Division of Endocrinology & Nutrition, Cliniques universitaires St-Luc and Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium.
Division of Cardiology, Cliniques universitaires St-Luc and Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium.
J Diabetes Complications. 2019 Nov;33(11):107413. doi: 10.1016/j.jdiacomp.2019.107413. Epub 2019 Aug 6.
The usefulness of C-reactive protein (CRP) to predict cardiovascular disease (CVD) in type 2 diabetes (T2DM) remains controversial. As many factors linked to obesity can modulate CRP in T2DM, we comprehensively revisited the cardiometabolic phenotype of patients with normal or raised CRP, taking into account the sexual dimorphism of its serum value.
1005 T2DM patients (651 males, 354 females; macroangiopathy 38%; coronary artery disease 26%; microangiopathy 47%) were divided depending on whether CRP level was ≤ or >3 mg/L. Thirty percent of men (n = 195) and 39% of women (n = 137) had raised CRP. Their cardiometabolic phenotype and presence of micro- and macrovascular complications were compared to those with normal CRP.
In both gender, patients with elevated CRP had higher body mass index, waist circumference, fat mass, visceral fat, insulinemia, HbA1c, and lower muscle mass and insulin sensitivity. They had more atherogenic dyslipidemia, higher non-HDL-C and apolipoprotein B, and more lipoprotein(a) (+59% in men and +38% in women). In both sexes, there was no difference between patients with normal or high CRP regarding overall macroangiopathy (42% vs. 45% [men]; 27% vs. 28% [women]), coronary and peripheral artery disease, or stroke. Only in men, microangiopathy was more prevalent when CRP was raised (61% vs 44%; p < 0.0001).
This study shows major sex-related differences in microangiopathies in T2DM patients with high CRP levels. The latter are unrelated to prevalent CVD despite an unfavorable metabolic phenotype. By contrast, increased CRP may represent an extended biomarker of microvascular risk in men with T2DM.
C 反应蛋白（CRP）在 2 型糖尿病（T2DM）患者中预测心血管疾病（CVD）的作用仍存在争议。由于许多与肥胖相关的因素可以调节 T2DM 患者的 CRP，因此我们综合考虑了 CRP 血清值的性别二态性，重新研究了 CRP 正常或升高的患者的代谢表型。
1005 名 T2DM 患者（651 名男性，354 名女性；大血管病变 38%；冠心病 26%；微血管病变 47%）根据 CRP 水平是否≤或>3mg/L 进行分组。30%的男性（n=195）和 39%的女性（n=137）CRP 升高。比较他们的代谢表型以及微血管和大血管并发症的发生情况与 CRP 正常的患者。
在两性中，CRP 升高的患者体重指数、腰围、体脂、内脏脂肪、胰岛素血症、糖化血红蛋白和肌肉量及胰岛素敏感性均较高。他们的血脂异常更具致动脉粥样硬化性，非高密度脂蛋白胆固醇和载脂蛋白 B 更高，脂蛋白（a）水平更高（男性增加 59%，女性增加 38%）。在两性中，CRP 正常或升高的患者总体大血管病变（42% vs. 45%[男性]；27% vs. 28%[女性]）、冠心病和外周动脉疾病或中风无差异。只有男性 CRP 升高时，微血管病变更为常见（61% vs 44%；p<0.0001）。
本研究显示，CRP 水平升高的 T2DM 患者中存在与性别相关的微血管病变的重大差异。尽管存在不良的代谢表型，但后者与已发生的 CVD 无关。相比之下，CRP 升高可能代表 T2DM 男性微血管风险的扩展生物标志物。
