Correlation Study On The Relationship Between NLR,PLR And Retinal Microangiopathy In Patients With Type 2 Diabetes Mellitus

Objective To investigate the correlation between neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)as inflammatory indexes and retinal microvascular pathological changes in type 2 diabetes mellitus(T2DM)patients by detecting the serum level of NLR and PLR in T2 DM patients with different clinical stages.Then further to study whether serum level of NLR and PLR would reflect the diseases progression of diabetic retinopathy as an effective biological indicator,thus to provide clinical supports for early detection and treatment.Methods we collected 117 patients with type 2 diabetes during October 2015 to march 2016 in our hospital according to united criteria in “Guidelines for prevention and treatment of type 2 diabetes in China(2013 Edition)”,89 patients With diabetic retinopathy were divided into DR group,and 28 healthy controls as NDR group.NPDR group had 54 patients,includingⅠstage,Ⅱstage and Ⅲstage,and PDR group had the other 40 patients including Ⅳ stage,Ⅴstage and Ⅵ stage.Collected the basic information and laboratory examination results including NLR,PLR,Fasting blood glucose(FPG),2h Postprandia glucosel(2h PPG),glycosylated hemoglobin,blood lipids and the renal fuction indicators.All the dataes were analyzed by SPSS 16.0 statistical software.Results 1.The length of the duration of diabetes,Systolic blood pressure(SBP),Fasting C peptide,Glycosylated hemoglobin(Hb A1c),Serum glycosylated albumin(GA),Homocysteine(Hcy),Free fatty acids(NEFA),Lymphocyte count(LYMPH),Platelet count(PLT),Cystatin c(Cys C),Superoxide dismutase(SOD),neutrophil-tolymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR)show statistically significant in different groups.(P<0.05)2.The levels of NLR were increased gradually with the progress of diabetic retinopathy.The NLR levels of PDR group(3.45 ± 2.38)was significantly higher than that of NDR group(1.76 ± 2)and NPDR group(2.58± 1.57),and the NLR was significantly higher than that in the NDR group(P =0.002),The NLR levels in NDR group and NPDR group was statistically significant after statistical analysis.The levels of NLR was positively correlated with this factors: the duration of diabetes mellitus,homocysteine,triglyceride,PLR,superoxide dismutase was negatively correlated with the NLR levels.The receiver operating characteristic curve(ROC)with NLR 2.0 as the cut-off as the critical point.the sensitivity of diagnosis DR was 55.6%,and the specificity was 66.7%.The area under the ROC was 0.694(95% CI: 0.586-0.803;P =0.041)3.The PLR levels of NDR group was(93.59 ± 35.88),and NPDR group was(112.37 ±55.89),was significant difference between NDR group and NPDR group(P = 0.047).The PLR level of PDR group was(132.71 ± 65.99),which was significantly higher than that of NDR group and NPDR group,suggesting PLR might be have the clinical value of identifying diabetic patients may be had DR.PLR was positively correlated with the duration of diabetes mellitus,triglyceride and the NLR,superoxide dismutase was negatively correlated with PLR.The ROC curve showed that the optimal critical value of PLR is 102.67,the sensitivity of diagnosis DR is 54.7%,the specificity is 60.7%.The area under the ROC curve was 0.667,95% CI: 0.553-0.781;P = 0.009.4.The activity SOD of NDR group(132.84 ± 25.21 U / ml)was significantly higher than that of NPDR group(111.19 ± 30.83 U / ml)and PDR group(108.38 ± 24.07 U /ml)(P <0.05),but they were not have statistically significant difference between NPDRgroup and PDR group.the SOD level was positively correlated with the duration of diabetes mellitus,negatively correlated with cystatin C,Lp(a)and homocysteine.The free fatty acids in NDR group was significantly lower than that in NPDR group and PDR group(P <0.05),The levels of free fatty acids was positively correlated with the factors: the duration of diabetes mellitus,Hb A1 c,homocysteine.Conclusion There was significant increase in serum NLR and PLR of type 2 diabetes mellitus patients,which had important clinical value in evaluating whether type 2diabetes mellitus patients would suffer retinopathy.The increase of serum NLR and PLR of type 2 diabetes mellitus patients may be closely related to the oxidative stress response and lipid metabolism,the mechanisms are still not well understood and need further study.