Relationship Of Retinol Binding Protein 4 And High Sensitive C-reactive Protein With Type 2 Diabetic Retinopathy

Diabetic retinopathy(DR) is one of the most common and severe microvascular complications of diabetes melitus(DM), a major causes of diabetic blindness. Pathophysiology of diabetic retinopathy is mainly manifested as the formation of capillary mico hemangioma, thickening of the basement membrane, endothelial cell hyperplasia, blood retinal barrier brokendown, capillary occlusion, new blood vessels forming. Its occurrence is a complex process and the pathogenesis is not clear at present. With new discoveries in recent years the role of oxidative stress, hyperglycemia, polyol pathway, advanced glycation end products and inflammatory reactions in the occurrence and development of DR, a growing number of scholars believe that inflammation and insulin resistance(IR) and the development of diabetic retinopathy are closely related. Hypersensitive C-reactive protein(hs-CRP) is a mainly synthesized by the liver inflammation response proteins.Normal human hypersensitive is minimal, when the body by inflammation and trauma hypersensitive levels will rise.Hypersensitive C-reactive protein is considered to reflect acute inflammation and subclinical inflammation nonspecific sensitive indicator. Many studies have found that diabetic retinopathy serum hypersensitive concentration lesions increased, suggesting that the development of hypersensitive associated with diabetic retinopathy.Retinol binding protein 4(RBP4) belongs to the fat-soluble vitamin carrier protein family, its main function is binding and transport of vitamin A(retinol). A basic research showes that retinol binding protein 4 gene expression associated with inflammatory facors and its markers.Because of retinol binding protein 4 and hypersensitive expression is associated with inflammation, so guess retinol binding protein 4 associated with hypersensitive, and is related to the occurrence of type 2 diabetic retinopathy, there is no relevant reports of the three relations.ObjectiveIn recent years about people retinol binding protein 4 involved in diabetes patients insulin resistance and atherosclerosis reported more, but retinol binding protein 4 expression in type 2 diabetic retinopathy group studied less. Because of retinol binding protein 4 and hypersensitive expression is associated with inflammation, so guess retinol binding protein 4 associated with hypersensitive, and is related to the occurrence of type 2 diabetic retinopathy, there is no relevant reports of the three relations.In this study, normal people, no retinopathy but with type 2 diabetes patients, and diabetic retinopathy patients as the research object, to investigate the expression and significance level of hypersensitive C-reactive protein and retinol binding protein 4 in patients with diabetic retinopathy.To provide the basis for early screening,to provide new ideas to the pathogenesis of DR,to provide new method for the treament of DR.MethodsAll diabetic patients were initial diagnosis of diabetic retinopathy and no application of drug therapy, ask and record all the patient’s age, sex, measured their height, weight, blood pressure, fasting for 10 hours and collecting 5ml the next morning fasting blood. The Baoding First Central Hospital of inspectors Hitachi 7600 automatic biochemical instrument fasting venous plasma sugar, triglycerides, cholesterol, low density lipoprotein, high density lipoprotein, uric acid, homocysteine concentrations.Japanese company Sysmex XE-2100 instrument measuring neutrophils, lymphocytes, calculate NLR = number of neutrophils / lymphocytes. ECL method(Roche, Germany ECL instrument Cobas6000-E601) fasting insulin. Steady-state model assessment insulin resistance index(HOMA-IR) = fasting plasma glucose(mmol / L) × fasting insulin(m IU / L) /22.5. Enzyme-linked immunosorbent determination retinol binding protein 4, hypersensitive C-reactive protein(enzyme-linked immune Shanghai Biological Technology Co. Ltd. provides a kit), intra difference <6% difference between batches <10%. Pearson correlation analysis the relationship between retinol binding protein 4 and related indicators, whether the risk factors of diabetic retinopathy using logistic regression analysis.Wih P<0.05 for the difference was statistically significant.Result1 Each group of patients for general information and biochemical indices comparing:four groups of age, sex and body mass index were not significantly different(P> 0.05). DM group compared with the control group, NPDR group, PDR group diastolic blood pressure was increasing, and the difference was statistically significant(P<0.05), compared with simple diabetic group, NPDR group, PDR group systolic blood pressure tended to increase, there is statistical difference significance(P<0.05).Compared with the control group, diabetic group, NPDR group, PDR group retinol binding protein 4, hypersensitive C-reactive protein, diastolic blood pressure, fasting glucose, lycosylated hemoglobin gfasting insulin, insulin resistance index,triglyceride,NLR significantly increased,but high-density lipoprotein decreased(P<0.05),LDL difference was not significant(P>0.05). Compared with the simple non-proliferative diabetic PDR group’s and NPDR group’s fasting glucose, insulin resistance index, cholesterol, homocysteine, hypersensitive,NLR were increased significantly(P<0.05),Triglycerides, fasting insulin, high-density lipoprotein, uric acid differences were not obvious(P>0.05). And compared with the NPDR group PDR group’s retinol binding protein 4, hypersensitive C-reactive protein, homocysteine was increased obvious(P<0.05),Fasting glucose, insulin resistance index, cholesterol, high density lipoprotein differences were not obvious(P>0.05),see table one.2Correlation analysis of retinol binding protein 4 and related indicators:systolic blood pressure,diastolic blood pressure,fasting glucose,insulin resistance index, triglycerides,cholesterol,homocysteine,highsensitivity C-reactive protein and NLR were obviously correlated with retinol binding protein 4(r=0.235,0.336,0.482,0.172,0.242,0.900,0.793,0.268 P<0.05),and high density lipoprotein was negatively correlated with retinol binding protein 4(r =-0.406, P<0.05),see table two.3Diabetic retinopathy risk factors analysis: after all the patients according to whether the DR group with systolic blood pressure, diastolic blood pressure, fasting glucose, high-density lipoprotein, triglycerides, retinol binding protein 4, hypersensitive as covariates logistic regression analysis the results showed that systolic blood pressure, fasting glucose, retinol binding protein 4, hypersensitive are risk factors in patients with DR,see table three.ConclusionDiabetic retinopathy patients’ s serum retinol binding protein 4, hypersensitive C-reactive protein increased significantly,and both in the proinflammatory mechanisms related, and both are independent risk factors for type 2 diabetic retinopathy. They can be a common inflammatory pathways accelerate the process of diabetic retinopathy. binding protein 4 can affect the metabolism of the blood sugar, blood lipids, blood pressure and increased the risk of diabetic retinopathy.