Ijcem 0037903
Ijcem 0037903
Ijcem 0037903
www.ijcem.com /ISSN:1940-5901/IJCEM0037903
Original Article
Correlation of retinopathy with serum levels of growth
hormones and insulin-like growth factor-1 in
patients with diabetic retinopathy
Jie Zhang1, Li Zhang2, Li Quan3, Wenxue Qi3, Yujie Jiang3, Sheng Jiang3
1
Department of Endocrinology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830000, Xinjiang,
China; 2Department of Ophthalmology, Armed Police Hospital of Xinjiang, Urumqi 830000, Xinjiang, China;
3
Department of Endocrinology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang,
China
Received August 14, 2016; Accepted October 19, 2016; Epub January 15, 2017; Published January 30, 2017
Abstract: Objective: This study aims to retrospectively analyze the correlation between levels of serum growth hor-
mones and insulin-like growth factor-1 (IGF-1) and severity of retinopathy in type 2 diabetes patients reaching the
goal of blood glucose control. Method: A retrospective analysis was adopted for 112 type 2 diabetes patients reach-
ing the goal of blood glucose control in the past 3 years. All patients received fundus fluorescein angiography, based
on which the patients were divided into normal fundus group, non-proliferative diabetic retinopathy (DR) group
and proliferative DR group. The three groups were compared with regard to the levels of serum growth hormones
and IGF-1. Their correlation with severity of DR was assessed using multivariate unconditional logistic regression.
Result: In the proliferative DR group, the levels of low density lipoprotein cholesterol (LDL-C), urine micro albumin
(UmALB), serum growth hormones and IGF-1 were all significantly higher than those of the normal group and the
non-proliferative DR group (P<0.05); however, no significant difference was found between the non-proliferative DR
group and the normal group (P>0.05). The C-peptide (C-P) level in the proliferative DR group was markedly lower
than that of the other two groups (P<0.05); but no significant difference was found between the non-proliferative
DR group and the normal group (P>0.05). As indicated by correlation analysis, course of disease, UmALB, IGF-1
and fasting C-P levels were correlated to the severity of DR. Conclusion: The common factors of DR are course of
diabetes, systolic pressure, LDL-C, fasting C-R risk and UmALB. In addition to these, higher levels of serum growth
hormones and IGF-1 may also contribute to DR, which is speculated to be one mechanism for the progression of
DR in type 2 diabetes.
_
Table 1. Comparison of clinical characteristics among three groups of patients ( x ± s)
Case Course of Waist
Group Age (years) BMI (Kg/M2) SBP (mmHg) DBP (mmHg)
(n) disease (years) circumference (cm)
PDR group 23 56.9 ± 10.42 13.45 ± 4.22 91.54 ± 4.94 23.89 ± 3.86 129.69 ± 13.87 85.55 ± 8.94
NPDR group 31 57.42 ± 9.24 11.63 ± 5.38* 90.15 ± 6.86 24.15 ± 5.14 125.65 ± 10.34 83.83 ± 7.82
N group 74 56.9 ± 13.55 10.81 ± 6.95* 93.25 ± 8.26 24.83 ± 4.82 127.43 ± 9.32 84.51 ± 8.43
F value - 0.168 11.671 0.285 0.310 0.547 0.675
P value - 0.506 0.004 0.753 0.734 0.073 0.531
*Compared with the PDR group, the difference was statistically significant (P<0.05).
_
Table 2. Comparison of blood markers among three groups of patients ( x ± s)
FPG LDL-C HDL-C PPG
Group GH (ng/ml) IGF-1 (ng/ml) C-P (ng/ml) PC-P (ng/ml) TG (mmol/L) TC (mmol/L) UA (mg/L)
(mmol/L) (mmol/L) (mmol/L) (mmol/L)
PDR group 2.61 ± 1.32 158.5 ± 41.42 0.68 ± 0.41 1.43 ± 0.91 7.38 ± 1.54 4.85 ± 1.13 4.15 ± 1.79 5.16 ± 1.31 1.06 ± 0.39 262 ± 49.61 10.14 ± 2.45
NPDR group 1.83 ± 1.14* 132. ± 33.81* 0.93 ± 0.56* 2.66 ± 1.04* 7.85 ± 2.63 3.0 ± 1.10* 3.95 ± 1.31 5.01 ± 1.22 1.11 ± 0.65 221 ± 37.91* 9.96 ± 3.78
N group 1.75 ± 1.06* 129. ± 38.25* 0.99 ± 0.47* 3.11 ± 1.12* 6.93 ± 1.22 3.1 ± 1.24* 3.77 ± 1.21 4.91 ± 0.92 1.13 ± 0.82 218 ± 29.53* 9.63 ± 4.48
F value 12.822 32.762 5.068 6.048 2.206 12.823 0.445 2.207 0.056 12.820 0.057
P value 0.002 0.013 0.014 0.005 0.063 0.008 0.643 0.065 0.946 0.012 0.944
*Compared with the PDR group, the difference was statistically significant (P<0.05).
Though the pathogenesis of DR is still unclear, [4] Chinese Medical Association Diabetes Branch.
several risk factors have been reported, includ- Chinese type 2 diabetes prevention guide
ing course of DM, systolic pressure, blood glu- (2013 Edition). Chinese Journal of Diabetes
cose control status and urine albumin. These Mellitus 2014; 88: 26-89.
[5] Long QY and Yu LH. Risk factors associated
factors are already attended to in clinics [12].
with diabetic retinopathy progression in pa-
According to our result, DM patients combined
tients with type 2 diabetes. Chinese Journal of
with PDR still had higher GH and IGF-1 levels Prevention and Control of Chronic Diseases
in spite of good blood glucose control status. 2014; 22: 411-413.
IGF-1 is a risk factor of DR. For these patients, [6] Muir KW, Grubber J, Mruthyunjaya P, McCant F
inhibiting IGF-1 may be one pathway for pre- and Bosworth HB. Progression of diabetic reti-
venting and treating DR. nopathy in the hypertension intervention nurse
telemedicine study. JAMA Ophthalmol 2013;
Acknowledgements 131: 957-958.
[7] Du YJ, Zhao ZY, Li XJ and Ma LX. Diabetic reti-
This work was supported by the Natural fund nopathy and serum growth hormone (analysis
project in Xinjiang (Name of the fund: The study of 31 cases). Chinese Journal of Gerontology
about Xinjiang uygur people’s osteocalcin level 1992; 12: 218-220.
difference and its relationship with insulin resi- [8] Ringholm L, Vestgaard M, Laugesen CS, Juul A,
stance. No. 2013ZRZD05) and the fund proj- Damm P and Mathiesen ER. Pregnancy-in-
duced increase in circulating IGF-I is associat-
ect of Hospital to Xinjiang Uygur Autonomous
ed with progression of diabetic retinopathy in
Region, NO. 20140102.
women with type 1 diabetes. Growth Horm IGF
Res 2011; 21: 25-30.
Disclosure of conflict of interest
[9] Bonfig W, Molz K, Woelfle J, Hofer SE, Hauffa
BP, Schoenau E, Golembowski S, Wudy SA and
None. Holl RW. Metabolic Safety of Growth Hormone
in Type 1 Diabetes and Idiopathic Growth Hor-
Address correspondence to: Sheng Jiang, Depart-
mone Deficiency. J Pediatr 2013; 163: 1095-
ment of Endocrinology, First Affiliated Hospital of 1098.e4.
Xinjiang Medical University, No.134 Liyushan South [10] Gokulakrishnan K, Velmurugan K, Ganesan S
Road, Urumqi 830000, Xinjiang, China. Tel: +86- and Mohan V. Circulating levels of insulin-like
18999936571; Fax: +86-18999936571; E-mail: growth factor binding protein-1 in relation to
jsheng_a@163.com insulin resistance, type 2 diabetes mellitus,and
metabolic syndrome (Chennai Urban Rural Epi-
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