Clinical research about the unbalanced statement of angiogenic growth factors and inhibitor with retinopathy under insulin treatment in type 2 diabetics

Abstract

Objective To observe the unbalanced statement of angiogenic growth factors and angiogenesis inhibitors with retinopathy development under insulin treatment in the type 2 diabetics, so as to provide reference for clinical monitoring. Methods Cross- sectional survey of 90 type 2 diabetic patients in the first people's hospital affiliated to Shanghai Jiaotong university from September of 2010 to March of 2011 (30 cases without retinopathy, 36 cases with mild non-proliferative diabetic retinopathy (NPDR) and 24 cases with moderate and severe NPDR). The level of vascular endothelial growth factor(VEGF) and CXC chemotatic factors, including SDF-1, IL-8, GROα, IP-10 and MIG were measured in those patients. One-way analysis of variance was used between groups compared, t test was used in pairwise comparison. Three ratio of angiogenic growth factors and angiogenesis inhibitors were selected using ROC curve and compared with the area under the curve. Result The expression of SDF-1 was significant higher in mild NPDR group than that in no retinal lesion group (t=-2.977, P<0.05, AUC=0.643). And compared with mild NPDR group, the expression of VEGF (t=3.333, P<0.05, AUC=0.952), IP-10 (t=-3.45, P<0.05, AUC=0.857) and IL-8 (t=-3.05, P<0.05, AUC=0.5) was significant higher in the moderate and severe NPDR group. At the early stasge, all the three type of ratio (SI: SDF-1/IP-10; II: IL-8/IP-10; VI: VEGF/IP-10) had diagnostic value (II: AUC=0.561, Sen=62.5%, Spe= 51.5%; SI: AUC=0.625, Sen=12.5%, Spe=100%; VI: AUC=0.655, Sen=87.5%, Spe=57.6%). However, only VI had the diagnostic value in the group of moderate and severe NPDR. Conclusion There is an unbalance phenomenon of angiogenic growth factors and angiogenesis inhibitors in the type 2 diabetic, which is relative to the development of diabetic retinopathy. The ratio of VEGF/IP-10 may be a good index for the progressive of DR. Key words: Insulin; Receptor, cytokine; Diabetic retinopathy; Receiver operating characteristic curve