Correspondence Between Diabetic Retinopathy And Diabetic Nephropathy From The Point Of View Of Nailfold Microcirculation

Objective:To discuss the correspondence between diabetic retinopathy and diabetic nephropathy in patients with type 2 diabetes mellitus by analyzing the integral values of nailfold microcirculation.Methods:(1)Totally 353 hospitalised type 2 diabetes patients in our hospital during January 2008 to December 2014 were enrolled. According to the nailfold microcirculation integral values(morphological integral values, flow integral values,perivascular integral values, and the total integral values),all of the patients were grouped: mild(2.1-3.9),moderate(4-7.9), severe(≥8).(2)Record the general clinical data of patients in each group, including age, gender, hypertension, smoking, course of diabetes mellitus, course of diabetic foot.(3)Drew their venous blood in the next morning and detect the fasting blood glucose(FBG),the percentage of glycated hemlglobin(Hb A1c),blood urea nitrogen(BUN), serum creatinine(SCr), uric acid(UA),total cholesterol(TC), triglycerides(TG), high-density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C), fasting C peptide. And drew their venous blood after having meals 2 hours and detect blood glucose, C peptide.(4)Without being treated by drugs to improve the circulation, all of the patients were asked to collect 24 h urine.These urine samples were sent to detect albumin.According to the results,all of the patients were be divided into three groups: SDM group(albumin were less than 30 mg /24 h), EDN group(albumin between 30-300 mg / 24 h), CDN group(albumin were greater than 300 mg / 24 h).(5) Without being treated by drug to improve the circulation,all of the patients wrere detected fundus examination or fundus fluorescence angiography(FFA) by doctors of department of eye.According to severity of the results of diabetic retinopathy : NDR group: normal fundus;NPDR group: there is micro-hemangioma, hard exudate or soft exudate, and blood spots;The PDR group: new blood vessels, vitreous hemorrhage or retinal hemorrhage.When there is a bilateral eyes with disease severity is not consistent, the severity of the most serious eye shall be prevail.(6)Each group were measured data using SPSS17.0 statistical software for analysis.Measurement datas with normal distribution were examined sum of ranks test.Using multiple Logistic regression to analysis related risk factors. The difference was statistically significant(P < 0.05).Results:1.The comparison of different DR and DN groups of nailfold microcirculation of integral values. The comparison of morphological integral values between NPDR and EDN group was statistically significant(P < 0.05). To compare the morphological integral values, flow integral values,perivascular integral values, and the total integral values between the NDR and SDM group, between the NPDR and EDN group, between the PDR and CDN group, there was no statistically significant difference(P > 0.05).2.The comparison of different severity of DR and DN correspondence between groups of nailfold microcirculation of integral values(1)The distribution and comparison of DR and DN between groups of integral values(mildly abnormal nailfold microcirculation) :to compare the morphological integral values, flow integral values,perivascular integral values, and the total integral values between NDR and SDM group, between NPDR and EDN group, between PDR and CDN group, there was no statistically significant difference(P > 0.05).(2)The distribution and comparison of DR and DN between groups of integral values(moderately abnormal nailfold microcirculation) : to compare the morphological integral values, flow integral values,perivascular integral values, and the total integral values between NDR and SDM group,between NPDR and EDN group, there was no statistically significant difference(P > 0.05); and to compare flow integral values between PDR and CDN group, there was statistically significant difference(P < 0.05).(3)The distribution and comparison of DR and DN between groups of integral values(severely abnormal nailfold microcirculation) : to compare the morphological integral values, flow integral values,perivascular integral values, and the total integral values between NDR and SDM group, between NPDR and EDN group, between PDR and CDN group, there was no statistically significant difference(P > 0.05).3. DR and DN related factors analysis3.1 DR related factors analysis:Logistic regression analysis was used to DR as dependent variable, analyzes the various factors may be associated with the DR, the results show that male, age, course of type 2 diabetes mellitus patients, glycosylated hemoglobin, blood glucose(2h after meals), C peptide(2h after meals) and albuminuria are independent risk factors of DR.3.2 DN related factors analysis:(UMA < 30 mg / 24 h, DN in installment is 0;UMA ≥30 mg/24 h, DN in installment is 1) DN as the dependent variable, the second classification logistic analysis was used, it is concluded that age, hypertension, diabetes duration, diabetic retinopathy and body mass index as the DN of risk factors(P < 0.05).Conclusion :There is positively correlation betweeen the same stage of diabetic retinopathy and diabetic nephropathy and they have same changes of nailfold microcirculation. Male, age, course of type 2 diabetes mellitus patients, glycosylated hemoglobin, blood glucose(2h after meals)and C peptide(2h after meals) are independent risk factors of DR.Age, hypertension, diabetes duration and body mass index are independent risk factors of DN.