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Introduction <p>The purpose of this study was to explore the roles and methods of inflammatory factors and total load of cerebral small vessel disease (CSVD) in diabetic retinopathy (DR) and cognitive impairment.</p> Materials and methods <p>In total, 1860 patients with type 2 diabetes mellitus (T2DM) were divided into a DR group and a non-diabetic retinopathy (NDR) group, and nonproliferative DR was divided into mild and moderate-to-severe according to the severity. The patients’ baseline data were recorded, and imaging indicators were collected to evaluate CSVD. Monofactor analysis was performed to identify the risk factors associated with DR and cognitive impairment, and a logistic regression model was used to determine independent risk factors. Finally, Nomogram and receiver operating characteristic (ROC) curves were constructed to evaluate the prediction effect of the model.</p> Results <p>(1) 693 patients (37.26%) had DR and 1167 patients (62.74%) had no DR. In the DR group, hypertension, disease course, low-density lipoprotein cholesterol (LDL-C), uric acid (UA), glycosylated hemoglobin (HbA1c), triglyceride glucose index (TyG), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were all significantly higher than in the NDR group (<i>p</i> &lt; 0.001). Multivariate logistic regression analysis further verified that hypertension, LDL-C, PLR, and SII were independent risk factors for DR. (2) Among 612 patients with nonproliferative DR, the levels of hypertension, UA, HbA1c, TyG index, interleukin-6 (IL-6), monocyte-to-lymphocyte ratio (MLR), and SII in the moderate-to-severe nonproliferative DR group were significantly higher than those in the mild nonproliferative DR group (<i>p</i> &lt; 0.01). (3) Patients with moderate-to-severe nonproliferative DR were divided into a cognitive impairment group and a non-cognitive impairment group. Smoking history, drinking history, fasting blood glucose, HbA1c, TyG index, PLR, MLR, SII, total CSVD magnetic resonance imaging (MRI) load, and white matter hyperintensities (WMHs) were significantly associated with cognitive impairment (<i>p</i> &lt; 0.01). Smoking history, fasting blood glucose, HbA1c, TyG index, SII, total CSVD load, and lacunar infarction (LI) were independent risk factors for cognitive impairment in patients with moderate-to-severe DR. In addition, total MRI load (<i>r</i> = 0.711, <i>p</i> &lt; 0.05), TyG index (<i>r</i> = 0.712, <i>p</i> &lt; 0.05), SII (<i>r</i> = 0.703, <i>p</i> &lt; 0.05), and PLR (<i>r</i> = 0.724, <i>p</i> &lt; 0.05) were significantly negatively correlated with Montreal Cognitive Assessment (MoCA) score.</p> Conclusions <p>This study identified hypertension history, LDL-C, PLR, and SII as factors independently associated with the presence of DR in patients with T2DM. In addition, UA, TyG, SII, total CSVD load, and WMHs were significantly associated with more severe stages of DR.</p>

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The Mechanisms of Inflammatory Factors and the Total Load of Cerebral Small Vessel Disease in Diabetic Retinopathy and Cognitive Impairment

  • 期刊论文

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  • 发表日期：

    2025年10月6日

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  • Junjun Miao,
  • Shi Chen,
  • Xinyi Sun,
  • Yun She,
  • Lijuan Wang,
  • Siman Liu,
  • Jiangyi Yu,
  • Jing Ge,
  • Zhenguo Qiao

摘要

Introduction

The purpose of this study was to explore the roles and methods of inflammatory factors and total load of cerebral small vessel disease (CSVD) in diabetic retinopathy (DR) and cognitive impairment.

Materials and methods

In total, 1860 patients with type 2 diabetes mellitus (T2DM) were divided into a DR group and a non-diabetic retinopathy (NDR) group, and nonproliferative DR was divided into mild and moderate-to-severe according to the severity. The patients’ baseline data were recorded, and imaging indicators were collected to evaluate CSVD. Monofactor analysis was performed to identify the risk factors associated with DR and cognitive impairment, and a logistic regression model was used to determine independent risk factors. Finally, Nomogram and receiver operating characteristic (ROC) curves were constructed to evaluate the prediction effect of the model.

Results

(1) 693 patients (37.26%) had DR and 1167 patients (62.74%) had no DR. In the DR group, hypertension, disease course, low-density lipoprotein cholesterol (LDL-C), uric acid (UA), glycosylated hemoglobin (HbA1c), triglyceride glucose index (TyG), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) were all significantly higher than in the NDR group (p < 0.001). Multivariate logistic regression analysis further verified that hypertension, LDL-C, PLR, and SII were independent risk factors for DR. (2) Among 612 patients with nonproliferative DR, the levels of hypertension, UA, HbA1c, TyG index, interleukin-6 (IL-6), monocyte-to-lymphocyte ratio (MLR), and SII in the moderate-to-severe nonproliferative DR group were significantly higher than those in the mild nonproliferative DR group (p < 0.01). (3) Patients with moderate-to-severe nonproliferative DR were divided into a cognitive impairment group and a non-cognitive impairment group. Smoking history, drinking history, fasting blood glucose, HbA1c, TyG index, PLR, MLR, SII, total CSVD magnetic resonance imaging (MRI) load, and white matter hyperintensities (WMHs) were significantly associated with cognitive impairment (p < 0.01). Smoking history, fasting blood glucose, HbA1c, TyG index, SII, total CSVD load, and lacunar infarction (LI) were independent risk factors for cognitive impairment in patients with moderate-to-severe DR. In addition, total MRI load (r = 0.711, p < 0.05), TyG index (r = 0.712, p < 0.05), SII (r = 0.703, p < 0.05), and PLR (r = 0.724, p < 0.05) were significantly negatively correlated with Montreal Cognitive Assessment (MoCA) score.

Conclusions

This study identified hypertension history, LDL-C, PLR, and SII as factors independently associated with the presence of DR in patients with T2DM. In addition, UA, TyG, SII, total CSVD load, and WMHs were significantly associated with more severe stages of DR.