Nguyen Tri Q, Tarnow Lise, Jorsal Anders, Oliver Noelynn, Roestenberg Peggy, Ito Yasuhiko, Parving Hans-Henrik, Rossing Peter, van Nieuwenhoven Frans A, Goldschmeding Roel
Pathology, University Medical Center Utrecht, Utrecht, the Netherlands.
Diabetes Care. 2008 Jun;31(6):1177-82. doi: 10.2337/dc07-2469. Epub 2008 Mar 14.
We evaluated the predictive value of baseline plasma connective tissue growth factor (CTGF) in a prospective study of patients with type 1 diabetes.
Subjects were 198 type 1 diabetic patients with established diabetic nephropathy and 188 type 1 diabetic patients with persistent normoalbuminuria. Follow-up time was 12.8 years. Prediction of end-stage renal disease (ESRD) and mortality by plasma CTGF was analyzed in conjunction with conventional risk factors.
Plasma CTGF was higher in patients with nephropathy than in patients with normoalbuminuria (median 381 [interquartile range 270-630] vs. 235 [168-353] pmol/l). In patients with nephropathy, elevated plasma CTGF was an independent predictor of ESRD (covariate-adjusted hazard ratio [HR] 1.6 [95% CI 1.1-2.5]) and correlated with the rate of decline in glomerular filtration rate (GFR) (cumulative R = 0.46). Area under the receiver operating characteristic curve for prediction of ESRD was 0.72. Plasma CTGF above a cutoff level of 413 pmol/l predicted ESRD with a sensitivity of 73% and a specificity of 63% and was associated with a higher rate of decline in GFR (mean +/- SD 5.4 +/- 4.9 vs. 3.3 +/- 3.5 ml/min per 1.73 m(2) per year). Moreover, in patients with nephrotic range albuminuria (>3 g/day), plasma CTGF was the only predictor of ESRD (covariate-adjusted HR 4.5 [2.0-10.4]). Plasma CTGF was an independent predictor also of overall mortality (covariate-adjusted HR 1.4 [1.1-1.7]). In contrast, in normoalbuminuric patients, plasma CTGF did not correlate with clinical parameters and did not predict outcome.
Plasma CTGF contributes significantly to prediction of ESRD and mortality in patients with type 1 diabetic nephropathy.
在一项针对1型糖尿病患者的前瞻性研究中，我们评估了基线血浆结缔组织生长因子（CTGF）的预测价值。
研究对象为198例已确诊糖尿病肾病的1型糖尿病患者和188例持续性正常白蛋白尿的1型糖尿病患者。随访时间为12.8年。结合传统危险因素分析血浆CTGF对终末期肾病（ESRD）和死亡率的预测情况。
肾病患者的血浆CTGF水平高于正常白蛋白尿患者（中位数381[四分位间距270 - 630]对235[168 - 353]pmol/l）。在肾病患者中，血浆CTGF升高是ESRD的独立预测因素（协变量调整风险比[HR]1.6[95%CI 1.1 - 2.5]），且与肾小球滤过率（GFR）下降速率相关（累积R = 0.46）。预测ESRD的受试者工作特征曲线下面积为0.72。血浆CTGF高于413 pmol/l的临界值预测ESRD的敏感性为73%，特异性为63%，并与较高的GFR下降速率相关（平均±标准差5.4±4.9对3.3±3.5 ml/min每1.73 m²每年）。此外，在肾病范围蛋白尿（>3 g/天）的患者中，血浆CTGF是ESRD的唯一预测因素（协变量调整HR 4.5[2.0 - 1）。血浆CTGF也是总体死亡率的独立预测因素（协变量调整HR 1.4[1.1 - 1.7]）。相比之下，在正常白蛋白尿患者中，血浆CTGF与临床参数无关，也不能预测预后。
血浆CTGF对1型糖尿病肾病患者ESRD和死亡率的预测有显著贡献。
