Nitric Oxide and Tnf-Α Are Correlates of Diabetic Retinopathy Independent of Hs-Crp and Hba1c Publisher Pubmed



Khaloo P¹ ; Qahremani R¹ ; Rabizadeh S¹ ; Omidi M¹ ; Rajab A¹ ; Heidari F¹ ; Farahmand G¹ ; Bitaraf M¹ ; Mirmiranpour H² ; Esteghamati A¹ ; Nakhjavani M¹ Show Affiliations
Source: Endocrine Published:2020

Abstract

Purpose: Regarding the role of inflammation in progression of diabetes this study was conducted to investigate the association between inflammatory biomarkers such as nitric oxide (NO), tumor necrosis factor alpha (TNF-α), and high-sensitivity C-reactive protein (hs-CRP) with the chance of existence of diabetic retinopathy and its progression in patients with diabetes. Methods: A total of 83 patients with T2DM (Type 2 diabetes mellitus) were divided into three groups of patients with proliferative diabetic retinopathy (PDR), patients with non-proliferative diabetic retinopathy (NPDR) and patients without diabetic retinopathy (NDR) based on ophthalmologic funduscopic examination. Twenty six healthy controls were also enrolled. Blood samples were taken after 12 h of overnight fasting, NO, TNF-α, and hs-CRP were measured. Association of the level of these biomarkers with retinopathy was analyzed. Results: The levels of TNF-α, NO and hs-CRP were higher among patients with diabetic retinopathy. Multinomial Logistic Regression model showed that TNF-α and NO could predict the presence of retinopathy among patients with diabetes when adjusted for hs-CRP, HbA1c, FBS, gender, total cholesterol, triglyceride, HDL, LDL, BMI, and age (respectively OR = 1.76, CI 95% = 1.01–3.02, p = 0.046 and OR = 1.12, CI 95% = 1.05–1.18, p < 0.001); however they could not predict the severity of retinopathy. In ROC analysis AUC for TNFα was 0.849 (p < 0.001) and for NO was 0.907 (p < 0.001). Serum TNF-α level of 7.10 pmol/L could be suggestive of the presence of retinopathy (sensitivity = 92.2% and specificity = 66.0%), also serum NO level of 45.96 μmol/L could be suggestive of the presence of retinopathy (sensitivity = 96.1% and specificity = 86%). Conclusions: Our results suggest elevated levels of NO and TNF-α can be suggestive of diabetic retinopathy. © 2020, Springer Science+Business Media, LLC, part of Springer Nature.