2型糖尿病患者血清胱抑素C与大血管病变的关系
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摘要
目的:探讨2型糖尿病患者的血清胱抑素C(CysC)水平与大血管病变的关系。
方法:选择住院的2型糖尿病患者156例,另选59例健康体检者为对照。采用PETIA法测定血清CysC水平,并以彩色多普勒超声诊断仪测量颈动脉内膜中层厚度(IMT),以脉搏波传导速度(PWV)自动测量系统检测PWV。156例糖尿病患者分为:糖尿病不伴大血管病变(DM1)组、糖尿病伴亚临床大血管病变(DM2)组、糖尿病伴临床大血管病变(DM3)组。
结果:(1)从DM1到DM2再到DM3组,随着大血管病变的加重血清CysC水平逐渐升高,分别为:0.94±0.23、1.30±0.53、1.51±0.64mg/L,各组间差别均有显著性(P＜0.05)。
(2)以对照组CysC的90百分位数为高CysC,DM1、DM2、DM3组高CysC的比例逐渐升高,分别为:23.9%、56.14%、69.8%,组间存在显著性差异(P＜0.05)。
(3)按IMT水平将糖尿病患者分为IMT正常组及增厚组,随着IMT的增厚血清CysC呈逐渐升高趋势,各组间差别均有显著性(P＜0.05)。以同样方法按PWV水平分组比较,血清CysC水平也随着动脉硬化的加重而呈升高趋势(P＜0.05)。
(4)将血清CysC按四分位法分成四组,随着血清CysC水平的逐级升高,亚临床/临床大血管病变的发生率亦呈升高趋势,分别为:9.1%、41.5%、57.4%、94.3%,组间存在显著性差异(P＜0.05)。
(5)血清CysC水平与IMT、PWV(C-R)、PWV(C-F)均呈显著正相关(P＜0.05)。多元回归分析2型糖尿病合并大血管病变的危险因素,血清CysC可作为一个独立的危险因素进入回归方程(P＜0.05)。
(6)经肾功能分层后,各层内血清CysC水平仍随大血管病变的加重而呈升高趋势。分层后血清CysC与大血管病变间仍存在关联(P＜0.05),调整后的OR值为2.83,提示血清CysC与大血管病变的相关性可独立于肾功能的影响。
(7)h-CRP水平随大血管病变的加重而升高,且糖尿病患者的血清CysC水平与h-CRP显著正相关(P＜0.05),提示参与炎症过程可能是CysC与大血管病变相关的原因之一。
结论:(1)2型糖尿病患者的血清CysC水平与大血管病变之间存在关联,可能可预测大血管病变的风险。
(2)血清CysC水平与大血管病变的相关性独立于肾功能的影响。
(3)参与炎症过程可能是高血清CysC水平增加大血管病变风险的原因之一。
[OBJECTIVE]To investigate the correlation between serum cystatin C and macroangiopathy in patients with type 2 diabetes mellitus.
[METHODS]156 patients with type 2 diabetes mellitus were selected in hospital,while a control group including 59 subjects without diabetes mellitus was selected from those who had physical examination.Serum cystatin C were determined by Particle enhanced turbidimetric immunoassay (PETIA).The pulse wave velocity(PWV) and the common carotid intima-media thickness(IMT) of all subjects were also assessed.All patients with type 2 diabetes mellitus were divided into three groups:the group DM1 was composed of the diabetie patients without macroangiopathy,the group DM2 was composed of the diabetie patients with subclinical macroangiopathy, and the group DM3 was composed of the diabetie patients with clinical macroangiopathy.
[RESULT](1) Serum cystatin C levels increased with the progression of macroangiopathy.According to the sequence from low to high,the serum cystatin C levels were:(DM1) 0.94±0.23 mg/L,(DM2) 1.30±0.53 mg/L, (DM3) 1.51±0.64mg/L.The discrepancy of the serum cystatin C concentration was significant between random two groups among the cases (P<0.05).(2) When elevated Cys C was defined as higher than the 90th percentile of serum cystatin C concentration in contral group,the proportion of elevated CysC concentration in each group increased with the progression of macroangiopathy.The proportion in each group was:23.9%、56.14%、69.8%.There was a significant discrepancy among the groups(P<0.05).(3)All cases were divided into two groups according to the levels of IMT,such as:group normal IMT,and group thick IMT.Serum cystatin C levels increased with the thickening of IMT.And the discrepancy was significant between random two groups(P＜0.05).While a similar result was found,when grouping according to the levels of PWV (P＜0.05).(4)All subjects were divided into four equal groups according to serum cystatin C levels.The incidence of subclinical/ clinical macroangiopathy tended to increase with serum cystatin C levels,that was: 9.1%、41.5%、57.4%,and 94.3%.There was significant discrepancy among the groups(P＜0.05).(5)The correlations between serum cystatin C and IMT、PWV(C-R)、PWV(C-F) were significant(P＜0.05).(6)After the stratification by renal function,serum cystatin C levels still increased with the progression of macroangiopathy within the layers.After the adjustment by stratification,there was still a significantly correlativity between serum cystatin C levels and macroangiopathy(P＜0.05),adjusted odds ratio was 2.83.(7)H-CRP levels increased with the progression of macroangiopathy(P＜0.05),while a significant correlation between serum cystatin C and h-CRP was found in patients with type 2 diabetes mellitus (P＜0.05).(8)It is suggested that cystatin C is an independent risk factor of the progression to macroangiopathy in patients with type 2 diabetes mellitus by the multiple regression procedure(P＜0.05).
[CONCLUSIONS](1)There was a significantly positive correlativity between serum cystatin C levels and macroangiopathy in patients with type 2 diabetes mellitus.Serum cystatin C might be a predictor for macroangiopathy in diabetic patients.(2)The correlation was independent of renal function.(3) Inflammatory reaction might be one of the mechanism that could explain how elevated cystatin C levels increased the risk of macroangiopathy.
方法:选择住院的2型糖尿病患者156例,另选59例健康体检者为对照。采用PETIA法测定血清CysC水平,并以彩色多普勒超声诊断仪测量颈动脉内膜中层厚度(IMT),以脉搏波传导速度(PWV)自动测量系统检测PWV。156例糖尿病患者分为:糖尿病不伴大血管病变(DM1)组、糖尿病伴亚临床大血管病变(DM2)组、糖尿病伴临床大血管病变(DM3)组。
结果:(1)从DM1到DM2再到DM3组,随着大血管病变的加重血清CysC水平逐渐升高,分别为:0.94±0.23、1.30±0.53、1.51±0.64mg/L,各组间差别均有显著性(P＜0.05)。
(2)以对照组CysC的90百分位数为高CysC,DM1、DM2、DM3组高CysC的比例逐渐升高,分别为:23.9%、56.14%、69.8%,组间存在显著性差异(P＜0.05)。
(3)按IMT水平将糖尿病患者分为IMT正常组及增厚组,随着IMT的增厚血清CysC呈逐渐升高趋势,各组间差别均有显著性(P＜0.05)。以同样方法按PWV水平分组比较,血清CysC水平也随着动脉硬化的加重而呈升高趋势(P＜0.05)。
(4)将血清CysC按四分位法分成四组,随着血清CysC水平的逐级升高,亚临床/临床大血管病变的发生率亦呈升高趋势,分别为:9.1%、41.5%、57.4%、94.3%,组间存在显著性差异(P＜0.05)。
(5)血清CysC水平与IMT、PWV(C-R)、PWV(C-F)均呈显著正相关(P＜0.05)。多元回归分析2型糖尿病合并大血管病变的危险因素,血清CysC可作为一个独立的危险因素进入回归方程(P＜0.05)。
(6)经肾功能分层后,各层内血清CysC水平仍随大血管病变的加重而呈升高趋势。分层后血清CysC与大血管病变间仍存在关联(P＜0.05),调整后的OR值为2.83,提示血清CysC与大血管病变的相关性可独立于肾功能的影响。
(7)h-CRP水平随大血管病变的加重而升高,且糖尿病患者的血清CysC水平与h-CRP显著正相关(P＜0.05),提示参与炎症过程可能是CysC与大血管病变相关的原因之一。
结论:(1)2型糖尿病患者的血清CysC水平与大血管病变之间存在关联,可能可预测大血管病变的风险。
(2)血清CysC水平与大血管病变的相关性独立于肾功能的影响。
(3)参与炎症过程可能是高血清CysC水平增加大血管病变风险的原因之一。
[OBJECTIVE]To investigate the correlation between serum cystatin C and macroangiopathy in patients with type 2 diabetes mellitus.
[METHODS]156 patients with type 2 diabetes mellitus were selected in hospital,while a control group including 59 subjects without diabetes mellitus was selected from those who had physical examination.Serum cystatin C were determined by Particle enhanced turbidimetric immunoassay (PETIA).The pulse wave velocity(PWV) and the common carotid intima-media thickness(IMT) of all subjects were also assessed.All patients with type 2 diabetes mellitus were divided into three groups:the group DM1 was composed of the diabetie patients without macroangiopathy,the group DM2 was composed of the diabetie patients with subclinical macroangiopathy, and the group DM3 was composed of the diabetie patients with clinical macroangiopathy.
[RESULT](1) Serum cystatin C levels increased with the progression of macroangiopathy.According to the sequence from low to high,the serum cystatin C levels were:(DM1) 0.94±0.23 mg/L,(DM2) 1.30±0.53 mg/L, (DM3) 1.51±0.64mg/L.The discrepancy of the serum cystatin C concentration was significant between random two groups among the cases (P<0.05).(2) When elevated Cys C was defined as higher than the 90th percentile of serum cystatin C concentration in contral group,the proportion of elevated CysC concentration in each group increased with the progression of macroangiopathy.The proportion in each group was:23.9%、56.14%、69.8%.There was a significant discrepancy among the groups(P<0.05).(3)All cases were divided into two groups according to the levels of IMT,such as:group normal IMT,and group thick IMT.Serum cystatin C levels increased with the thickening of IMT.And the discrepancy was significant between random two groups(P＜0.05).While a similar result was found,when grouping according to the levels of PWV (P＜0.05).(4)All subjects were divided into four equal groups according to serum cystatin C levels.The incidence of subclinical/ clinical macroangiopathy tended to increase with serum cystatin C levels,that was: 9.1%、41.5%、57.4%,and 94.3%.There was significant discrepancy among the groups(P＜0.05).(5)The correlations between serum cystatin C and IMT、PWV(C-R)、PWV(C-F) were significant(P＜0.05).(6)After the stratification by renal function,serum cystatin C levels still increased with the progression of macroangiopathy within the layers.After the adjustment by stratification,there was still a significantly correlativity between serum cystatin C levels and macroangiopathy(P＜0.05),adjusted odds ratio was 2.83.(7)H-CRP levels increased with the progression of macroangiopathy(P＜0.05),while a significant correlation between serum cystatin C and h-CRP was found in patients with type 2 diabetes mellitus (P＜0.05).(8)It is suggested that cystatin C is an independent risk factor of the progression to macroangiopathy in patients with type 2 diabetes mellitus by the multiple regression procedure(P＜0.05).
[CONCLUSIONS](1)There was a significantly positive correlativity between serum cystatin C levels and macroangiopathy in patients with type 2 diabetes mellitus.Serum cystatin C might be a predictor for macroangiopathy in diabetic patients.(2)The correlation was independent of renal function.(3) Inflammatory reaction might be one of the mechanism that could explain how elevated cystatin C levels increased the risk of macroangiopathy.
引文
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