2型糖尿病患者血清糖化白蛋白、C反应蛋白和肿瘤坏死因子-α水平与冠状动脉疾病严重程度及肾功能损害的相关性

Association of serum levels of glycated albumin, C-reactive protein and tumor necrosis factor-alpha with the severity of coronary artery disease and renal impairment in patients with type 2 diabetes mellitus.

作者信息

Lu Lin, Pu Li Jin, Xu Xue Wei, Zhang Qi, Zhang Rui Yan, Zhang Jian Sheng, Hu Jian, Yang Zheng Kun, Lu An Kang, Ding Feng Hua, Shen Jie, Chen Qiu Jin, Lou Sheng, Fang Dan Hong, Shen Wei Feng

机构信息

Department of Cardiology, Rui Jin Hospital, Jiaotong University School of Medicine, Shanghai, PR China.

出版信息

Clin Biochem. 2007 Jul;40(11):810-6. doi: 10.1016/j.clinbiochem.2007.03.022. Epub 2007 Apr 19.

DOI:10.1016/j.clinbiochem.2007.03.022

PMID:17499233

Abstract

OBJECTIVES

This study aimed to determine whether elevated serum levels of glycated albumin, high-sensitivity C-reactive protein (hsCRP) and tumor necrosis factor (TNF)-alpha were related to an increased risk for coronary artery disease (CAD) and renal insufficiency in patients with type 2 diabetes mellitus (T2DM).

DESIGN AND METHODS

Serum levels of glycated albumin, hsCRP, TNF-alpha and blood glycosylated hemoglobin A1c (HbA1c) were measured in 317 consecutive patients with T2DM and 309 normal controls. Patients with T2DM were grouped based upon coronary angiographic findings (Group I: 151 patients with normal coronary arteries; Group II: 166 patients with significant coronary stenosis [>70% luminal diameter narrowing]) and renal functional status evaluated by estimated creatinine clearance (CrCl) (normal renal function group: 187 patients with CrCl >90 mL/min; mild renal insufficiency group: 103 patients with CrCl 60-90 mL/min; moderate renal insufficiency group: 27 patients with CrCl 30-60 mL/min). Multivariate analysis was performed to determine independent risk factors for CAD and renal insufficiency in patients with T2DM.

RESULTS

Serum levels of glycated albumin, hsCRP and TNF-alpha were significantly higher in Group II than in controls (P<0.01) and Group I (P<0.01). A significant difference was found in glycated albumin, hsCRP and TNF-alpha levels among diabetic patients with mild, moderate renal insufficiency and normal renal function (P<0.05). These biochemical measurements correlated significantly with number of diseased coronary vessels (P<0.01) and status of renal function (P<0.05). No difference existed in HbA1c levels between Group II and Group I, and among patients with various CrCL stages. Multivariate analysis revealed that male gender, old age and serum levels of glycated albumin, hsCRP, TNF-alpha and lipoprotein (a) were independent risk factors for CAD, and older age, hypertension and glycated albumin were for CrCl <60 mL/min in diabetes.

CONCLUSIONS

Increased serum levels of glycated albumin, hsCRP and TNF-alpha are associated with the presence and severity of CAD and renal impairment in patients with T2DM.

摘要

目的

本研究旨在确定2型糖尿病（T2DM）患者血清糖化白蛋白、高敏C反应蛋白（hsCRP）和肿瘤坏死因子（TNF）-α水平升高是否与冠状动脉疾病（CAD）风险增加及肾功能不全有关。

设计与方法

检测317例连续性T2DM患者和309例正常对照者的血清糖化白蛋白、hsCRP、TNF-α及糖化血红蛋白A1c（HbA1c）水平。根据冠状动脉造影结果将T2DM患者分组（I组：151例冠状动脉正常患者；II组：166例冠状动脉显著狭窄[管腔直径狭窄>70%]患者），并根据估算的肌酐清除率（CrCl）评估肾功能状态（肾功能正常组：187例CrCl>90 mL/min患者；轻度肾功能不全组：103例CrCl 60 - 90 mL/min患者；中度肾功能不全组：27例CrCl 30 - 60 mL/min患者）。进行多变量分析以确定T2DM患者CAD和肾功能不全的独立危险因素。

结果

II组患者血清糖化白蛋白、hsCRP和TNF-α水平显著高于对照组（P<0.01）和I组（P<0.01）。轻度、中度肾功能不全及肾功能正常的糖尿病患者在糖化白蛋白、hsCRP和TNF-α水平上存在显著差异（P<0.05）。这些生化指标与病变冠状动脉血管数量（P<0.01）及肾功能状态（P<0.05）显著相关。II组与I组之间以及不同CrCl阶段患者的HbA1c水平无差异。多变量分析显示，男性、老年以及血清糖化白蛋白、hsCRP、TNF-α和脂蛋白（a）水平是CAD的独立危险因素，而老年、高血压和糖化白蛋白是糖尿病患者CrCl<60 mL/min的独立危险因素。