基线高敏 C 反应蛋白预测 2 型糖尿病大血管和微血管并发症：一项基于人群的研究。

Baseline High-Sensitivity C-Reactive Protein Predicts Macrovascular and Microvascular Complications of Type 2 Diabetes: A Population-Based Study.

机构信息

Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Student's Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.

出版信息

Ann Nutr Metab. 2018;72(4):287-295. doi: 10.1159/000488537. Epub 2018 Apr 25.

DOI:10.1159/000488537

PMID:29694948

Abstract

BACKGROUND/AIMS: This prospective study is aimed at examining the predictive value of high-sensitivity C-reactive protein (hs-CRP) for coronary heart disease (CHD) events and microvascular complications of type 2 diabetes mellitus (T2DM).

METHODS

A population-based study (NCT02958579) was conducted on 1,301 participants with T2DM (mean follow-up of 7.5 years). Risk assessment for vascular events was done at baseline, and serum hs-CRP was measured. End points of this study include CHD events, diabetic retinopathy, neuropathy, and diabetic kidney disease. Individuals with unavailable data or hs-CRP >20 mg/L were excluded. The discrimination and reclassification improvement of study end points were tested after addition of hs-CRP to traditional risk factors.

RESULTS

Median serum hs-CRP was 2.00 ranging from 0.1 to 17 mg/L. Hazards ratio of each SD increment in baseline hs-CRP was 1.028 (1.024-1.032) for CHD, 1.025 (1.021-1.029) for diabetic neuropathy, 1.037 (1.030-1.043) for diabetic retinopathy, and 1.035 (1.027-1.043) for diabetic kidney disease. The addition of hs-CRP to traditional risk factors of vascular complications of T2DM improved discrimination of all end points (p < 0.001). Net reclassification improvement ranged from 8% for diabetic neuropathy to 31% for diabetic kidney disease (p < 0.05).

CONCLUSION

Baseline hs-CRP predicts both of CHD events and microvascular complications of patients with T2D.

摘要

背景/目的：本前瞻性研究旨在探讨高敏 C 反应蛋白（hs-CRP）对 2 型糖尿病（T2DM）患者冠心病（CHD）事件和微血管并发症的预测价值。

方法

对 1301 例 T2DM 患者（平均随访 7.5 年）进行基于人群的研究（NCT02958579）。在基线时进行血管事件风险评估，并测量血清 hs-CRP。本研究的终点包括 CHD 事件、糖尿病视网膜病变、神经病变和糖尿病肾病。排除数据不可用或 hs-CRP>20mg/L 的个体。在将 hs-CRP 添加到传统危险因素后，测试研究终点的区分度和重新分类改善情况。

结果

中位血清 hs-CRP 为 2.00，范围为 0.1-17mg/L。基线 hs-CRP 每增加 1 个标准差的危险比为 1.028（1.024-1.032），用于 CHD，1.025（1.021-1.029）用于糖尿病神经病变，1.037（1.030-1.043）用于糖尿病视网膜病变，1.035（1.027-1.043）用于糖尿病肾病。将 hs-CRP 添加到 T2DM 血管并发症的传统危险因素中，改善了所有终点的区分度（p<0.001）。净重新分类改善范围从糖尿病神经病变的 8%到糖尿病肾病的 31%（p<0.05）。