一项关于可溶性肿瘤坏死因子-α受体II（sTNF-RII）与2型糖尿病女性冠心病风险的前瞻性研究。

A prospective study of soluble tumor necrosis factor-alpha receptor II (sTNF-RII) and risk of coronary heart disease among women with type 2 diabetes.

作者信息

Shai Iris, Schulze Matthias B, Manson Joann E, Rexrode Kathryn M, Stampfer Meir J, Mantzoros Christos, Hu Frank B

机构信息

Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.

出版信息

Diabetes Care. 2005 Jun;28(6):1376-82. doi: 10.2337/diacare.28.6.1376.

DOI:10.2337/diacare.28.6.1376

PMID:15920055

Abstract

OBJECTIVE

Tumor necrosis factor-alpha (TNF-alpha), a cytokine secreted by adipose tissue and other cells, might play a role in insulin resistance.

RESEARCH DESIGN AND METHODS

Of 32,826 women from the Nurses' Health Study who provided blood at baseline, we followed 929 women with type 2 diabetes. During 10 years of follow-up, we documented 124 incident cases of coronary heart disease (CHD).

RESULTS

After adjustment for age, smoking, BMI, and other cardiovascular risk factors, the relative risks (RRs) comparing extreme quartiles of soluble TNF-alpha receptor II (sTNF-RII) were 2.48 (95% CI 1.08-5.69; P = 0.034) for myocardial infarction (MI) and 2.02 (1.17-3.48; P = 0.003) for total CHD. The probability of developing CHD over 10 years was higher among diabetic subjects with substantially higher levels of both sTNF-RII (>75th percentile) and HbA(1c) (>7%), compared with diabetic subjects with lower levels (25% vs. 7%, P < 0.0001). Diabetic subjects with only higher sTNF-RII or HbA(1c) had similar (16-17%) risk. In a multivariate model, diabetic subjects with higher levels of both sTNF-RII and HbA(1c) had an RR of 3.66 (1.85-7.22) for MI and 3.03 (1.82-5.05) for total CHD, compared with those with lower levels of both biomarkers.

CONCLUSIONS

Increased levels of sTNF-RII were strongly associated with risk of CHD among diabetic women, independent of hyperglycemia.

摘要

目的

肿瘤坏死因子-α（TNF-α）是一种由脂肪组织和其他细胞分泌的细胞因子，可能在胰岛素抵抗中发挥作用。

研究设计与方法

在护士健康研究中，有32826名女性在基线时提供了血液样本，我们对其中929名2型糖尿病女性进行了随访。在10年的随访期间，我们记录了124例冠心病（CHD）新发病例。

结果

在调整年龄、吸烟、体重指数（BMI）和其他心血管危险因素后，比较可溶性TNF-α受体II（sTNF-RII）极端四分位数时，心肌梗死（MI）的相对风险（RRs）为2.48（95%可信区间[CI]1.08 - 5.69；P = 0.034），总CHD的RRs为2.02（1.17 - 3.48；P = 0.003）。与sTNF-RII水平较低（>第75百分位数）和糖化血红蛋白（HbA1c）水平较低（>7%）的糖尿病患者相比，sTNF-RII水平较高（>第75百分位数）且HbA1c水平较高（>7%）的糖尿病患者在10年内发生CHD的概率更高（25%对7%，P < 0.0001）。仅sTNF-RII或HbA1c水平较高的糖尿病患者有相似的风险（16 - 17%）。在多变量模型中，与两种生物标志物水平较低的糖尿病患者相比，sTNF-RII和HbA1c水平较高的糖尿病患者发生MI的RR为3.66（1.85 - 7.22），总CHD的RR为3.03（1.82 - 5.05）。