Han Thang S, Sattar Naveed, Williams Ken, Gonzalez-Villalpando Clicerio, Lean Michael E J, Haffner Steven M
Addenbrooke's Hospital, Cambridge University Medical School, Cambridge, U.K.
Diabetes Care. 2002 Nov;25(11):2016-21. doi: 10.2337/diacare.25.11.2016.
Recent evidence suggests that C-reactive protein (CRP) may predict development of diabetes in Caucasian populations. We evaluated CRP as a possible risk factor of the development of diabetes and metabolic syndrome in a 6-year study of 515 men and 729 women from the Mexico City Diabetes Study.
Baseline CRP, indexes of adiposity, and insulin resistance (homeostasis model assessment [HOMA-IR]) were used to predict development of the metabolic syndrome, defined as including two or more of the following: 1) dyslipidemia (triglyceride >/=2.26 mmol/l or HDL cholesterol </=0.91 mmol/l in men and </=1.17 mmol/l in women; <35 and 40 mg/dl for men and women); 2) hypertension (blood pressure >140/90 mmHg or on hypertensive medication); or 3) diabetes (1999 World Health Organization criteria).
At baseline, CRP correlated significantly (P < 0.001) with all metabolic indexes in women, but less so in men. After 6 years, 14.2% of men and 16.0% of women developed the metabolic syndrome. Compared with tertile 1, women with CRP in the highest tertile had an increased relative risk of developing the metabolic syndrome by 4.0 (95% CI 2.0-7.9) and diabetes by 5.5 (2.2-13.5); these risks changed minimally after adjusting for BMI or HOMA-IR. The area under receiver-operating characteristic (ROC) curve for the prediction of the development of the syndrome was 0.684 for CRP, increasing to 0.706 when combined with BMI and to 0.710 for a complex model of CRP, BMI, and HOMA-IR.
CRP was not a significant predictor of the development of the metabolic syndrome in men. Our data strongly support the notion that inflammation is important in the pathogenesis of diabetes and metabolic disorders in women.
近期证据表明，C反应蛋白（CRP）可能预测白种人群中糖尿病的发生。在一项针对墨西哥城糖尿病研究中515名男性和729名女性的6年研究中，我们评估了CRP作为糖尿病和代谢综合征发生的一种可能风险因素。
使用基线CRP、肥胖指标和胰岛素抵抗（稳态模型评估[HOMA-IR]）来预测代谢综合征的发生，代谢综合征定义为包括以下两项或更多项：1）血脂异常（男性甘油三酯≥2.26 mmol/l或高密度脂蛋白胆固醇≤0.91 mmol/l，女性≤1.17 mmol/l；男性和女性分别<35和40 mg/dl）；2）高血压（血压>140/90 mmHg或正在服用降压药物）；或3）糖尿病（1999年世界卫生组织标准）。
在基线时，CRP与女性所有代谢指标显著相关（P<0.001），但与男性的相关性较弱。6年后，14.2%的男性和16.0%的女性发生了代谢综合征。与第一三分位数相比，CRP处于最高三分位数的女性发生代谢综合征的相对风险增加4.0（95%CI 2.0 - 7.9），发生糖尿病的相对风险增加5.5（2.2 - 13.5）；在调整BMI或HOMA-IR后，这些风险变化极小。CRP预测该综合征发生的受试者操作特征（ROC）曲线下面积为0.684，与BMI联合时增至0.706，对于CRP、BMI和HOMA-IR的综合模型则为0.710。
CRP不是男性代谢综合征发生的显著预测因素。我们的数据有力支持了炎症在女性糖尿病和代谢紊乱发病机制中起重要作用这一观点。
