Bjornstad Petter, Maahs David M, Jensen Thomas, Lanaspa Miguel A, Johnson Richard J, Rewers Marian, Snell-Bergeon Janet K
Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO; Barbara Davis Center for Diabetes, University of Colorado Denver, Aurora, CO.
Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO; Barbara Davis Center for Diabetes, University of Colorado Denver, Aurora, CO; Department of Nephrology, University of Colorado Denver, Aurora, CO.
J Diabetes Complications. 2016 Aug;30(6):1093-6. doi: 10.1016/j.jdiacomp.2016.04.012. Epub 2016 Apr 19.
Vasopressin exerts important cardio-renal effects, but remains problematic to measure. Copeptin is a more stable peptide derived from the same precursor molecule. We examined the associations between copeptin, coronary artery calcium (CAC), albuminuria and impaired glomerular filtration rate (GFR) in adults with type 1 diabetes (T1D).
Participants with (n=209) and without T1D (n=244) in the Coronary Artery Calcification in Type 1 Diabetes (CACTI) study were assessed for serum copeptin, CAC measured using 128-slice spiral CT, urinary albumin-to-creatinine ratio (UACR) and eGFR calculated by CKD-EPI creatinine. Impaired GFR was defined as eGFR <60mL/min/1.73m(2), albuminuria as UACR ≥30mg/g, high and very high CAC score as ≥100 and ≥300AU, and elevated copeptin as >13pmol/L (>97.5th percentile for healthy adults). Unadjusted and adjusted (age, sex, HbA1c, SBP and LDL-C) logistic models were applied to examine the relationships.
Participants with T1D had greater ultrasensitive copeptin concentrations than non-diabetics (3.5 [95% CI 2.3-3.8] vs. 2.8 [2.7-3.1], p=0.003). In participants with T1D, elevated copeptin was associated with greater odds of impaired eGFR (OR: 18.52, 95% CI 4.03-85.02), albuminuria (10.55, 2.24-49.62), high CAC (6.61, 1.39-31.31) and very high CAC (6.24, 1.51-25.90) in multivariable models. Similar linear relationships were obtained with ultrasensitive copeptin, eGFR, UACR, CAC volume and CAC score in adjusted models.
In this cross-sectional analysis, copeptin was strongly associated with diabetic kidney disease and coronary atherosclerosis in adults with T1D. Further research is needed to determine whether these relationships hold true longitudinally in people with T1D.
血管加压素发挥着重要的心脏-肾脏效应，但测量起来仍存在问题。 copeptin是一种源自同一前体分子的更稳定的肽。我们研究了1型糖尿病（T1D）成人患者中copeptin、冠状动脉钙化（CAC）、蛋白尿和肾小球滤过率（GFR）受损之间的关联。
在1型糖尿病冠状动脉钙化（CACTI）研究中，对患有T1D（n = 209）和未患T1D（n = 244）的参与者进行血清copeptin评估，使用128层螺旋CT测量CAC，测量尿白蛋白与肌酐比值（UACR），并通过CKD-EPI肌酐公式计算估算肾小球滤过率（eGFR）。GFR受损定义为eGFR <60mL/min/1.73m²，蛋白尿定义为UACR≥30mg/g，高和非常高的CAC评分分别为≥100和≥300AU，copeptin升高定义为>13pmol/L（健康成年人的第97.5百分位数以上）。应用未调整和调整（年龄、性别、糖化血红蛋白、收缩压和低密度脂蛋白胆固醇）的逻辑模型来检验这些关系。
患有T1D的参与者超敏copeptin浓度高于非糖尿病患者（3.5 [95%CI 2.3 - 3.8] vs. 2.8 [2.7 - 3.1]，p = 0.003）。在患有T1D的参与者中，在多变量模型中，copeptin升高与eGFR受损（比值比：18.52，95%CI 4.03 - 85.02）、蛋白尿（10.55，2.24 - 49.62）、高CAC（6.61，1.39 - 31.31）和非常高的CAC（6.24，1.51 - 25.90）的更高几率相关。在调整模型中，超敏copeptin、eGFR、UACR、CAC体积和CAC评分之间也获得了类似的线性关系。
在这项横断面分析中，copeptin与T1D成人患者的糖尿病肾病和冠状动脉粥样硬化密切相关。需要进一步研究以确定这些关系在T1D患者中是否纵向成立。
