血清肌酐与胱抑素 C 比值可预测 2 型糖尿病患者的骨折：福冈糖尿病登记研究。
The serum creatinine to cystatin C ratio predicts bone fracture in patients with type 2 diabetes: The Fukuoka Diabetes Registry.
机构信息
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Division of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan.
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Diabetes Center, Hakujyuji Hospital, Fukuoka, Japan.
出版信息
Diabetes Res Clin Pract. 2018 Dec;146:202-210. doi: 10.1016/j.diabres.2018.10.021. Epub 2018 Nov 1.
AIMS
Sarcopenia is involved in the pathogenesis of increased fracture risk associated with diabetes. The serum creatinine to cystatin C (Cr/CysC) ratio has been reported as a surrogate marker for muscle mass. We aimed to prospectively investigate the relationship between the Cr/CysC ratio and fracture risk.
METHODS
We followed 1911 postmenopausal women and 2689 men with type 2 diabetes (mean age, 66 years) for a median of 5.3 years, and divided into Cr/CysC ratio quartiles by sex. The primary outcome was fragility fractures and the secondary outcome was any fracture.
RESULTS
Fragility fractures occurred in 192 participants, and any fracture occurred in 645 participants. Multivariate-adjusted hazard ratios (95% CI) for fragility fractures were 2.15 (1.19-3.88) (Q1), 1.63 (0.89-2.98) (Q2), 1.34 (0.72-2.51) (Q3) and 1.0 (ref.) (Q4) in postmenopausal women, and 1.75 (0.64-4.50) (Q1), 2.09 (0.83-5.26) (Q2), 1.56 (0.58-4.18) (Q3) and 1.0 (ref.) (Q4) in men. Those for any fracture were 1.46 (1.07-1.98) (Q1), 1.33 (0.98-1.81) (Q2), 1.40 (1.03-1.88) (Q3) and 1.0 (ref.) (Q4) in postmenopausal women, and 2.33 (1.54-3.54) (Q1), 2.02 (1.54-3.04) (Q2), 1.13 (0.71-1.78) (Q3) and 1.0 (ref.) (Q4) in men.
CONCLUSIONS
A lower Cr/CysC ratio is a significant risk factor for fractures in patients with type 2 diabetes.
目的
肌少症与糖尿病相关的骨折风险增加的发病机制有关。血清肌酐与半胱氨酸蛋白酶抑制剂 C（Cr/CysC）的比值已被报道为肌肉质量的替代标志物。我们旨在前瞻性研究 Cr/CysC 比值与骨折风险之间的关系。
方法
我们随访了 1911 名绝经后妇女和 2689 名 2 型糖尿病男性（平均年龄 66 岁），中位随访时间为 5.3 年，并按性别将 Cr/CysC 比值分为四分位。主要结局是脆性骨折，次要结局是任何骨折。
结果
192 名参与者发生脆性骨折，645 名参与者发生任何骨折。多变量调整后的脆性骨折风险比（95%CI）在绝经后妇女中分别为 2.15（1.19-3.88）（Q1）、1.63（0.89-2.98）（Q2）、1.34（0.72-2.51）（Q3）和 1.0（参考）（Q4），在男性中分别为 1.75（0.64-4.50）（Q1）、2.09（0.83-5.26）（Q2）、1.56（0.58-4.18）（Q3）和 1.0（参考）（Q4）。任何骨折的风险比分别为 1.46（1.07-1.98）（Q1）、1.33（0.98-1.81）（Q2）、1.40（1.03-1.88）（Q3）和 1.0（参考）（Q4）在绝经后妇女中，2.33（1.54-3.54）（Q1）、2.02（1.54-3.04）（Q2）、1.13（0.71-1.78）（Q3）和 1.0（参考）（Q4）在男性中。
结论
Cr/CysC 比值较低是 2 型糖尿病患者骨折的一个重要危险因素。
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