Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, Colorado 80045, USA.
Diabetes Technol Ther. 2010 Jan;12(1):25-33. doi: 10.1089/dia.2009.0086.
Cystatin C has been proposed to better estimate renal function and predict cardiovascular disease (CVD) than serum creatinine. To expand on our previous report, we investigated whether the relationship of cystatin C to progression of coronary artery atherosclerosis (CA) differed between individuals with type 1 diabetes (T1D) and persons without diabetes.
Coronary artery calcium was measured twice over 2.4 +/- 0.4 years (n = 1,123, age = 39 +/- 9 years, 47% male, 45% T1D). Significant CA progression was defined as a > or = 2.5 increase in square root calcium volume score or development of clinical coronary artery disease. Stepwise multiple logistic regression was performed to investigate whether the association of cystatin C to CA progression differed by T1D status.
The main finding and novelty of this article is that while the univariate association of cystatin C to CA progression was similar in T1D patients and persons without diabetes mellitus and in the expected direction (increased cystatin C as a biomarker of worsening renal function associated with CA progression), the association of cystatin C to progression of CA differed by T1D status (P = 0.01) after adjustment for other CVD risk factors. Unexpectedly, in persons without diabetes mellitus having relatively normal renal function, increased cystatin C was associated with decreased CA progression (odd ratio [OR] = 0.65, 95% confidence interval 0.44-0.96, P = 0.029) after adjustment, primarily due to adjustment for body mass index (BMI). Removal of BMI from this model resulted in a 49% change in the OR.
Our hypothesis-generating data suggest a complex relationship among cystatin C, BMI, and CA progression that requires further study.
胱抑素 C 被认为比血清肌酐更能准确评估肾功能并预测心血管疾病（CVD）。为了进一步阐述我们之前的报告，我们研究了胱抑素 C 与 1 型糖尿病（T1D）患者和非糖尿病患者冠状动脉粥样硬化（CA）进展之间的关系是否不同。
在 2.4 +/- 0.4 年期间对冠状动脉钙进行了两次测量（n = 1,123，年龄 = 39 +/- 9 岁，47%为男性，45%为 T1D）。显著的 CA 进展定义为平方根钙体积评分增加>=2.5 或出现临床冠状动脉疾病。采用逐步多因素逻辑回归分析来研究胱抑素 C 与 CA 进展之间的关系是否因 T1D 状态而异。
本文的主要发现和新颖之处在于，虽然胱抑素 C 与 CA 进展的单变量相关性在 T1D 患者和非糖尿病患者中相似，且方向与预期一致（作为肾功能恶化的生物标志物，胱抑素 C 升高与 CA 进展相关），但胱抑素 C 与 CA 进展的相关性因 T1D 状态而异（P = 0.01），在调整其他 CVD 风险因素后。出乎意料的是，在肾功能相对正常的非糖尿病患者中，调整 BMI 后，升高的胱抑素 C 与 CA 进展减少相关（比值比 [OR] = 0.65，95%置信区间 0.44-0.96，P = 0.029），主要是由于调整了 BMI。从该模型中去除 BMI 会使 OR 发生 49%的变化。
我们生成数据的假设表明胱抑素 C、BMI 和 CA 进展之间存在复杂的关系，需要进一步研究。
