内皮功能障碍和促凝状态生物标志物对 2 型糖尿病患者 10 年心血管风险的影响。

Impact of biomarkers for endothelial dysfunction and procoagulant state on 10-year cardiovascular risk in Type 2 diabetes.

机构信息

Department of Cardiology, Essex Cardiothoracic Centre, Basildon, UK.

出版信息

Diabet Med. 2011 Oct;28(10):1201-5. doi: 10.1111/j.1464-5491.2011.03311.x.

DOI:10.1111/j.1464-5491.2011.03311.x

PMID:21480978

Abstract

AIMS

To estimate the coronary heart disease and cardiovascular disease risk associated with novel biomarkers in Type 2 diabetes mellitus.

METHODS

We measured baseline peripheral blood concentrations of soluble E-selectin, factor XIIa, thrombin-antithrombin III complex and plasminogen activator inhibitor-1 in 86 patients with Type 2 diabetes free of known coronary heart disease. We used Cox proportional hazard models to estimate multivariable-adjusted hazard ratios associated with biomarker levels for 10-year coronary heart disease risk (n = 33 events) or total cardiovascular disease risk (n = 45 events).

RESULTS

At baseline, mean (sd) age was 62 years (7 years); 62 were men; and 43 had microalbuminuria. Soluble E-selectin demonstrated cross-sectional relationships with glucose and factor XIIa was related to plasminogen activator inhibitor-1 and triglycerides (all P < 0.05). Baseline log soluble E-selectin was significantly related to incident coronary heart disease and cardiovascular disease. Hazard ratios (95% CIs) associated with a 1-unit increase in log soluble E-selectin in age- and sex-adjusted models were: coronary heart disease : 4.6 (95% CI 1.9-11.3), P = 0.001; cardiovascular disease: 3.6 (95% CI 1.7-7.4, P = 0.001); and in multivariable-adjusted models were: coronary heart disease: 2.9 (95% CI 1.2-7.1, P = 0.02); cardiovascular disease: 2.3 (95% CI 1.1-4.8), P = 0.02. Factor XIIa was significantly related to incident cardiovascular disease. The hazard ratios associated with a 1-unit increase in factor XIIa in age- and sex-adjusted models was 1.5 (95% CI 1.1-1.9, P = 0.003) and in a multivariable-adjusted model was 1.3 (95% CI 1.0-1.6, P = 0.047). Plasminogen activator inhibitor-1 and thrombin-antithrombin III complex were not related to cardiovascular disease events.

CONCLUSIONS

In our study, soluble E-selectin and factor XIIa were significantly related to 10-year incident macrovascular events in patients with Type 2 diabetes. These preliminary findings call for replication in larger studies.

摘要

目的

评估 2 型糖尿病新型生物标志物与冠心病和心血管疾病风险的相关性。

方法

我们在 86 例无已知冠心病的 2 型糖尿病患者中测量了基线外周血可溶性 E-选择素、因子 XIIa、凝血酶-抗凝血酶 III 复合物和纤溶酶原激活物抑制剂-1 的浓度。我们使用 Cox 比例风险模型来估计与生物标志物水平相关的多变量调整风险比，用于预测 10 年冠心病风险（n=33 例事件）或总心血管疾病风险（n=45 例事件）。

结果

基线时，平均（标准差）年龄为 62 岁（7 岁）；62 名男性；43 名患者有微量白蛋白尿。可溶性 E-选择素与血糖呈横断面相关，因子 XIIa 与纤溶酶原激活物抑制剂-1 和甘油三酯相关（均 P<0.05）。基线时的可溶性 E-选择素对数与新发冠心病和心血管疾病显著相关。年龄和性别调整模型中，可溶性 E-选择素增加 1 单位与冠心病的风险比（95%可信区间）为：4.6（95%可信区间 1.9-11.3），P=0.001；心血管疾病：3.6（95%可信区间 1.7-7.4），P=0.001）；在多变量调整模型中，冠心病：2.9（95%可信区间 1.2-7.1），P=0.02；心血管疾病：2.3（95%可信区间 1.1-4.8），P=0.02。因子 XIIa 与新发心血管疾病显著相关。在年龄和性别调整模型中，因子 XIIa 增加 1 单位的风险比为 1.5（95%可信区间 1.1-1.9，P=0.003），在多变量调整模型中为 1.3（95%可信区间 1.0-1.6，P=0.047）。纤溶酶原激活物抑制剂-1 和凝血酶-抗凝血酶 III 复合物与心血管疾病事件无关。