Rudolfstiftung Hospital Vienna, Medicine I, Vienna, Austria.
Eur J Clin Invest. 2011 Jun;41(6):589-96. doi: 10.1111/j.1365-2362.2010.02446.x. Epub 2010 Dec 16.
Type 2 diabetic patients with albuminuria have an increased risk for vascular complications. Albuminuria is related to endothelial dysfunction and plaque instability. YKL-40 is also associated with both and elevated in nondiabetic vascular patients. We investigated YKL-40 and its association with vascular disease in type 2 diabetic patients with albuminuria.
Two hundred and four patients with type 2 diabetes were included in a cross-sectional study: One hundred and six normo- (No-A), 64 micro- (Mi-A) and 34 macroalbuminuric (Ma-A) patients that did not differ for age, diabetes duration, HbA1c, body-mass-index, blood pressure, lipids and creatinine. YKL-40 was measured in serum samples and determined by ELISA.
YKL-40 was significantly different in No-A: 87±57 vs. Mi-A 119±68 vs. Ma-A 157±75ng mL(-1) ; P<0·001. Patients with macrovascular disease showed higher YKL-40 than those without: 115±72 vs. 87±49ng mL(-1) , P=0·003. In correlation analysis, YKL-40 was associated with urinary albumin excretion rate (AER), plasma creatinine, creatinine clearance (CC) and age. Two multivariate regression analyses were conducted: in the first one, AER and CC remained associated with YKL-40 and in the second one AER and age.
This is the first report of a significant elevation of YKL-40 in type 2 diabetic patients with albuminuria. In addition, we observed a significant association with macrovascular disease. Because we detected an association between YKL-40 with renal, micro- and macrovascular disease, this protein could play an important for the increased risk of type 2 diabetic patients with albuminuria for the development of cardiovascular disease.
患有白蛋白尿的 2 型糖尿病患者发生血管并发症的风险增加。白蛋白尿与内皮功能障碍和斑块不稳定有关。YKL-40 也与两者相关，并且在非糖尿病血管患者中升高。我们研究了 YKL-40 在患有白蛋白尿的 2 型糖尿病患者中的血管疾病及其相关性。
我们进行了一项横断面研究，共纳入 204 例 2 型糖尿病患者：106 例正常白蛋白尿（No-A）、64 例微量白蛋白尿（Mi-A）和 34 例大量白蛋白尿（Ma-A）患者，这些患者在年龄、糖尿病病程、HbA1c、体重指数、血压、血脂和肌酐方面没有差异。在血清样本中测量 YKL-40 并通过 ELISA 法测定。
No-A、Mi-A 和 Ma-A 组的 YKL-40 水平分别为 87±57、119±68 和 157±75ng/mL（P<0·001）。患有大血管疾病的患者的 YKL-40 高于无大血管疾病的患者：115±72 vs. 87±49ng/mL（P=0·003）。在相关分析中，YKL-40 与尿白蛋白排泄率（AER）、血浆肌酐、肌酐清除率（CC）和年龄相关。进行了两项多元回归分析：在第一项分析中，AER 和 CC 与 YKL-40 相关，在第二项分析中，AER 和年龄与 YKL-40 相关。
这是首次报道 YKL-40 在白蛋白尿的 2 型糖尿病患者中显著升高。此外，我们观察到它与大血管疾病有显著关联。由于我们检测到 YKL-40 与肾脏、微血管和大血管疾病之间存在关联，因此该蛋白可能在患有白蛋白尿的 2 型糖尿病患者发生心血管疾病风险增加中发挥重要作用。
