Velho Gilberto, Bouby Nadine, Hadjadj Samy, Matallah Nadia, Mohammedi Kamel, Fumeron Frédéric, Potier Louis, Bellili-Munoz Naïma, Taveau Christopher, Alhenc-Gelas François, Bankir Lise, Marre Michel, Roussel Ronan
Corresponding author: Gilberto Velho,
Diabetes Care. 2013 Nov;36(11):3639-45. doi: 10.2337/dc13-0683. Epub 2013 Jul 17.
Plasma copeptin, a surrogate for vasopressin, was associated with albuminuria in population-based studies. These associations are consistent with the effect of vasopressin on albuminuria observed in humans and rodents. The objective of this study was to determine whether plasma copeptin is an independent marker of risk of renal events in people with type 2 diabetes and albuminuria.
We studied 3,101 participants of the DIABHYCAR trial (6-year follow-up) with type 2 diabetes and albuminuria. A renal event was defined as doubling of serum creatinine or development of end-stage renal disease.
During follow-up, 86 renal events occurred in 76 subjects (2.45%). Incidences by tertiles of baseline plasma copeptin were 1.06% (T1), 1.45% (T2), and 4.84% (T3). They were 2.43% (T1), 5.11% (T2), and 11.81% (T3) for the subset of subjects with macroalbuminuria at baseline (n = 729). Hazard ratio for plasma copeptin tertiles as a risk for renal events was 4.79 (95% CI, 2.48-9.24; P < 0.0001; for T3 vs. T1). In a stepwise regression analysis, urinary albumin excretion and plasma copeptin remained positively associated and HDL cholesterol and estimated glomerular filtration rate were inversely associated with the incidence of renal events. These independent predictors explained ∼18% of the variance of the outcome. The yearly variations of estimated glomerular filtration rate by copeptin tertiles were -1.43 ± 0.51 (T1), -2.29 ± 0.49 (T2), and -3.52 ± 0.44 mL/min/1.73 m2 per year (T3) (P = 0.005) in subjects with macroalbuminuria.
Plasma copeptin may help to identify subjects with diabetic chronic kidney disease who are at high risk for renal function decline.
在基于人群的研究中，血浆 copeptin（一种抗利尿激素替代指标）与蛋白尿相关。这些关联与在人类和啮齿动物中观察到的抗利尿激素对蛋白尿的影响一致。本研究的目的是确定血浆 copeptin 是否为 2 型糖尿病和蛋白尿患者发生肾脏事件风险的独立标志物。
我们研究了 DIABHYCAR 试验的 3101 名参与者（6 年随访），这些参与者患有 2 型糖尿病和蛋白尿。肾脏事件定义为血清肌酐翻倍或终末期肾病的发生。
随访期间，76 名受试者（2.45%）发生了 86 次肾脏事件。根据基线血浆 copeptin 的三分位数计算的发生率分别为 1.06%（T1）、1.45%（T2）和 4.84%（T3）。对于基线时有大量蛋白尿的受试者子集（n = 729），发生率分别为 2.43%（T1）、5.11%（T2）和 11.81%（T3）。血浆 copeptin 三分位数作为肾脏事件风险的风险比为 4.79（95%CI，2.48 - 9.24；P < 0.0001；T3 与 T1 相比）。在逐步回归分析中，尿白蛋白排泄和血浆 copeptin 仍呈正相关，高密度脂蛋白胆固醇和估计肾小球滤过率与肾脏事件的发生率呈负相关。这些独立预测因子解释了约 18%的结局方差。在有大量蛋白尿的受试者中，根据 copeptin 三分位数计算的估计肾小球滤过率的年变化分别为每年 -1.43 ± 0.51（T1）、-2.29 ± 0.49（T2）和 -3.52 ± 0.44 mL/min/1.73 m²（T3）（P = 0.005）。
血浆 copeptin 可能有助于识别糖尿病慢性肾脏病患者中肾功能下降风险较高的患者。
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