在一项1型糖尿病女性纵向队列研究中抗苗勒管激素及其与亚临床心血管疾病和肾脏疾病的关系
Anti-Müllerian hormone and its relationships with subclinical cardiovascular disease and renal disease in a longitudinal cohort study of women with type 1 diabetes.
作者信息
Kim Catherine, Pan Yuanyuan, Braffett Barbara H, Arends Valerie L, Steffes Michael W, Wessells Hunter, Sarma Aruna V
机构信息
1Departments of Medicine, Obstetrics & Gynecology, and Epidemiology, University of Michigan, 2800 Plymouth Road, Building 16, Room 430W, Ann Arbor, MI 48109-2800 USA.
2The Biostatistics Center, George Washington University, Rockville, MD USA.
出版信息
Womens Midlife Health. 2017 Aug 18;3:5. doi: 10.1186/s40695-017-0023-9. eCollection 2017.
BACKGROUND
Reproductive age may be a risk factor for vascular disease. Anti-Müllerian hormone (AMH) is produced by viable ovarian follicles and reflects reproductive age. We examined whether AMH concentrations were associated with markers of subclinical cardiovascular disease (CVD) and kidney disease among women with type 1 diabetes.
METHODS
We performed a cross-sectional analysis of the Epidemiology of Diabetes Interventions and Complications Study Participants included women with type 1 diabetes and ≥1 AMH measurement ( = 390). In multivariable regression models which adjusted for repeated measures, we examined the associations between AMH with CVD risk factors, estimated glomerular filtration rate, and albumin excretion ratio. We also examined whether initial AMH concentrations were associated with the presence of any coronary artery calcification (CAC) or carotid intima media thickness (cIMT).
RESULTS
After adjustment for age, AMH was not associated with waist circumference, blood pressure, lipid profiles, or renal function. Higher initial AMH concentrations had borderline but non-significant associations with the presence of CAC after adjustment for age (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.00, 1.16) which were minimally altered by addition of other CVD risk factors, although women in the 3rd quartile of AMH had lower odds of CAC than women in the lowest quartile (OR 0.40, 95% CI 0.17, 0.94). After adjustment for age, higher AMH was associated with statistically significant but only slightly higher cIMT (0.005 mm, = 0.0087) which was minimally altered by addition of other CVD risk factors.
CONCLUSIONS
Among midlife women with type 1 diabetes, AMH has slight but significant associations with subclinical measures of atherosclerosis. Future studies should examine whether these associations are clinically significant.
TRIAL REGISTRATION
NCT00360815 and NCT00360893 Study Start Date April 1994.
背景
生育年龄可能是血管疾病的一个风险因素。抗苗勒管激素（AMH）由存活的卵巢卵泡产生，反映生育年龄。我们研究了1型糖尿病女性中AMH浓度是否与亚临床心血管疾病（CVD）和肾脏疾病的标志物相关。
方法
我们对糖尿病干预与并发症流行病学研究进行了横断面分析。研究对象包括1型糖尿病女性且有≥1次AMH测量值（n = 390）。在调整了重复测量的多变量回归模型中，我们研究了AMH与CVD危险因素、估计肾小球滤过率和白蛋白排泄率之间的关联。我们还研究了初始AMH浓度是否与任何冠状动脉钙化（CAC）或颈动脉内膜中层厚度（cIMT）的存在相关。
结果
在调整年龄后，AMH与腰围、血压、血脂谱或肾功能无关。在调整年龄后，较高的初始AMH浓度与CAC的存在有临界但不显著的关联（优势比[OR] 1.08，95%置信区间[CI] 1.00，1.16），在加入其他CVD危险因素后变化很小，尽管AMH第三四分位数的女性患CAC的几率低于最低四分位数的女性（OR 0.40，95% CI 0.17，0.94）。在调整年龄后，较高的AMH与具有统计学意义但仅略高的cIMT相关（0.005 mm，P = 0.0087），在加入其他CVD危险因素后变化很小。
结论
在中年1型糖尿病女性中，AMH与动脉粥样硬化的亚临床指标有轻微但显著的关联。未来的研究应检查这些关联是否具有临床意义。
试验注册
NCT00360815和NCT00360893 研究开始日期1994年4月。
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