Division of Diabetic Research, Clinical Research Institute, Diabetes Center, Department of Nephrology, National Hospital Organization, Kyoto Medical Center, 1-1 Fukakusa Mukaihata-cho, Fushimi-ku, Kyoto 612-8555, Japan.
Clin J Am Soc Nephrol. 2011 Feb;6(2):265-73. doi: 10.2215/CJN.04830610. Epub 2010 Nov 4.
Obesity and metabolic syndrome (MS) increase the risk of cardiovascular disease (CVD), chronic kidney disease (CKD), and all-cause mortality. Serum cystatin C (S-CysC), a marker of GFR, has been shown to be associated with CVD and CKD. This study was designed to elucidate the association of urinary CysC (U-CysC), a marker of renal tubular dysfunction, with CVD and CKD risk factors in patients with obesity and MS.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The U-CysC-creatinine ratio (UCCR) was examined in 343 Japanese obese outpatients enrolled in the multi-centered Japan Obesity and Metabolic Syndrome Study.
UCCR was positively correlated with urine albumin-creatinine ratio (UACR) and S-CysC and negatively correlated with estimated GFR (eGFR). Among obese patients, UCCR was significantly higher in MS patients than in non-MS patients. UCCR had significant correlations with the number of components of MS and arterial stiffness, all of which are CVD predictors, similarly to UACR (P<0.05). Interestingly, diet- and exercise-induced weight reduction for 3 months significantly decreased only UCCR among all of the renal markers examined (P<0.01), in parallel with the decrease in BMI, HbA1c, and arterial stiffness, suggesting the beneficial effect of weight reduction on renal tubular dysfunction.
This study demonstrates that UCCR is significantly associated with renal dysfunction, the severity of MS, arterial stiffness, and weight change in obese patients. The data of this study suggest that U-CysC could serve as a CVD and CKD risk factor in patients with obesity and MS.
肥胖和代谢综合征（MS）会增加心血管疾病（CVD）、慢性肾脏病（CKD）和全因死亡率的风险。血清胱抑素 C（S-CysC）是肾小球滤过率（GFR）的标志物，已被证明与 CVD 和 CKD 相关。本研究旨在阐明尿胱抑素 C（U-CysC）——肾小管功能障碍的标志物，与肥胖和 MS 患者 CVD 和 CKD 危险因素的相关性。
设计、地点、参与者和测量：在日本肥胖和代谢综合征多中心研究中，纳入了 343 名日本肥胖门诊患者，检测了 U-CysC-肌酐比值（UCCR）。
UCCR 与尿白蛋白-肌酐比值（UACR）和 S-CysC 呈正相关，与估算肾小球滤过率（eGFR）呈负相关。在肥胖患者中，MS 患者的 UCCR 明显高于非 MS 患者。UCCR 与 MS 的成分数量和动脉僵硬显著相关，与 UACR 相似，均为 CVD 预测指标（P<0.05）。有趣的是，饮食和运动诱导的体重减轻 3 个月仅显著降低了所有检测到的肾脏标志物中的 UCCR（P<0.01），与 BMI、HbA1c 和动脉僵硬的降低平行，表明体重减轻对肾小管功能障碍有益。
本研究表明，UCCR 与肥胖患者的肾功能障碍、MS 的严重程度、动脉僵硬和体重变化显著相关。本研究的数据表明，U-CysC 可能是肥胖和 MS 患者 CVD 和 CKD 的危险因素。
