心脏、肾脏和糖尿病生物标志物与动脉粥样硬化风险社区研究（ARIC）中老年人群外周神经病变的关联。
Associations of Cardiac, Kidney, and Diabetes Biomarkers With Peripheral Neuropathy among Older Adults in the Atherosclerosis Risk in Communities (ARIC) Study.
机构信息
Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
出版信息
Clin Chem. 2020 May 1;66(5):686-696. doi: 10.1093/clinchem/hvaa051.
BACKGROUND
The aim of this study was to assess the association of high-sensitivity cardiac troponin (hs-cTnT) and other cardiac, kidney, hyperglycemia, and inflammatory biomarkers with peripheral neuropathy (PN) in a community-based population.
METHODS
We conducted a cross-sectional analysis of 3056 black and white participants in the Atherosclerosis Risk in Communities (ARIC) study who underwent standardized monofilament PN testing and had measures of cardiac function (hs-cTnT, N-terminal pro-B-type natriuretic peptide [NT-proBNP], and growth differentiation factor 15 [GDF15]), kidney function (serum creatinine, cystatin C, β-2 microglobulin, urine albumin-to-creatinine ratio), hyperglycemia (fasting glucose, hemoglobin A1c [Hb A1c], fructosamine, glycated albumin, 1,5-anhydroglucitol), and inflammation (C-reactive protein) assessed at visit 6 (2016-2017; age 71-94 years). We used logistic regression to assess the associations of these biomarkers (modeled in diabetes-specific tertiles) with PN in older adults with and without diabetes after adjusting for traditional risk factors.
RESULTS
In total, 33.5% of participants had PN (37.3% with diabetes and 31.9% without diabetes). There was an independent association of hs-cTnT with PN regardless of diabetes status (diabetes T3 vs. T1: odds ratio [OR], 2.15 [95% CI, 1.44-3.22]; no diabetes: OR, 2.31 [95%CI, 1.76-3.03]; P = 0.72 for interaction). Among participants without diabetes, there were also significant associations of NT-proBNP (OR, 1.40 [95% CI, 1.08-1.81]) and urine albumin-to-creatinine ratio (OR, 1.55 [95% CI, 1.22-1.97]) with PN. Associations of hyperglycemia biomarkers including Hb A1c (OR, 1.76 [95% CI, 1.22-2.54]), fructosamine (OR, 1.71 [95% CI, 1.19-2.46]), and glycated albumin (OR, 1.45 [95% CI, 1.03-2.03]) with PN were significant only among participants with diabetes.
CONCLUSIONS
Overall, hs-cTnT appears to be a global marker of end organ damage, including PN. Laboratory biomarkers may be able to help us identify those individuals with PN.
背景
本研究旨在评估高敏心肌肌钙蛋白（hs-cTnT）和其他心脏、肾脏、高血糖和炎症生物标志物与社区人群中周围神经病变（PN）的相关性。
方法
我们对参加动脉粥样硬化风险社区（ARIC）研究的 3056 名黑人和白人进行了横断面分析，这些人接受了标准化单丝 PN 测试，并测量了心脏功能（hs-cTnT、N 末端 pro-B 型利钠肽 [NT-proBNP]和生长分化因子 15 [GDF15]）、肾脏功能（血清肌酐、胱抑素 C、β-2 微球蛋白、尿白蛋白/肌酐比）、高血糖（空腹血糖、糖化血红蛋白 [Hb A1c]、果糖胺、糖化白蛋白、1,5-脱水葡萄糖醇）和炎症（C 反应蛋白），在第 6 次（2016-2017 年；年龄 71-94 岁）进行了评估。我们使用逻辑回归来评估这些生物标志物（按糖尿病特异性三分位组建模）与糖尿病和非糖尿病老年人 PN 之间的相关性，在调整了传统危险因素后。
结果
共有 33.5%的参与者患有 PN（37.3%有糖尿病，31.9%无糖尿病）。hs-cTnT 与 PN 独立相关，无论糖尿病状态如何（糖尿病 T3 与 T1：比值比 [OR]，2.15 [95%CI，1.44-3.22]；无糖尿病：OR，2.31 [95%CI，1.76-3.03]；交互作用 P=0.72）。在没有糖尿病的参与者中，NT-proBNP（OR，1.40 [95%CI，1.08-1.81]）和尿白蛋白/肌酐比（OR，1.55 [95%CI，1.22-1.97]）与 PN 也有显著相关性。高血糖生物标志物，包括 Hb A1c（OR，1.76 [95%CI，1.22-2.54]）、果糖胺（OR，1.71 [95%CI，1.19-2.46]）和糖化白蛋白（OR，1.45 [95%CI，1.03-2.03]）与 PN 的相关性仅在糖尿病患者中显著。
结论
总的来说，hs-cTnT 似乎是终末器官损伤的一个全球标志物，包括 PN。实验室生物标志物可能有助于我们识别那些患有 PN 的人。
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