Steno Diabetes Center Copenhagen, Gentofte, Denmark.
Steno Diabetes Center Copenhagen, Gentofte, Denmark.
Kidney Int. 2017 Nov;92(5):1242-1248. doi: 10.1016/j.kint.2017.04.018. Epub 2017 Jul 14.
High-sensitivity troponin T (hsTnT) is a marker of cardiovascular disease (CVD) and in type 2 diabetes also a marker of renal events, but has not been evaluated in type 1 diabetics. We therefore reviewed a type 1 diabetes cohort of 442 without and 458 with diabetic nephropathy. Baseline samples were analyzed for hsTnT levels. Cox regression analyses assessed predictive value in relation to the development of end-stage renal disease (ESRD) in 99 patients, all-cause mortality in 178, and CVD events in 134 after up to 12 years of follow-up. To assess if hsTnT improved risk prediction beyond traditional clinical risk markers, we calculated c statistics and relative integrated discrimination improvement. HsTnT was significantly higher in patients with diabetic nephropathy compared to normoalbuminuria (median 8.9 vs 3.1 ng/L). For a doubling in hsTnT levels, and after adjustment for well-known risk factors, including NT-proBNP and hsCRP, the hazard ratio for ESRD at 1.26 was not significant in the diabetic nephropathy group, but there was a significant association with GFR decline after adjustment during follow-up (2.9 ml/min/1.73 m annual decline per doubling in hsTnT). The unadjusted and adjusted hazard ratios for mortality (1.64 and 1.32, respectively) were significant in patients with, but not for patients without, nephropathy. Adjusted hazard ratios for fatal and non-fatal CVD events were significant for the whole cohort (1.13), and those with nephropathy (1.14), but not significant for normoalbuminuria (1.06). Addition of hsTNT to traditional risk factors significantly increased the area under the curve by 0.01 in a receiver-operating characteristic curve for mortality. The relative integrated discrimination improvement was increased 15.7% for mortality, 6.3% for CVD, and 1.9% for ESRD (all significant). Thus, higher hsTnT is an independent predictor of renal decline and cardiovascular events in patients with type 1 diabetes and diabetic nephropathy.
高敏肌钙蛋白 T（hsTnT）是心血管疾病（CVD）的标志物，在 2 型糖尿病中也是肾脏事件的标志物，但尚未在 1 型糖尿病患者中进行评估。因此，我们回顾了 442 名无糖尿病肾病和 458 名有糖尿病肾病的 1 型糖尿病患者队列。对基线样本进行 hsTnT 水平分析。Cox 回归分析评估了 99 例患者发生终末期肾病（ESRD）、178 例患者全因死亡率和 134 例患者 CVD 事件的预测价值，随访时间长达 12 年。为了评估 hsTnT 是否优于传统临床风险标志物来改善风险预测，我们计算了 c 统计量和相对综合判别改善。与正常白蛋白尿患者相比，糖尿病肾病患者的 hsTnT 明显升高（中位数 8.9 与 3.1ng/L）。hsTnT 水平增加一倍，在调整包括 NT-proBNP 和 hsCRP 在内的已知危险因素后，在糖尿病肾病组中，ESRD 的风险比为 1.26 无显著意义，但在随访期间调整 GFR 下降后，与 GFR 下降有显著相关性（hsTnT 每增加一倍，每年下降 2.9ml/min/1.73m）。未调整和调整后的死亡率风险比（分别为 1.64 和 1.32）在有肾病的患者中显著，而在无肾病的患者中不显著。整个队列的致命和非致命 CVD 事件的调整后风险比（1.13）以及肾病患者的风险比（1.14）显著，但正常白蛋白尿患者的风险比（1.06）不显著。在传统危险因素的基础上加入 hsTNT，显著提高了死亡率的曲线下面积 0.01（ROC 曲线）。相对综合判别改善增加了 15.7%用于死亡率，6.3%用于 CVD，1.9%用于 ESRD（均有显著意义）。因此，hsTnT 升高是 1 型糖尿病合并糖尿病肾病患者肾脏下降和心血管事件的独立预测因子。
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