Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata, Japan; Health Management Center, Toranomon Hospital, Tokyo, Japan.
Health Management Center, Toranomon Hospital, Tokyo, Japan; Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan.
Diabetes Res Clin Pract. 2016 Mar;113:60-8. doi: 10.1016/j.diabres.2016.01.026. Epub 2016 Feb 1.
Whether early stages of kidney dysfunction assessed by the estimated glomerular filtration rate from cystatin C measurements (eGFRCysC) rather than from creatinine measurements (eGFRCr) would more precisely reflect the risk of developing type 2 diabetes (T2D) has not been clarified. We compared the risk of developing T2D associated with renal dysfunction indicated by eGFRCysC or eGFRCr measurements.
Studied were 2131 Japanese individuals without diabetes. Hazard ratios (HRs) for the development of T2D over 3-5 y were calculated across categories of eGFRCysC and eGFRCr, respectively.
Reduced levels of eGFRCysC were associated with a step-wise increase in the cumulative incidence rate of T2D (p=0.007). In comparison with the eGFRCysC >85th percentile group (≥ 117.4 ml/min/1.73 m(2)), the lowest group, which was the eGFRCysC <15th percentile group (<86.2 ml/min/1.73 m(2)), had an adjusted HR of 2.30 (95% CI 1.13, 4.68) for T2D. Compared with the eGFRCr >85th percentile group, the lowest eGFRCr group (<15th percentile) had an HR of 1.19 (0.63, 2.24) for T2D. However, individuals with eGFRCr <60 ml/min/1.73 m(2) had a significantly increased risk of T2D. Clustering of both low eGFRCysC and low eGFRCr further elevated the HR for T2D compared with the presence of either.
Although eGFRCr in ranges indicating chronic kidney disease reflected an elevated risk of developing diabetes, earlier stages of kidney dysfunction indicated by reduced eGFRCysC, which could not be captured by reduced eGFRCr, would be a marker for an elevated risk of developing T2D.
通过胱抑素 C 测量估算肾小球滤过率（eGFRCysC）而不是通过肌酐测量（eGFRCr）评估早期肾功能障碍是否更能准确反映发生 2 型糖尿病（T2D）的风险尚未明确。我们比较了 eGFRCysC 或 eGFRCr 测量提示肾功能障碍与发生 T2D 的风险。
研究了 2131 名无糖尿病的日本个体。计算了 eGFRCysC 和 eGFRCr 各分类中 3-5 年内发生 T2D 的风险比（HRs）。
eGFRCysC 水平降低与 T2D 累积发生率呈逐步增加（p=0.007）相关。与 eGFRCysC＞第 85 百分位组（≥117.4 ml/min/1.73 m²）相比，最低组（即 eGFRCysC＜第 15 百分位组，＜86.2 ml/min/1.73 m²）调整后的 T2D HR 为 2.30（95%CI 1.13，4.68）。与 eGFRCr＞第 85 百分位组相比，eGFRCr 最低组（＜第 15 百分位）的 T2D HR 为 1.19（0.63，2.24）。然而，eGFRCr＜60 ml/min/1.73 m²的个体发生 T2D 的风险显著增加。与仅存在低 eGFRCr 相比，同时存在低 eGFRCysC 和低 eGFRCr 会进一步增加 T2D 的 HR。
虽然 eGFRCr 处于提示慢性肾脏病的范围内反映了发生糖尿病的风险增加，但 eGFRCysC 降低提示早期肾功能障碍，这不能被 eGFRCr 降低所捕捉，可能是发生 T2D 风险增加的标志物。
