2型糖尿病患者冠状动脉钙化进展的决定因素：血糖控制及炎症/血管钙化标志物的作用
Determinants of progression of coronary artery calcification in type 2 diabetes role of glycemic control and inflammatory/vascular calcification markers.
作者信息
Anand Dhakshinamurthy Vijay, Lim Eric, Darko Daniel, Bassett Paul, Hopkins David, Lipkin David, Corder Roger, Lahiri Avijit
机构信息
Cardiac Imaging and Research Centre, Wellington Hospital, London, United Kingdom.
出版信息
J Am Coll Cardiol. 2007 Dec 4;50(23):2218-25. doi: 10.1016/j.jacc.2007.08.032. Epub 2007 Nov 19.
OBJECTIVES
This study prospectively evaluated the relationship between cardiovascular risk factors, selected biomarkers (high-sensitivity C-reactive protein [hs-CRP], interleukin [IL]-6, and osteoprotegerin [OPG]), and the progression of coronary artery calcification (CAC) in type 2 diabetic subjects.
BACKGROUND
Coronary artery calcification is pathognomonic of coronary atherosclerosis. Osteoprotegerin is a signaling molecule involved in bone remodeling that has been implicated in the regulation of vascular calcification and atherogenesis.
METHODS
Three hundred ninety-eight type 2 diabetic subjects without prior coronary disease or symptoms (age 52 +/- 8 years, 61% male, glycated hemoglobin [HbA(1)c] 8 +/- 1.5) were evaluated serially by CAC imaging (mean follow-up 2.5 +/- 0.4 years). Progression/regression of CAC was defined as a change > or =2.5 between the square root transformed values of baseline and follow-up volumetric CAC scores. Demographic data, risk factors, glycemic control, medication use, serum hs-CRP, IL-6, and plasma OPG levels were measured at baseline and follow-up.
RESULTS
Two hundred eleven patients (53%) had CAC at baseline. One hundred eighteen patients (29.6%) had CAC progression, whereas 3 patients (0.8%) had regression. Age, male gender, hypertension, baseline CAC, HbA(1)c >7, waist-hip ratio, IL-6, OPG, use of beta-blockers, calcium channel antagonists, angiotensin-converting enzyme (ACE) inhibitors, statins, and Framingham/UKPDS (United Kingdom Prospective Diabetes Study) risk scores were univariable predictors of CAC progression. In the multivariate model, baseline CAC (odds ratio [OR] for CAC >400 = 6.38, 95% confidence interval [CI] 2.63 to 15.5, p < 0.001), HbA(1)c >7 (OR 1.95, CI 1.08 to 3.52, p = 0.03), and statin use (OR 2.27, CI 1.38 to 3.73, p = 0.001) were independent predictors of CAC progression.
CONCLUSIONS
Baseline CAC severity and suboptimal glycemic control are strong risk factors for CAC progression in type 2 diabetic subjects.
目的
本研究前瞻性评估了2型糖尿病患者心血管危险因素、选定的生物标志物（高敏C反应蛋白[hs-CRP]、白细胞介素[IL]-6和骨保护素[OPG]）与冠状动脉钙化（CAC）进展之间的关系。
背景
冠状动脉钙化是冠状动脉粥样硬化的特征性表现。骨保护素是一种参与骨重塑的信号分子，已被认为与血管钙化和动脉粥样硬化的调节有关。
方法
对398例无既往冠心病或症状的2型糖尿病患者（年龄52±8岁，男性占61%，糖化血红蛋白[HbA(1)c] 8±1.5）进行连续的CAC成像评估（平均随访2.5±0.4年）。CAC的进展/消退定义为基线和随访时体积性CAC评分的平方根转换值之间的变化≥2.5。在基线和随访时测量人口统计学数据、危险因素、血糖控制、药物使用、血清hs-CRP、IL-6和血浆OPG水平。
结果
211例患者（53%）基线时有CAC。118例患者（29.6%）有CAC进展，而3例患者（0.8%）有消退。年龄、男性、高血压、基线CAC、HbA(1)c>7、腰臀比、IL-6、OPG、使用β受体阻滞剂、钙通道拮抗剂、血管紧张素转换酶（ACE）抑制剂、他汀类药物以及弗雷明汉/英国前瞻性糖尿病研究（UKPDS）风险评分是CAC进展的单变量预测因素。在多变量模型中，基线CAC（CAC>400的比值比[OR]=6.38，95%置信区间[CI] 2.63至15.5，p<0.001）、HbA(1)c>7（OR 1.95，CI 1.08至3.52，p=0.03）和他汀类药物使用（OR 2.27，CI 1.38至3.73，p=0.001）是CAC进展的独立预测因素。
结论
基线CAC严重程度和血糖控制不佳是2型糖尿病患者CAC进展的强危险因素。
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