level of glycosylated hemoglobin checking parameters were increased. Level of lipids at different periods of observation are shown in table 4. (Table number 4)

Significant correlation was found:

1) between GH and: HDL cholesterol (r = - 0,38, p = 0.027);

2) between MD and: TG (r = 0,32, p = 0,041), VLDL (r = 0,43, p = 0.039);

3) between LD and: LDL cholesterol (r = 0,50, p = 0.028);

4) between average thickness of the central retina and VLDL (r = 0,49, p = 0.022); cholesterol (r = 0,44, p = 0.032).

In patients with decompensated level of glycosylated hemoglobin - NPDR progressed to more severe stage. Lipid spectrum was increased. Data presented in Table 5. (Table number 5)

Significant correlation was:

1) between GH and: VLDL (r = 0,39, p = 0.35), total cholesterol (r = 0,40, p = 0.035);

2) between MD and: cholesterol (r = 0,36, p = 0,033) VLDL (r = 0,32, p = 0,034), TG (r = 0,40, p = 0,037);

3) between the number of local defects in visual field and: cholesterol (r = 0,43, p = 0.019), VLDL (r = 0,64, p = 0.034), TG (r = 0,38, p = 0.032), LDL (r = 0,35, p = 0.034);

4) between the average thickness of the central retina and: LDL (r = 0,50, p = 0.021), triglycerides (r = 0,44, p = 0.034);

5) between the Volume of central retina and: LDL (r = 0,32, p = 0.035), TG (r = 0,44, p = 0,037), VLDL (r = 0,57, p = 0.11).

Thus, as a result of monitoring of patients with initial (A) and developing (B) stages of nonproliferative diabetic retinopathy in patients with diabetes mellitus type 2 it was defined correlation between the level of glycosylated hemoglobin, lipids, mean deviation of sensitivity of the retina, quantity of local defects in the visual field, average thickness of the central retina.

Conclusions

It was established correlation between lipids and nonproliferative diabetic retinopathy in patients with diabetes mellitus type 2 during the year.

So, the correlation between lipid profile and diabetic retinopathy: mean deviation (MD), quantity of local defects in vision field, average thickness and volume of the central retina was significant, and increased with an increasing level of glycosylated hemoglobin.

Diabetic retinopathy with normal level of glycosylated hemoglobin was stabilized. Diabetic retinopathy with subcompensated level of glycosylated hemoglobin progressed to next stage and correlation increased in 1.2 times. DR with decompensated level of glycosylated hemoglobin progressed to most severe stage with correlation increasing in 1.4 times.

Литература
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Возможности лечения сахарного диабета 2 типа на современном этапе / Н.Г. Потешкина, Е.Ю. Мирина, М.И. Балаболкин [и др.] // Русский медицинский журнал. – 2009. - № 608. – С. 32-37.
Критерии компенсации нарушений углеводного обмена и целевые значения HbA1C при сахарном диабете: Федеральная целевая программа “Сахарный диабет”: метод. рекомендации для врачей / Под. ред. И.И. Дедова [и др.]. - М.: Медиздат, 2007. – 37 с.
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Смирнова О.М. Впервые выявленный сахарный диабет 2 типа. Диагностика, тактика лечении: методическое пособие / О.М. Смирнова. - М. – 2008. – С. 34-47.
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