PROGRESSION OF DIABETIC NON-PROLIFERATIVE RETINOPATHY IN TYPE 2 DIABETES MELLITUS: THE CONNECTION WITH THE BLOOD ENDOTHELIAL MONOCYTE-ACTIVATING POLYPEPTIDE-II LEVEL

Abstract

Relevance. The numerous pro-inflammatory and antiangiogenic properties of endothelial monocyte-activating polypeptide-II (EMAP-II) suggest its possible role in the onset and progression of diabetic non-proliferative retinopathy (DNPR) in type 2 diabetes mellitus (T2DM). Objective – is to determine the blood EMAP-II in the DM2 patients and to establish its connection with the progression of DNPR. Material and methods. We examined 91 patients with DM2 (182 eyes), who were divided into groups: 1st – there was no DNPR in both eyes and 2nd – there was no retinopathy in one eye, and isolated vascular anomalies were noted in the other (ETDRS level 14, 15). The control group included 25 patients of the corresponding age and gender. The patients were re-examined after 1 year. The level of EMAP-II was determined by the enzyme immunoassay in blood plasma once at the beginning of the study. Statistical packages MedStat and MedCalc v.15.1 (MedCalc Software bvba) were used for statistical research. Results. The analysis of clinical and laboratory parameters showed that the initial manifestations of diabetic retinal lesions were manifested in 27.5% of patients after 7.16±1.11 years and were accompanied by greater glycemia. The level of EMAP-II in DM2 was many times higher than in the control, which depended on the presence of diabetic vascular changes in the retina: in patients without changes in the retina (group 1) – by 3.7 times, and in patients with initial vascular anomalies (group 2) – 5.2 times (p<0.001). The level of EMAP-II at the beginning of the study was associated with the progression of diabetic changes in the retina after 1 year – with their presence, it was 1.5 times higher than without them (p<0.001). Stratification by stage of DNPR after 1 year also showed the dependence of the severity of diabetic changes in the retina on the initial level of EMAP-II: in the presence of single vascular anomalies and initial DNPR, it was increased by 3-4 times, while with moderate DNPR – 5.9 times (p<0.001 for all comparisons). Conclusion. Thus, a significant increase in the level of EMAP-II in T2DM was established, and the dependence of the initial diabetic changes in the retina and the degree of their progression in 1 year after the increasing of the blood EMAP-II level.