SUMMARY
Ishchenko V.A. Diagnostic and prognostic value of adipokines in patients with diabetic retinopathy in type 2 diabetes mellitus. - Qualifying scientific work published as a manuscript.
Thesis for the degree of Philosophy Doctor in the field of knowledge 22 "Healthcare" in the specialty 222 "Medicine". - State Institution "Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine", Dnipro, 2021.
The dissertation presents the results of the study of the main adipose tissue hormone leptin level and tumor necrosis factor alpha (TNF-α), immunoreactive insulin, blood glucose, blood pressure at different stages of diabetic retinopathy (DR) in patients with type-2 diabetes mellitus and metabolic syndrome and, depending on the age of patients, diabetes duration, glycated hemoglobin level and type of antidiabetic therapy. The results of a mathematical algorithm development to determine the possibility of the nature of development and the risk of progression of DR taking into account serum leptin are presented as well.
The study of diagnostic and prognostic value of the main adipose tissue hormone leptin and the leading lipocytokine TNF-α in a comprehensive assessment of the risk of development and progression of diabetic retinopathy in patients with type 2 diabetes with metabolic syndrome is a new relevant area of research in ophthalmology as it is the leading cause of irreversible blindness in various countries around the world; a key predictor of the metabolic syndrome formation is insulin resistance, which is induced by adipose tissue hormones and lipocytokines; compensatory hyperinsulinemia that occurs may affect the development and progression of proliferative diabetic retinopathy in type 2 diabetes; The role of adipose tissue hormones and anti-inflammatory lipocytokines in the development and progression of DR remains controversial and has not been definitively elucidated to date.
The study was performed to increase the effectiveness of diagnosis of the occurrence and development of diabetic retinopathy in patients with type 2 diabetes based on determining the diagnostic and prognostic value of the study in the blood of leptin and TNF-α at different stages of diabetic retinopathy.
As a result of the study, discriminant models of clinical, morphometric and biochemical parameters of metabolic syndrome and type 2 diabetes mellitus at different stages of diabetic retinopathy were created. The prognostic capacity for the stage (severity) of DR triglycerides, low-density lipoprotein cholesterol (LDL cholesterol), HbA1C, leptin and the type of antidiabetic therapy (metformin therapy, combination therapy with oral hypoglycemic agents or antihypertensives) has been demonstrated.
Making a diagnostic decision using the proposed models takes place in several stages. At the 1st stage the concentration of triglycerides or cholesterol LDL, HbA1C and leptin in the blood is investigated. At the 2nd stage, according to the obtained clinical and laboratory data, the values of the classification functions are calculated with further determination of the most important one. The prognostic decision is made as a choice of the function that is more important.
In patients with type 2 diabetes with obesity, the prognostic accuracy of the mathematical model for assessing the diagnostic and prognostic significance of clusters of metabolic syndrome in the progression of diabetic retinopathy, which is 78,5 – 82,4%, and in combination with determining the level of leptin in the blood – 67,8 – 68,9% (depending on the mathematical model).
A new method of DR risk assessment in patients with type 2 diabetes and metabolic syndrome has been proposed, which allows to determine the possibility of progression or stabilization of the pathological process at each stage of DR depending on the content of leptin in the blood. The application of the algorithm for estimating the prognosis of DR development allowed us to predict the stabilization of DR in more than a half of cases (57,7%), where 38,25% - at the 1st stage, 38,25% - at the 2nd stage and 23,5% - at the 3rd stage of DR (p = 0.02, p = 0.01 depending on the type of mathematical model). Recommendations for assessing the risk of DR progression in patients with type 2 diabetes and metabolic syndrome by determining the concentration of leptin in the blood, as well as taking into account the lower confidence limit of the average level of leptin in the blood (14.00 ng / ml), which is confirmed by the results ROC analysis. It is proposed to use TNF-α in the complex treatment of diabetic retinopathy in metabolic syndrome as a potential therapeutic target.
Key words: diabetic retinopathy, leptin, tumor necrosis factor alpha, type 2 diabetes mellitus, metabolic syndrome.
