Ito Ryo, Yamakage Hajime, Kotani Kazuhiko, Wada Hiromichi, Otani Sumire, Yonezawa Kazuya, Ogo Atsushi, Okajima Taiichiro, Adachi Masahiro, Araki Rika, Yoshida Kazuro, Saito Miho, Nagaoka Tadasu, Toyonaga Tetsushi, Tanaka Tsuyoshi, Yamada Tsutomu, Ota Itsuro, Oishi Mariko, Miyanaga Fumiko, Shimatsu Akira, Satoh-Asahara Noriko
Diabetes Center, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan.
Endocr J. 2015;62(2):201-7. doi: 10.1507/endocrj.EJ14-0352. Epub 2014 Nov 14.
The aim of this study is to determine which indicator of chronic kidney disease most closely correlates with 10-year Framingham coronary heart disease (CHD) risk among serum creatinine, serum cystatin C (S-CysC), urine albumin-creatinine ratio (UACR), estimated creatinine-based GFRs (eGFRcre), and estimated CysC-based GFRs (eGFRcys) in patients with obesity and diabetes. Serum creatinine, S-CysC, UACR, and cardio-ankle vascular index (CAVI) were examined in 468 outpatients with obesity and type 2 diabetes, free of severe renal dysfunction or previous history of cardiovascular disease, as a cross-sectional survey using baseline data from the multi-centered Japan Diabetes and Obesity Study. S-CysC and eGFRcys had significantly stronger correlations with the 10-year Framingham CHD risk than serum creatinine, eGFRcre, and UACR (creatinine, ρ = 0.318; S-CysC, ρ = 0.497; UACR, ρ = 0.174; eGFRcre, ρ = -0.291; eGFRcys, ρ = -0.521; P < 0.01 by Fisher's z-test). S-CysC and eGFRcys had significantly stronger correlations with CAVI than serum creatinine, eGFRcre, and UACR (creatinine, ρ = 0.198; S-CysC, ρ = 0.383; UACR, ρ = 0.183; eGFRcre, ρ = -0.302; eGFRcys, ρ = -0.444; P < 0.05 by Fisher's z-test). The receiver operating characteristic curves to distinguish the high-risk patients for CHD revealed significantly larger areas under the curve of S-CysC and eGFRcys than those of serum creatinine, UACR, and eGFRcre (serum creatinine, 0.64; S-CysC, 0.75; UACR, 0.56; eGFRcre, 0.63; eGFRcys, 0.76; P < 0.01). The data suggested that eGFRcys can be more predictive of the 10-year CHD risk than eGFRcre in Japanese patients with obesity and diabetes.
本研究旨在确定在肥胖和糖尿病患者中，慢性肾脏病的哪种指标与基于弗雷明汉10年冠心病（CHD）风险的关联最为密切，这些指标包括血清肌酐、血清胱抑素C（S-CysC）、尿白蛋白肌酐比值（UACR）、基于肌酐估算的肾小球滤过率（eGFRcre）以及基于胱抑素C估算的肾小球滤过率（eGFRcys）。作为一项横断面调查，我们使用多中心日本糖尿病和肥胖研究的基线数据，对468例无严重肾功能不全或心血管疾病既往史的肥胖和2型糖尿病门诊患者进行了血清肌酐、S-CysC、UACR和心踝血管指数（CAVI）的检测。与血清肌酐、eGFRcre和UACR相比，S-CysC和eGFRcys与基于弗雷明汉10年CHD风险的相关性显著更强（肌酐，ρ = 0.318；S-CysC，ρ = 0.497；UACR，ρ = 0.174；eGFRcre，ρ = -0.291；eGFRcys，ρ = -0.521；Fisher z检验，P < 0.01）。与血清肌酐、eGFRcre和UACR相比，S-CysC和eGFRcys与CAVI的相关性显著更强（肌酐，ρ = 0.198；S-CysC，ρ = 0.383；UACR，ρ = 0.183；eGFRcre，ρ = -0.302；eGFRcys，ρ = -0.444；Fisher z检验，P < 0.05）。用于区分CHD高危患者的受试者工作特征曲线显示，S-CysC和eGFRcys曲线下面积显著大于血清肌酐、UACR和eGFRcre（血清肌酐，0.64；S-CysC，0.75；UACR，0.56；eGFRcre，0.63；eGFRcys，0.76；P < 0.01）。数据表明，在日本肥胖和糖尿病患者中，eGFRcys比eGFRcre更能预测10年CHD风险。
