果糖胺和糖化白蛋白用于风险分层和预测糖尿病及微血管并发症的发生：社区动脉粥样硬化风险研究（ARIC）的前瞻性队列分析。

Fructosamine and glycated albumin for risk stratification and prediction of incident diabetes and microvascular complications: a prospective cohort analysis of the Atherosclerosis Risk in Communities (ARIC) study.

机构信息

Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.

出版信息

Lancet Diabetes Endocrinol. 2014 Apr;2(4):279-288. doi: 10.1016/S2213-8587(13)70199-2. Epub 2014 Jan 15.

DOI:10.1016/S2213-8587(13)70199-2

PMID:24703046

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4212648/

Abstract

BACKGROUND

HbA1c is the standard measure by which to monitor long-term (2-3 months) glucose control in people with diabetes and is now used for diagnosis of diabetes. Fructosamine and glycated albumin are markers of short-term (2-4 weeks) glycaemic control that might add complementary prognostic information to HbA1c. Our aim was to clarify the performance of fructosamine and glycated albumin measurements for identifying people at risk of incident diabetes or diabetic complications.

METHODS

We measured glycated albumin and fructosamine in blood samples from 11 348 adults without diabetes and 958 adults diagnosed with diabetes mellitus (both type 1 and 2) who attended the second examination of the Atherosclerosis Risk in Communities (ARIC) study in 1990-92 (baseline). We assessed the associations of fructosamine and glycated albumin with risk of incident diabetes, retinopathy, and risk of incident chronic kidney disease (CKD), during two decades of follow-up. We compared these associations with those of HbA1c with incident diabetes, retinopathy, and CKD. For analyses of associations with incident diabetes and CKD, adjusted hazard ratios (HRs) and their corresponding 95% CIs were estimated using Cox proportional hazards models. Model discrimination was assessed using Harrell's C statistic.

FINDINGS

The HRs for incident diabetes were 4·96 (4·36-5·64) for fructosamine above the 95th percentile and 6·17 (5·45-6·99) for glycated albumin above the 95th percentile. Associations were attenuated but persisted after adjustment for HbA1c. Fructosamine and glycated albumin were strongly associated with retinopathy (p<0·0001 for trend). The multivariable-adjusted HRs for CKD for people with fructosamine and glycated albumin above the 95th percentile were 1·50 (95% CI 1·22-1·85) and 1·48 (1·20-1·83), respectively, when compared with people with no diabetes and fructosamine or glycated albumin below the 75th percentile. Prediction of incident CKD by fructosamine (C statistic 0·717) and glycated albumin (0·717) were nearly as strong as by HbA1c (0·726), but HbA1c outperformed fructosamine and glycated albumin for prediction of incident diabetes with C statistics of 0·760, 0·706, and 0·703, respectively.

INTERPRETATION

Fructosamine and glycated albumin were strongly associated with incident diabetes and its microvascular complications, with prognostic value comparable to HbA1c.

FUNDING

National Heart, Lung, and Blood Institute.

摘要

背景

糖化血红蛋白是监测糖尿病患者长期（2-3 个月）血糖控制的标准指标，现在也用于糖尿病的诊断。果糖胺和糖化白蛋白是短期（2-4 周）血糖控制的标志物，可能为糖化血红蛋白补充补充预后信息。我们的目的是阐明果糖胺和糖化白蛋白测量在识别发生糖尿病或糖尿病并发症风险方面的表现。

方法

我们测量了 11348 名无糖尿病的成年人和 958 名 1990-92 年参加社区动脉粥样硬化风险（ARIC）研究第二次检查的已确诊为 1 型和 2 型糖尿病的成年人血液样本中的糖化白蛋白和果糖胺（基线）。我们评估了果糖胺和糖化白蛋白与 20 年随访期间发生糖尿病、视网膜病变和发生慢性肾脏病（CKD）的风险之间的相关性。我们将这些相关性与 HbA1c 与发生糖尿病、视网膜病变和 CKD 的相关性进行了比较。对于与发生糖尿病和 CKD 相关的分析，使用 Cox 比例风险模型估计了调整后的风险比（HR）及其相应的 95%置信区间（CI）。使用 Harrell 的 C 统计量评估模型区分度。

结果

果糖胺高于第 95 百分位的 HR 为 4.96（4.36-5.64），而高于第 95 百分位的糖化白蛋白的 HR 为 6.17（5.45-6.99）。校正 HbA1c 后，相关性减弱但仍然存在。果糖胺和糖化白蛋白与视网膜病变密切相关（趋势 P<0.0001）。果糖胺和糖化白蛋白高于第 95 百分位的人发生 CKD 的多变量调整 HR 分别为 1.50（95%CI 1.22-1.85）和 1.48（1.20-1.83），与无糖尿病且果糖胺或糖化白蛋白低于第 75 百分位的人相比。果糖胺（C 统计量 0.717）和糖化白蛋白（0.717）预测发生 CKD 的能力与 HbA1c（0.726）相当，但 HbA1c 在预测发生糖尿病方面的表现优于果糖胺和糖化白蛋白，C 统计量分别为 0.760、0.706 和 0.703。