NTproBNP 在胰岛素抵抗相关条件下的变化：超重/肥胖、代谢综合征和糖尿病。基于人群的卡萨莱蒙费拉托研究。
NTproBNP in insulin-resistance mediated conditions: overweight/obesity, metabolic syndrome and diabetes. The population-based Casale Monferrato Study.
机构信息
Dept. of Medical Sciences, University of Torino, corso Dogliotti 14, 10126, Turin, Italy.
Clinical Chemistry Laboratory, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Turin, Italy.
出版信息
Cardiovasc Diabetol. 2017 Sep 25;16(1):119. doi: 10.1186/s12933-017-0601-z.
BACKGROUND AND AIMS
NTproBNP and BNP levels are reduced in obese subjects, but population-based data comparing the pattern of this relationship in the full spectrum of insulin-resistance mediated conditions, overweight/obesity, metabolic syndrome and diabetes, are limited.
METHODS
The study-base were 3244 individuals aged 45-74 years, none of whom had heart failure, 1880 without diabetes and 1364 with diabetes, identified as part of two surveys of the population-based Casale Monferrato Study. All measurements were centralized. We examined with multiple linear regression and cubic regression splines the relationship between NTproBNP and BMI, independently of known risk factors and confounders. A logistic regression analysis was also performed to assess the effect of overweight/obesity (BMI ≥ 25 kg/m), diabetes and metabolic syndrome on NTproBNP values.
RESULTS
Out of the overall cohort of 3244 people, overweight/obesity was observed in 1118 (59.4%) non-diabetic and 917 (67.2%) diabetic subjects, respectively. In logistic regression, compared to normal weight individuals, those with a BMI ≥ 25 kg/m had a OR of 0.70 (95% CI 0.56-0.87) of having high NTproBNP values, independently of diabetes. As interaction between diabetes and NTproBNP was evident (p < 0.001), stratified analyses were performed. Diabetes either alone or combined with overweight/obesity or metabolic syndrome enhanced fourfold and over the OR of having high NTproBNP levels, while the presence of metabolic syndrome alone had a more modest effect (OR 1.54, 1.18-2.01) even after having excluded individuals with CVD. In the non-diabetic cohort, obesity/overweight and HOMA-IR ≥ 2.0 decreased to a similar extent the ORs of high NTproBNP [0.76 (0.60-0.95) and 0.74 (0.59-0.93)], but the association between overweight/obesity and NTproBNP was no longer significant after the inclusion into the model of HOMA-IR, whereas CRP > 3 mg/dl conferred a fully adjusted OR of 0.65 (0.49-0.86).
CONCLUSIONS
NT-proBNP levels are lower in overweight/obesity, even in those with diabetes. Both insulin-resistance and chronic low-grade inflammation are involved in this relationship. Further intervention studies are required to clarify the potential role of drugs affecting the natriuretic peptides system on body weight and risk of diabetes.
背景和目的
NTproBNP 和 BNP 水平在肥胖人群中降低，但比较胰岛素抵抗介导的各种情况（超重/肥胖、代谢综合征和糖尿病）中这种关系模式的基于人群的数据有限，包括肥胖/超重、代谢综合征和糖尿病。
方法
本研究的基础是年龄在 45-74 岁的 3244 名个体，他们都没有心力衰竭，1880 名没有糖尿病，1364 名有糖尿病，这些人是人群为基础的卡萨莱蒙费拉托研究的两项调查的一部分。所有测量均集中进行。我们使用多元线性回归和三次回归样条独立于已知的危险因素和混杂因素，研究了 NTproBNP 与 BMI 之间的关系。还进行了逻辑回归分析，以评估超重/肥胖（BMI≥25kg/m）、糖尿病和代谢综合征对 NTproBNP 值的影响。
结果
在 3244 人的总体队列中，1118 名（59.4%）非糖尿病患者和 917 名（67.2%）糖尿病患者超重/肥胖。在逻辑回归中，与正常体重者相比，BMI≥25kg/m 的个体发生高 NTproBNP 值的比值比为 0.70（95%可信区间 0.56-0.87），独立于糖尿病。由于糖尿病和 NTproBNP 之间存在交互作用（p<0.001），因此进行了分层分析。糖尿病单独或与超重/肥胖或代谢综合征联合使发生高 NTproBNP 水平的比值比增加了四倍以上，而代谢综合征本身的作用更为温和（比值比 1.54，1.18-2.01），即使在排除了心血管疾病患者后也是如此。在非糖尿病队列中，肥胖/超重和 HOMA-IR≥2.0 降低了高 NTproBNP 的比值比[0.76（0.60-0.95）和 0.74（0.59-0.93）]，但在模型中纳入 HOMA-IR 后，超重/肥胖与 NTproBNP 之间的关联不再显著，而 CRP>3mg/dl 则赋予了完全调整后的比值比 0.65（0.49-0.86）。
结论
超重/肥胖者的 NT-proBNP 水平较低，即使在糖尿病患者中也是如此。胰岛素抵抗和慢性低度炎症都参与了这种关系。需要进一步的干预研究来阐明影响利钠肽系统的药物对体重和糖尿病风险的潜在作用。
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