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Ding R, Zeng Y, Wei Z, He Z, Jiang Z, Yu J, You C. The L-shape relationship between hemoglobin, albumin, lymphocyte, platelet score and the risk of diabetic retinopathy in the US population. Front Endocrinol (Lausanne) 2024; 15:1356929. [PMID: 38800491 PMCID: PMC11116578 DOI: 10.3389/fendo.2024.1356929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
Background The primary aim of this study was to investigate the correlation between diabetic retinopathy (DR) and the HALP score (hemoglobin, albumin, lymphocyte, and platelet) in individuals with diabetes within the United States population. Methods This cross-sectional investigation was based on the National Health and Nutrition Examination Survey (NHANES) database from 2003-2018. The following module calculated the HALP score: HALP score = [lymphocytes (/L) × hemoglobin (g/L) × albumin (g/L)]/platelets (/L). By performing the receiver operating characteristic (ROC) analysis, the optimal cutoff value of HALP was ascertained. Restricted cubic splines (RCS), multivariable logistic regression analysis, sensitivity analysis, and subgroup analysis were conducted to evaluate the effect of the HALP score on DR patients. Finally, the decision curve analysis (DCA) and clinical impact curve (CIC) were conducted to estimate the predictive power and clinical utility of the HALP score with clinical indicators. Results According to the cutoff value (42.9) determined by the ROC curve, the participants were stratified into a lower HALP group (HALPlow) and a higher HALP group (HALPhigh). An L-shaped relationship between HALP score and DR risk was presented in the RCS model (P for nonlinearity <0.001). The DR risk sharply decreased with the increase of HALP, and the decline reached a plateau when HALP was more than 42.9. After fully adjustment, the multivariate logistic regression analysis found that HALPlow was an independent risk factor for DR (OR = 1.363, 95% CI: 1.111-1.671, P < 0.001). Besides, sensitivity analysis showed consistent results. Furthermore, the combination of HALP score and clinical indicators demonstrated predictive power and clinical utility, as shown by the ROC curve, DCA, and CIC. Conclusion The HALP score has an L-shaped correlation with the risk of DR, and thus, the HALP score may contribute to the timely intervention of diabetes patients.
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Affiliation(s)
- Ranran Ding
- Department of Ophthalmology, Tianjin Medical University General Hospital, Heping District, Tianjin, China
- Tianjin Medical University, Heping District, Tianjin, China
| | - Yusong Zeng
- Department of Ophthalmology, Tianjin Medical University General Hospital, Heping District, Tianjin, China
- Tianjin Medical University, Heping District, Tianjin, China
| | - Zhimei Wei
- Department of Ophthalmology, Tianjin Medical University General Hospital, Heping District, Tianjin, China
- Tianjin Medical University, Heping District, Tianjin, China
| | - Zitong He
- Department of Ophthalmology, Tianjin Medical University General Hospital, Heping District, Tianjin, China
- Tianjin Medical University, Heping District, Tianjin, China
| | - Zhixin Jiang
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin, China
| | - Jinguo Yu
- Department of Ophthalmology, Tianjin Medical University General Hospital, Heping District, Tianjin, China
| | - Caiyun You
- Department of Ophthalmology, Tianjin Medical University General Hospital, Heping District, Tianjin, China
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Wang Q, Cheng H, Jiang S, Zhang L, Liu X, Chen P, Liu J, Li Y, Liu X, Wang L, Li Z, Cai G, Chen X, Dong Z. The relationship between diabetic retinopathy and diabetic nephropathy in type 2 diabetes. Front Endocrinol (Lausanne) 2024; 15:1292412. [PMID: 38344659 PMCID: PMC10853456 DOI: 10.3389/fendo.2024.1292412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/10/2024] [Indexed: 02/15/2024] Open
Abstract
Context Diabetic retinopathy (DR) and diabetic nephropathy (DN), are major microvascular complications of diabetes. DR is an important predictor of DN, but the relationship between the severity of DR and the pathological severity of diabetic glomerulopathy remains unclear. Objective To investigate the relationship between severity of diabetic retinopathy (DR) and histological changes and clinical indicators of diabetic nephropathy (DN) in patients with type 2 diabetes mellitus (T2DM). Methods Patients with T2DM (n=272) who underwent a renal biopsy were eligible. Severity of DR was classified as non-diabetic retinopathy, non-proliferative retinopathy, and proliferative retinopathy (PDR). Relationship between DN and DR and the diagnostic efficacy of DR for DN were explored. Results DN had a higher prevalence of DR (86.4%) and DR was more severe. The sensitivity and specificity of DR in DN were 86.4% and 78.8%, while PDR was 26.4% and 98.5%, respectively. In DN patients, the severity of glomerular lesions (p=0.001) and prevalence of KW nodules (p<0.001) significantly increased with increasing severity of DR. The presence of KW nodules, lower hemoglobin levels, and younger age were independent risk factors associated with more severe DR in patients with DN. Conclusion DR was a good predictor of DN. In DN patients, the severity of DR was associated with glomerular injury, and presence of KW nodules, lower hemoglobin levels and younger age were independent risk factors associated with more severe DR. Trial registration ClinicalTrails.gov, NCT03865914.
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Affiliation(s)
- Qian Wang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Haimei Cheng
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Shuangshuang Jiang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Li Zhang
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Xiaomin Liu
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Pu Chen
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Jiaona Liu
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Ying Li
- Senior Department of Ophthalmology, The Third Medical Center of PLA General Hospital, Beijing, China
| | - Xiaocui Liu
- Senior Department of Ophthalmology, The Third Medical Center of PLA General Hospital, Beijing, China
| | - Liqiang Wang
- Senior Department of Ophthalmology, The Third Medical Center of PLA General Hospital, Beijing, China
| | - Zhaohui Li
- Senior Department of Ophthalmology, The Third Medical Center of PLA General Hospital, Beijing, China
| | - Guangyan Cai
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Xiangmei Chen
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
| | - Zheyi Dong
- Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Nephrology Institute of the Chinese People’s Liberation Army, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China
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Li X, Chen M. Correlation of hemoglobin levels with diabetic retinopathy in US adults aged ≥40 years: the NHANES 2005-2008. Front Endocrinol (Lausanne) 2023; 14:1195647. [PMID: 37600684 PMCID: PMC10433903 DOI: 10.3389/fendo.2023.1195647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/14/2023] [Indexed: 08/22/2023] Open
Abstract
Purpose The aim of this study was to explore the connection between hemoglobin levels and diabetic retinopathy (DR). Methods Cross-sectional research used data from the National Health and Nutrition Examination Survey (NHANES) 2005-2008. A multiple logistic regression analysis was performed to investigate the association between DR and hemoglobin levels. Additionally, generalized additivity models and smoothed curve fitting were carried out. Results After adjusting for several covariates, there was a negative association between hemoglobin levels and DR in the study, which included 837 participants. The negative association between hemoglobin levels and DR was present in men and women, the obese (BMI > 30), and 60- to 69-year-olds in subgroup analyses stratified by sex, BMI, and age. The association between hemoglobin levels and DR in the normal weight group (BMI < 25) displayed an inverted U-shaped curve with an inflection point of 13.7 (g/dL). Conclusion In conclusion, our research reveals that high hemoglobin levels are related to a decreased risk of DR. Ascertaining the hemoglobin levels ought to be regarded as an integral facet of the monitoring regimen for patients with diabetic complications and that the risk of DR is reduced through the detection and management of hemoglobin levels.
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Affiliation(s)
- Xiao Li
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Meirong Chen
- Ophthalmology Department, Shandong Hospital of Traditional Chinese Medicine, Jinan, China
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Traveset A, Rubinat E, Ortega E, Alcubierre N, Vazquez B, Hernández M, Jurjo C, Espinet R, Ezpeleta JA, Mauricio D. Lower Hemoglobin Concentration Is Associated with Retinal Ischemia and the Severity of Diabetic Retinopathy in Type 2 Diabetes. J Diabetes Res 2016; 2016:3674946. [PMID: 27200379 PMCID: PMC4855016 DOI: 10.1155/2016/3674946] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 03/31/2016] [Indexed: 12/25/2022] Open
Abstract
Aims. To assess the association of blood oxygen-transport capacity variables with the prevalence of diabetic retinopathy (DR), retinal ischemia, and macular oedema in patients with type 2 diabetes mellitus (T2DM). Methods. Cross-sectional, case-control study (N = 312) with T2DM: 153 individuals with DR and 159 individuals with no DR. Participants were classified according to the severity of DR and the presence of retinal ischemia or macular oedema. Hematological variables were collected by standardized methods. Three logistic models were adjusted to ascertain the association between hematologic variables with the severity of DR and the presence of retinal ischemia or macular oedema. Results. Individuals with severe DR showed significantly lower hemoglobin, hematocrit, and erythrocyte levels compared with those with mild disease and in individuals with retinal ischemia and macular oedema compared with those without these disorders. Hemoglobin was the only factor that showed a significant inverse association with the severity of DR [beta-coefficient = -0.52, P value = 0.003] and retinal ischemia [beta-coefficient = -0.49, P value = 0.001]. Lower erythrocyte level showed a marginally significant association with macular oedema [beta-coefficient = -0.86, P value = 0.055]. Conclusions. In patients with DR, low blood oxygen-transport capacity was associated with more severe DR and the presence of retinal ischemia. Low hemoglobin levels may have a key role in the development and progression of DR.
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Affiliation(s)
- Alicia Traveset
- Department of Ophthalmology, University Hospital Arnau de Vilanova, 25198 Lleida, Spain
- *Alicia Traveset: and
| | - Esther Rubinat
- Department of Endocrinology and Nutrition, University Hospital Arnau de Vilanova, 25198 Lleida, Spain
- Institut de Recerca Biomedica de Lleida, University of Lleida, 25198 Lleida, Spain
| | - Emilio Ortega
- Department of Endocrinology and Nutrition, Institut d'Investigacions Biomediques August Pi Suñer, CIBER de Obesidad y Nutrición, Hospital Clinic, 08036 Barcelona, Spain
| | - Nuria Alcubierre
- Institut de Recerca Biomedica de Lleida, University of Lleida, 25198 Lleida, Spain
| | - Beatriz Vazquez
- Department of Optometry, University Hospital Arnau de Vilanova, 25198 Lleida, Spain
| | - Marta Hernández
- Department of Endocrinology and Nutrition, University Hospital Arnau de Vilanova, 25198 Lleida, Spain
| | - Carmen Jurjo
- Department of Ophthalmology, University Hospital Arnau de Vilanova, 25198 Lleida, Spain
| | - Ramon Espinet
- Department of Ophthalmology, University Hospital Arnau de Vilanova, 25198 Lleida, Spain
| | - Juan Antonio Ezpeleta
- Department of Ophthalmology, University Hospital Arnau de Vilanova, 25198 Lleida, Spain
| | - Didac Mauricio
- Department of Endocrinology and Nutrition, CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Health Sciences Research Institute and University Hospital Germans Trias i Pujol, 08916 Badalona, Spain
- *Didac Mauricio:
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Lemonne N, Lamarre Y, Romana M, Hardy-Dessources MD, Lionnet F, Waltz X, Tarer V, Mougenel D, Tressières B, Lalanne-Mistrih ML, Etienne-Julan M, Connes P. Impaired blood rheology plays a role in the chronic disorders associated with sickle cell-hemoglobin C disease. Haematologica 2014; 99:74-5. [PMID: 24633868 DOI: 10.3324/haematol.2014.104745] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Ivanov I. Impedance spectroscopy of human erythrocyte membrane: Effect of frequency at the spectrin denaturation transition temperature. Bioelectrochemistry 2010; 78:181-5. [DOI: 10.1016/j.bioelechem.2009.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Revised: 08/25/2009] [Accepted: 08/28/2009] [Indexed: 10/20/2022]
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Margetis PI, Antonelou MH, Petropoulos IK, Margaritis LH, Papassideri IS. Increased protein carbonylation of red blood cell membrane in diabetic retinopathy. Exp Mol Pathol 2009; 87:76-82. [PMID: 19379730 DOI: 10.1016/j.yexmp.2009.04.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 04/07/2009] [Accepted: 04/13/2009] [Indexed: 02/02/2023]
Abstract
We investigated the protein carbonylation of red blood cell (RBC) membrane in type 2 diabetic patients and the potential implication of carbonyl/oxidative stress in reflecting disease severity. Sixty-four diabetic patients with or without retinopathy of variable clinical severity (Groups DR and DM, respectively) and 20 healthy controls were included in the study. Protein carbonyls were determined in RBC membranes by immunoblotting. Compared to healthy volunteers, the RBC membranes of diabetic patients were characterized by significantly increased levels of carbonylated proteins. The carbonylation of Group DR was higher compared to that of Group DM. The subgroup of patients with proliferative retinopathy exhibited a trend towards a significant increase in protein carbonyls, compared to both free-of-retinopathy diabetic cases and non-proliferative diabetic retinopathy cases. The correlation between the chemical modifications of the erythrocyte membrane proteins and the clinical severity of diabetic retinopathy suggests a potential utility of membrane carbonylation as a marker and risk factor in the development of retinopathy.
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Affiliation(s)
- Panagiotis I Margetis
- Department of Cell Biology and Biophysics, Faculty of Biology, University of Athens, Athens, Greece
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Petropoulos IK, Margetis PI, Antonelou MH, Koliopoulos JX, Gartaganis SP, Margaritis LH, Papassideri IS. Structural alterations of the erythrocyte membrane proteins in diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol 2008; 245:1179-88. [PMID: 17219119 DOI: 10.1007/s00417-006-0500-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2006] [Revised: 11/12/2006] [Accepted: 11/13/2006] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Several rheological disorders of the erythrocytes, such as increased aggregation and decreased deformability, have been observed in diabetes mellitus and have been implicated in the development of diabetic microangiopathy. Structural alterations of the erythrocyte membrane proteins caused by the diabetic process may be at the origin of those observations. In the present study, we searched for erythrocyte membrane protein alterations in diabetic retinopathy. METHODS We examined peripheral blood samples from 40 type-2 diabetic patients with diabetic retinopathy of variable severity (19 males and 21 females, mean age 66.8 years, Group A) and we compared them with samples from 19 type-2 diabetic patients without diabetic retinopathy (13 males and six females, mean age 66.5 years, Group B) and 16 healthy volunteers (eight males and eight females, mean age 65.6 years, Group C). Erythrocyte membrane ghosts from all samples were subjected to SDS-PAGE, and the electrophoretic pattern of transmembrane and cytoskeletal proteins was analysed for each sample. The protein quantification of each electrophoretic band was accomplished through scanning densitometry. RESULTS No significant deviations from normal electrophoresis were observed in Groups B and C, apart from an increase in band 8 in two samples from Group B (11%). In contrast, in 14 samples from Group A (35%) we detected increases in protein band 8 and/or membrane-bound haemoglobin along with a decrease in spectrin. Moreover, increased mobility of band 3, an aberrant high molecular weight (MW) (> 255 kDa) band and a low MW (42 kDa) band were evident in ten samples from Group A (25%). Glycophorins were altered in 46% of Group-A patients versus 38% of Group-B patients. Females and patients with long duration of diabetes presented more electrophoretic abnormalities. CONCLUSIONS Structural alterations of the erythrocyte membrane proteins are shown for the first time in association with diabetic retinopathy. Their detection may serve as a blood marker for the development of diabetic microangiopathy. Further studies are needed to assess whether pharmaceutical intervention to the rheology of erythrocytes can prevent or alleviate microvascular diabetic complications.
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Affiliation(s)
- Ioannis K Petropoulos
- Department of Ophthalmology, University Hospitals of Geneva, 22 Alcide-Jentzer Street, 1211 Geneva 14, Switzerland.
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