高敏C反应蛋白与2型糖尿病发病风险：一项嵌套于新加坡华人健康研究中的病例对照研究。
High-sensitive C-reactive protein and risk of incident type 2 diabetes: a case-control study nested within the Singapore Chinese Health Study.
作者信息
Pan An, Wang Yeli, Yuan Jian-Min, Koh Woon-Puay
机构信息
Department of Epidemiology and Biostatistics, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
出版信息
BMC Endocr Disord. 2017 Feb 8;17(1):8. doi: 10.1186/s12902-017-0159-5.
BACKGROUND
The liver-derived C-reactive protein (CRP) is a sensitive and systemic biomarker of inflammation, and has been associated with increased risk of developing type 2 diabetes in populations other than Chinese. Therefore, we prospectively examined the relation between plasma levels of CRP and risk of type 2 diabetes (T2D) among a Chinese population.
METHODS
Plasma high-sensitive CRP (hs-CRP) concentrations were assayed among 571 T2D cases and 571 controls nested in the prospective cohort of the Singapore Chinese Health Study. Both cases and controls were free of physician-diagnosed diabetes, cardiovascular disease and cancer at blood collections (1999-2004). Incident physician-diagnosed T2D cases were self-reported during the follow-up visits (2006-2010), and controls were matched for age (±3 years) and date (±6 months) of blood collection and gender. Multivariable logistic regression models were used to compute the odds ratio (OR) and the corresponding 95% confidence intervals (CIs).
RESULTS
The mean (SD) concentrations of hs-CRP were 2.79 (2.65) and 1.86 (2.03) mg/L, respectively, in cases and controls (P < 0.001). After multivariate adjustment for T2D risk factors such as lifestyle, body mass index, plasma triglycerides and HDL cholesterol, the OR comparing the extreme quartiles of hs-CRP was 1.74 [95% CI 1.12-2.70; P for trend = 0.016]. When the analysis was limited to 279 cases who had HbA1c ≥6.5% at the time of blood collection and their controls, the OR comparing the extreme quartiles of hs-CRP was 2.43 (95% CI 1.25-4.71; P for trend = 0.003). When confined to the other 292 subjects with HbA1c <6.5% and their controls, the corresponding OR was 1.24 (95% CI 0.64-2.39; P for trend = 0.93).
CONCLUSIONS
We found that CRP was not associated with increased risk of incident diabetes in this cohort of Chinese in Singapore. Previous positive findings from prospective studies might be partly due to undiagnosed T2D among the cases during blood collection.
背景
肝脏来源的C反应蛋白（CRP）是一种敏感的全身性炎症生物标志物，在非中国人群中，其与2型糖尿病发病风险增加有关。因此，我们前瞻性地研究了中国人群中血浆CRP水平与2型糖尿病（T2D）风险之间的关系。
方法
在新加坡华人健康研究的前瞻性队列中，对571例T2D患者和571例对照者进行了血浆高敏CRP（hs-CRP）浓度检测。病例组和对照组在采血时（1999 - 2004年）均无医生诊断的糖尿病、心血管疾病和癌症。随访期间（2006 - 2010年），通过自我报告确定新诊断的医生诊断T2D病例，对照组在年龄（±3岁）、采血日期（±6个月）和性别方面进行匹配。采用多变量逻辑回归模型计算比值比（OR）及相应的95%置信区间（CIs）。
结果
病例组和对照组hs-CRP的平均（标准差）浓度分别为2.79（2.65）和1.86（2.03）mg/L（P < 0.001）。在对T2D风险因素如生活方式、体重指数、血浆甘油三酯和高密度脂蛋白胆固醇进行多变量调整后，比较hs-CRP最高和最低四分位数的OR为1.74 [95% CI 1.12 - 2.70；趋势P值 = 0.016]。当分析仅限于采血时HbA1c≥6.5%的279例病例及其对照时，比较hs-CRP最高和最低四分位数的OR为2.43（95% CI 1.25 - 4.71；趋势P值 = 0.003）。当仅限于其他HbA1c < 6.5%的292名受试者及其对照时，相应的OR为1.24（95% CI 0.64 - 2.39；趋势P值 = 0.93）。
结论
我们发现，在新加坡的这组华人队列中，CRP与新发糖尿病风险增加无关。先前前瞻性研究的阳性结果可能部分归因于采血时病例中存在未被诊断的T2D。
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