Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Diabetes Metab Res Rev. 2013 Jul;29(5):398-405. doi: 10.1002/dmrr.2406.
Elevated high-sensitivity C-reactive protein (hs-CRP), a marker of low-grade systemic inflammation, may be involved in the etiology of type 2 diabetes mellitus (T2DM). However, whether inflammation precedes development of T2DM independent of cigarette smoking and obesity remains to be confirmed.
We studied 4213 civil servants in a local government in Japan aged 35-66 years at baseline in 2002, who donated blood samples and were followed 6 years. Hazard ratios (HR) of T2DM according to the hs-CRP quartiles [range Q1: 0.02-0.18 (reference), Q2: 0.18-0.33, Q3: 0.33-0.67 and Q4: 0.67-9.62 mg/L) were estimated by Cox proportional hazards model adjusted for gender, age, body mass index, alcohol intake, smoking status (current, past and never), number of cigarettes per day, physical activity, family history of diabetes (Model 1) and variables in Model 1 + glucose (Model 2).
The geometric mean [95% confidence interval (CI)] of hs-CRP was 0.36 mg/L (0.34-0.37). During the follow-up, 156 new T2DM cases were confirmed. In total sample, Model 2 HRs (95% CIs) for hs-CRP quartiles Q2-Q4 compared with Q1 were 0.69 (0.36-1.26), 1.47 (0.91-2.39) and 1.78 (1.10-2.88), respectively (p for linear trend = 0.014). Stratified analysis revealed that a statistically significant association was observed only in normal weight non-current smokers with Model 2 HRs (CIs) being 0.79 (0.29-2.17), 2.63 (1.25-5.56) and 3.19 (1.49-6.86) for Q2-Q4 compared with Q1, respectively (p for linear trend = 0.0006). The relationship did not change materially after further adjusting for log-homeostasis model assessment or exclusion of past smokers.
These findings imply that higher hs-CRP itself or existence of chronic systemic inflammation precedes onset of T2DM independent of obesity and smoking.
高敏 C 反应蛋白（hs-CRP）是一种低度全身炎症的标志物，可能与 2 型糖尿病（T2DM）的病因有关。然而，炎症是否在不考虑吸烟和肥胖的情况下先于 T2DM 发生仍有待证实。
我们研究了日本当地政府的 4213 名 35-66 岁的公务员，他们在 2002 年基线时捐献了血液样本，并随访了 6 年。通过 Cox 比例风险模型估计 T2DM 的风险比（HR）[范围 Q1：0.02-0.18（参考），Q2：0.18-0.33，Q3：0.33-0.67 和 Q4：0.67-9.62mg/L]，调整了性别、年龄、体重指数、酒精摄入量、吸烟状况（当前、过去和从不）、每天吸烟量、身体活动、糖尿病家族史（模型 1）和模型 1 中变量的葡萄糖（模型 2）。
hs-CRP 的几何平均值[95%置信区间（CI）]为 0.36mg/L（0.34-0.37）。在随访期间，确认了 156 例新的 T2DM 病例。在总样本中，与 Q1 相比，Q2-Q4 的 hs-CRP 四分位数模型 2 HR（95%CI）分别为 0.69（0.36-1.26）、1.47（0.91-2.39）和 1.78（1.10-2.88）（p 趋势值=0.014）。分层分析显示，仅在正常体重非当前吸烟者中观察到统计学显著关联，模型 2 HR（CI）分别为 0.79（0.29-2.17）、2.63（1.25-5.56）和 3.19（1.49-6.86）与 Q1 相比（p 趋势值=0.0006）。进一步调整对数稳态模型评估或排除过去吸烟者后，这种关系没有实质性变化。
这些发现表明，较高的 hs-CRP 本身或慢性全身性炎症的存在先于肥胖和吸烟发生 T2DM。
