Neutrophillia significantly associated with increased risk of macular edema in type 2 diabetes patients

Immune dysregulation and inflammation are involved in DME pathogenesis. The progressive neutrophils increase in peripheral blood can increase the retina's number of neutrophils, thus leading to sustained damage of the retinal vascular system and the destruction of the blood-retinal barrier (BRB). Lymphocytes protect against vascular diseases caused by type 2 diabetes mellitus (T2DM).

Against the above background, Yan Zhu, Ophthalmology Department, Nantong First People's Hospital, Nantong, China, and colleagues aimed to study the relationship between the changes in leukocytes and their classification in peripheral blood and the progression and occurrence of DME in type 2 diabetes patients.

For this purpose, the researchers conducted a retrospective analysis of 81 patients with T2DM with DME (DME group) hospitalized from January 2019 to December 2020. The patients were divided into an early DME group (n=33) and the late DME group (n=48) based on the morphological characteristics of macular edema in optical coherence tomography (OCT). Thirty-three diabetic retinopathy patients without DME matched in age and course of disease served as the control group (NO-DME group). The clinical parameters assessed included OCT results, eye examination, WBCs and subtypes, glycosylated hemoglobin, and blood glucose.

The study led to the following findings:

• Neutrophils% in the DME group (n=81) was more significant (57.37±9.52 vs. 63.27±7.85); Monocyte% (7.63±1.77 vs. 6.88±1.83) and lymphocyte% (30.35±9.51 vs. 27.26±6.59) were reduced, compared Compared with NO-DME group (n=33).
• With R 4.0.5 software, the optimal model was obtained. With other relevant variables being similar, females had a significantly increased DME risk (b=1.273), %neutrophils were significantly associated with an increased DME risk (b=0.152), and %lymphocytes were significantly associated with a reduced DME risk (b=−0.027).
• No significant differences in biological markers were found in the early and late DME groups, and a high-quality model was not obtained.

"WBCs and subtypes are representative markers of immune system and inflammation, and their associations with DR have been shown," the researchers wrote in their conclusion; however, only a few have described their relationships with DME.

The current study showed that with all the predictors being similar, %neutrophils were significantly associated with increased DME risk, and %lymphocytes were significantly associated with reduced DME risk. There is a higher likelihood for females to develop DME.

" A predictive accuracy of 82.46% was observed in the model we established," they wrote. "In addition, an imbalance of the immune system plays a critical role in the DME pathogenesis, and it will become a prime target for treating diabetic macular edema in the future."

Reference:

Zhu Y, Xu M, Li J, Li J, Li L, Zhou Y, Song Y, Cai Q. Peripheral white blood cell subtypes and the development/progression of diabetic macular edema in type 2 diabetic patients: a comparative study. Ann Palliat Med 2022;11(9):2887-2896. doi: 10.21037/apm-22-962