Department of Endocrinology & Metabolism, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Diseases, Shanghai, China.
PLoS One. 2013 Jul 2;8(7):e66907. doi: 10.1371/journal.pone.0066907. Print 2013.
Cystatin C is growing to be an ideal indicator for renal function and cardiovascular events. The aim of this study was to investigate the relationship between serum cystatin C levels and peripheral arterial disease and to explore its diagnostic value for lower limb ischemia (LLI) in type 2 diabetic population.
A total of 1609 T2DM patients were included in this cross-sectional study. Their clinical and biochemical characteristics, ankle-brachial index (ABI), carotid and lower extremity arterial ultrasound were detected. LLI was defined by ABI <0.9 and lower extremity arterial stenosis >50% by ultrasound examination. Patients were divided to two groups: with LLI and without. The risk factors of LLI were explored by binary logistic regression analysis.
The serum concentrations of cystatin C were 1.53±0.60 and 1.08±0.30 mg/L in patients with and without LLI, respectively. Binary logistic regression analysis showed that the significant risk factors were cystatin C (P = 0.007, OR = 5.081), the presence of hypertension (P = 0.011, OR = 3.527), age (P<0.001, OR = 1.181), GA (P = 0.002, OR = 1.089) and diabetes duration (P = 0.008, OR = 1.074). The prevalence of coronary artery disease, cerebral infarction and LLI increased with cystatin C (P<0.01), and the prevalence of LLI in patients with cystatin C >1.2 mg/L was much higher than other three quartile groups. Receiver operating characteristic curve analysis revealed the cut point of cystatin C for LLI was 1.2 mg/L. The risk of LLI dramatically increased in patients with cystatin C >1.2 mg/L (OR = 21.793, 95% confidence interval 10.046-47.280, P<0.001). After adjusting for sex, age, duration, HbA1c, GA and hypertension, its OR still remained 3.395 (95% confidence interval 1.335-8.634).
There was a strong and independent association between cystatin C and limb arterial disease in diabetic population, and cystatin C >1.2 mg/L indicated a great increased risk of LLI.
胱抑素 C 逐渐成为评估肾功能和心血管事件的理想指标。本研究旨在探讨血清胱抑素 C 水平与外周动脉疾病的关系，并探讨其在 2 型糖尿病患者下肢缺血（LLI）中的诊断价值。
本横断面研究共纳入 1609 例 2 型糖尿病患者。检测其临床和生化特征、踝肱指数（ABI）、颈动脉和下肢动脉超声。ABI<0.9 和下肢动脉超声检查狭窄>50%定义为 LLI。根据有无 LLI 将患者分为两组。采用二元逻辑回归分析探讨 LLI 的危险因素。
有 LLI 患者的血清胱抑素 C 浓度为 1.53±0.60mg/L，无 LLI 患者为 1.08±0.30mg/L。二元逻辑回归分析显示，胱抑素 C（P=0.007，OR=5.081）、高血压（P=0.011，OR=3.527）、年龄（P<0.001，OR=1.181）、GA（P=0.002，OR=1.089）和糖尿病病程（P=0.008，OR=1.074）是 LLI 的显著危险因素。随着胱抑素 C 的升高，冠状动脉疾病、脑梗死和 LLI 的患病率增加（P<0.01），胱抑素 C>1.2mg/L 患者的 LLI 患病率明显高于其他三个四分位组。受试者工作特征曲线分析显示，胱抑素 C 预测 LLI 的截断值为 1.2mg/L。胱抑素 C>1.2mg/L 患者发生 LLI 的风险显著增加（OR=21.793，95%置信区间 10.046-47.280，P<0.001）。在校正性别、年龄、病程、HbA1c、GA 和高血压后，其 OR 仍为 3.395（95%置信区间 1.335-8.634）。
在糖尿病患者中，胱抑素 C 与肢体动脉疾病之间存在强烈的独立关联，胱抑素 C>1.2mg/L 提示 LLI 的风险显著增加。
Zotero 插件