|
The Mean Lipid Profile and Severity of Retinal Hard Exudates Table 3 showed the severity of RHE in diabetic patients type 2 with diabetic retinopathy among the severity of RHE in diabetic patients type 2 with DR, there were 11 patients with mild RHE, and 13 with moderate RHE and 16 with severe RHE. The mean cholesterol, LDL, and triglyceride levels in the severe RHE group were higher than mild and moderate RHE, however these differences are not statistically significant (Table 3).
Figure 1 Diabetic retinopathy （略）
A:Grade I；B: Grade II; C: Grade III
Table 1 Patient demography（略）
Table 2Comparing lipid profile between the two groups（略）
Table 3 Retinal hard exudates and lipid profile（略）
Table 4 Association of oxidized LDL with systemic comorbidity and duration of diabetes（略）
Table 5 Glycated HbA1C and oxidized LDL in patients in Group A and Group B（略）
Association of oxidized LDL Among Diabetic Patients with Systemic comorbidity There was no significant difference between the mean levels of oxidized LDL with hypertension, ischemic heart disease and dyslipidemia or the duration of diabetes mellitus(Table 4).
Glycated haemoglobin and oxidized LDL in Group A and B The diabetic control was poor in both groups (>6.5%). The mean level of glycated (HbA1C) was 8.7%±2.1% in Group A and was 8.4%±2.1% in Group B, which is comparable in both groups. The mean oxLDL in Group A was 183±118U/L and in Group B was 217±114U/L which also showed no statistical significant difference(Table 5).
DISCUSSION
Our study describes the association of serum cholesterol and LDL with DR which complements other studies on the related fields. The mean age in our study participants was 56.1±9.1 years, the same finding was seen in a study done in Nepal by Shrestha et al[10].We found the mean level of total cholesterol was significantly higher in DR compared to those without DR (P=0.001), and also the mean level of LDL was high (P=0.005) in diabetic patients with DR compared to those without DR. The same finding was noted by Sinav et al[11] which reported that Plasma total cholesterol & LDL were related to DR mainly proliferative type. In our study the levels of cholesterol, and LDL in severe RHE in DR patients were higher compared with those of mild and moderate (P=0.082, 0.218) respectivly . In contrast what have been seen by ETDRS group and WESDR where they found a statistically significant association between serum cholesterol and LDL and the increase in the severity of RHE in DR[12].This may be due to our small sample size in the DR group and the unequal distribution of the sub groups of RHE. We found also the triglyceride in severe RHE were higher compared to mild and moderate RHE. However, there was no significant difference between the three groups (P>0.05). LDLC was higher in type 2 DM patients with maculopathy and increased maculopathy rates have been observed in patients with higher baseline cholesterol levels[13]. In our study the mean level of HbA1C in Group A (8.7%) and in Group B (8.4%) were comparable (P=0.246). The means HbA1C for both groups reflect that our study participants have poor diabetic control. Hyperglycemia, duration of diabetes, hypertension, dyslipidaemia and obesity are important risk factors for the development and progression of DR[14,15]. In our study there was no significant difference between oxLDL and the duration of DM and systemic comorbidity. These factors need to be further investigated in our population.And also There was no statistical significant difference in the mean oxLDL between the DR group and non DR group (P=0.884). Timothy also unable to find any association of retinopathy status with the susceptibility of isolated LDL to the oxidative stress[16]. There were several studies done where they found that LDL oxidizability may be increased in people with type 2 diabetes and that lipid peroxidation in such individuals is particularly high when glycemic control is poor[17,18]. In our study both groups were diabetic patients and we lacked the normal population which could give a clear comparison between the level of glycemic status and oxidized LDL. The relationship between LDLC values and both macular edema and hard exudates is of practical importance and lowering lipids either through diet or pharmacological agents has a beneficial effect not only in preventing development of hard exudates but also in reducing hard exudates already present[19].
Our limitations in this study were the sample size was small in the diabetic group, which makes the subdivision group according to the severity of RHE inadequate and unequal. The control group in this study was also diabetic patients, which could be better if we could add another group of normal population, so that we can differentiate between the normal and abnormal values of lipid profiles as well as oxidized LDL. Classification of retinal hard exudates would be preferably done with macular oedema for it to be clinically meaningful. Involvement of the RHE at the fovea also bears further investigation.
Acknowledgements:Thanks to all who involved in this study (Department of Ophthalmology HUSM, Chemopathology Department HUSM).
上一页 [1] [2] [3] 下一页 |
