2型糖尿病患者胱抑素C水平与冠脉病变发生风险的关联研究
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摘要
目的评价胱抑素C与2型糖尿病患者中冠心病病情及冠脉病变严重程度的相关性。方法随机选取199名怀疑或确诊为冠心病的2型糖尿病患者进行冠脉造影术,依据入院时的病情分组为对照组、稳定性心绞痛、不稳定性心绞痛及急性心肌梗死组;并依据Gensini评分分组为正常冠脉结构组、轻度、中度及重度冠脉病变组,分析评价2型糖尿病患者中胱抑素C和冠心病的关系。结果急性心肌梗死组及重度冠脉病变组的胱抑素C水平升高,且和病情严重程度(r=0.172,P=0.002)及Gensini评分(r=0.177,P=0.002)呈正相关,但在多元回归分析中,不同于糖基化血红蛋白,胱抑素C并不是冠心病合并2型糖尿病患者的病情或冠脉病变严重程度的独立危险因素(均有P>0.05)。结论胱抑素C对于冠心病合并2型糖尿病患者的预测价值不如糖基化血红蛋白,但该指标和冠心病密切相关。
Objective To evaluate the role of cystatin C in predicting coronary artery disease(CAD) and their severity in type 2 diabetes mellitus(T2 DM) patients.Methods Totally 199 T2 DM patients who suspected of CAD were enrolled,and underwent coronary angiography.The condition of inpatients(non-CAD,stable angina pectoris(SAP),and unstable angina pectoris(UAP)),acute myocardial infarction( AMI) and Gensini scores were measured to evaluate the severity of CAD and coronary lesions,respectively.Multivariate analysis was performed to evaluate the prediction value of cystatin C as a hiomarker.Results Cystatin C levels were significantly elevated in the AMI group,as with in the Gensini score >50 group.Levels were positively correlated with the severity of CAD(r = 0.172,P =0.002) and Gensini score(r= 0.177,P =0.002).However,contrast to glycosylated hemoglobin,using multivariate analysis,cystatin C was not an independent predictor of CAD severity and vascular lesions in patients with T2 DM(all P >0.05).Conclusion Cystatin C is a less sensitive predictor of CAD than HbAlc.However,it appears to correlate with CAD in T2 DM patients.
Objective To evaluate the role of cystatin C in predicting coronary artery disease(CAD) and their severity in type 2 diabetes mellitus(T2 DM) patients.Methods Totally 199 T2 DM patients who suspected of CAD were enrolled,and underwent coronary angiography.The condition of inpatients(non-CAD,stable angina pectoris(SAP),and unstable angina pectoris(UAP)),acute myocardial infarction( AMI) and Gensini scores were measured to evaluate the severity of CAD and coronary lesions,respectively.Multivariate analysis was performed to evaluate the prediction value of cystatin C as a hiomarker.Results Cystatin C levels were significantly elevated in the AMI group,as with in the Gensini score >50 group.Levels were positively correlated with the severity of CAD(r = 0.172,P =0.002) and Gensini score(r= 0.177,P =0.002).However,contrast to glycosylated hemoglobin,using multivariate analysis,cystatin C was not an independent predictor of CAD severity and vascular lesions in patients with T2 DM(all P >0.05).Conclusion Cystatin C is a less sensitive predictor of CAD than HbAlc.However,it appears to correlate with CAD in T2 DM patients.
引文
[1]邓大同,杨明功.2型糖尿病与冠心病[J].疾病控制杂志,2002,6(3):241-244.
[2]Go AS,Mozaffarian D,Roger VL,et al.Executive summary:heart disease and stroke statistics——2014 update.[J].Circulation,2014,129(3):399-410.
[3]Donahoe SM,Stewart GC,McCabe CH,et al.Diabetes and mortality following acute coronary syndromes[J].JAMA,2007,298(7):765-775.
[4]邹飒枫,乔晶.4158例高血压合并糖尿病病人现况及并发症分析[J].中华疾病控制杂志,2010,14(11):1124-1125-
[5]Fliser D,Ritz E.Serum cystatin C concentration as a marker of renal dysfunction in the elderly[J].Am J Kidney Dis,2001,37(1):79-83.
[6]Zhang J,Wu X,Gao P,et al.Correlations of serum cystatin C and glomerular filtration rate with vascular lesions and severity in acute coronary syndrome[J].BMC Cardiovasc Disord,2017,17(1):47.
[7]Noto D,Cefalu'AB,Barbagallo CM,et al.Cystatin C levels are decreased in acute myocardial infarction:effect of cystatin C G73Agene polymorphism on plasma levels[J].Int J Cardiol,2005,101(2):213-217.
[8]Fu Z,Xae H,Guo J,et al.Long-term prognostic impact of cystatin c on acute coronary syndroms octogenarians with diabetes mellitus[J].Cardiovasc Diabetol,2013,12(1):157.
[9]Kim EH,Yu JH,Lee SA,et al.Lack of association between serum cystatin C levels and coronary artery disease in diabetic patients[J].Korean Diabetes J,2010,34(2):95-100.
[10]Goldberg R,Szklo M,Tonascia JA,et al.Acute myocardial infarction.Prognosis complicated by ventricular fibrillation or cardiac arrest[J].JAMA,1979,241(19):2024-2027.
[11]Braunwald E.Unstable angina.A classification[J].Circulation,1989,80(2):410-414.
[12]Gensini GG.A more meaningful scoring system for determining the severity of coronary heart disease[J].Am J Cardiol,1983,51(3):606.
[13]Libby P,Ridker PM,Maseri A.Inflammation and atherosclerosis[J].Circulation,2002,105(9)::135-1143.
[14]Doganer YC,Aydogan U,Aydogdu A,et al.Relationship of cystatin C with coronary artery disease and its severity[J].Coron Artery Dis,2013,24(2):119-126.
[15]Dandana A,Gammoudi I,Chalghoum A,et al.Clinical utility of serum cystatin C in predicting coronary artery disease in patientswithout chronic kidney disease[J].J Clin Lab Anal,2014,28(3):191-197.
[16]Silva D,Cortez-Dias N,Jorge C,et al.Cystatin C as prognostic biomarker in ST-segment elevation acute myocardial infarction[J].Am J Cardiol,2012,109(10):1431-1438.
[17]Ichimoto E,Jo K,Kobayashi Y,et al.Prognostic significance of cystatin C in patients with ST-elevation myocardial infarction[J].Circ J,2009,73(9):1669-1673.
[18]Jernberg T,Lindahl B,James S,et al.Cystatin C:a novel predictor of outcome in suspected or confirmed non-ST-elevation acute coronary syndrome[J].Circulation,2004,110(16):2342-2348.
[19]Wang J,Yan G,Qiao Y,et al.Different levels of glycosylated hemoglobin influence severity and long-term prognosis of coronary heart disease patients with stent implantation[J].Exp Ther Med,2015,9(2):361-366.
[20]Kmet M,Rajer B,Pernat A.Hemoglobin A1c is a better predictor of prognosis following the non-ST elevation acute coronary syndrome than fasting and admission glucose[J].Wien Klin Wochenschr,2014,126(5-6):156-162.
[2]Go AS,Mozaffarian D,Roger VL,et al.Executive summary:heart disease and stroke statistics——2014 update.[J].Circulation,2014,129(3):399-410.
[3]Donahoe SM,Stewart GC,McCabe CH,et al.Diabetes and mortality following acute coronary syndromes[J].JAMA,2007,298(7):765-775.
[4]邹飒枫,乔晶.4158例高血压合并糖尿病病人现况及并发症分析[J].中华疾病控制杂志,2010,14(11):1124-1125-
[5]Fliser D,Ritz E.Serum cystatin C concentration as a marker of renal dysfunction in the elderly[J].Am J Kidney Dis,2001,37(1):79-83.
[6]Zhang J,Wu X,Gao P,et al.Correlations of serum cystatin C and glomerular filtration rate with vascular lesions and severity in acute coronary syndrome[J].BMC Cardiovasc Disord,2017,17(1):47.
[7]Noto D,Cefalu'AB,Barbagallo CM,et al.Cystatin C levels are decreased in acute myocardial infarction:effect of cystatin C G73Agene polymorphism on plasma levels[J].Int J Cardiol,2005,101(2):213-217.
[8]Fu Z,Xae H,Guo J,et al.Long-term prognostic impact of cystatin c on acute coronary syndroms octogenarians with diabetes mellitus[J].Cardiovasc Diabetol,2013,12(1):157.
[9]Kim EH,Yu JH,Lee SA,et al.Lack of association between serum cystatin C levels and coronary artery disease in diabetic patients[J].Korean Diabetes J,2010,34(2):95-100.
[10]Goldberg R,Szklo M,Tonascia JA,et al.Acute myocardial infarction.Prognosis complicated by ventricular fibrillation or cardiac arrest[J].JAMA,1979,241(19):2024-2027.
[11]Braunwald E.Unstable angina.A classification[J].Circulation,1989,80(2):410-414.
[12]Gensini GG.A more meaningful scoring system for determining the severity of coronary heart disease[J].Am J Cardiol,1983,51(3):606.
[13]Libby P,Ridker PM,Maseri A.Inflammation and atherosclerosis[J].Circulation,2002,105(9)::135-1143.
[14]Doganer YC,Aydogan U,Aydogdu A,et al.Relationship of cystatin C with coronary artery disease and its severity[J].Coron Artery Dis,2013,24(2):119-126.
[15]Dandana A,Gammoudi I,Chalghoum A,et al.Clinical utility of serum cystatin C in predicting coronary artery disease in patientswithout chronic kidney disease[J].J Clin Lab Anal,2014,28(3):191-197.
[16]Silva D,Cortez-Dias N,Jorge C,et al.Cystatin C as prognostic biomarker in ST-segment elevation acute myocardial infarction[J].Am J Cardiol,2012,109(10):1431-1438.
[17]Ichimoto E,Jo K,Kobayashi Y,et al.Prognostic significance of cystatin C in patients with ST-elevation myocardial infarction[J].Circ J,2009,73(9):1669-1673.
[18]Jernberg T,Lindahl B,James S,et al.Cystatin C:a novel predictor of outcome in suspected or confirmed non-ST-elevation acute coronary syndrome[J].Circulation,2004,110(16):2342-2348.
[19]Wang J,Yan G,Qiao Y,et al.Different levels of glycosylated hemoglobin influence severity and long-term prognosis of coronary heart disease patients with stent implantation[J].Exp Ther Med,2015,9(2):361-366.
[20]Kmet M,Rajer B,Pernat A.Hemoglobin A1c is a better predictor of prognosis following the non-ST elevation acute coronary syndrome than fasting and admission glucose[J].Wien Klin Wochenschr,2014,126(5-6):156-162.