Department of Nephrology, Nara Medical University, Nara, Japan.
First Department of Internal Medicine, Nara Medical University, Nara, Japan.
Diabet Med. 2020 Dec;37(12):2143-2152. doi: 10.1111/dme.14301. Epub 2020 May 7.
Diabetic nephropathy, a pathologically diagnosed microvascular complication of diabetes, is a strong risk factor for cardiovascular events, which mainly involve arteries larger than those affected in diabetic nephropathy. However, the association between diabetic nephropathy pathological findings and cardiovascular events has not been well studied. We aimed to investigate whether the pathological findings in diabetic nephropathy are closely associated with cardiovascular event development.
This retrospective cohort study analysed 377 people with type 2 diabetes and biopsy-proven diabetic nephropathy, with a median follow-up of 5.9 years (interquartile range 2.0 to 13.5). We investigated how cardiovascular events were impacted by two vascular diabetic nephropathy lesions, namely arteriolar hyalinosis and arterial intimal thickening, and by glomerular and interstitial lesions.
Of the 377 people with diabetic nephropathy, 331 (88%) and 295 (78%) had arteriolar hyalinosis and arterial intimal thickening, respectively. During the entire follow-up period, those with arteriolar hyalinosis had higher cardiovascular event rates in the crude Kaplan-Meier analysis than those without these lesions (P = 0.005, log-rank test). When fully adjusted for clinically relevant confounders, arteriolar hyalinosis independently predicted cardiovascular events [hazard ratio (HR) 1.99; 95% confidence interval (CI) 1.12, 3.86], but we did not find any relationship between arterial intimal thickening and cardiovascular events (HR 0.89; 95% CI 0.60, 1.37). Additionally, neither glomerular nor interstitial lesions were independently associated with cardiovascular events in the fully adjusted model.
Arteriolar hyalinosis, but not intimal thickening of large arteries, was strongly associated with cardiovascular events in people with diabetic nephropathy.
糖尿病肾病是糖尿病的一种病理性微血管并发症，是心血管事件的一个强烈危险因素，主要涉及大于糖尿病肾病所影响的动脉。然而，糖尿病肾病的病理发现与心血管事件之间的关系尚未得到很好的研究。我们旨在研究糖尿病肾病的病理发现是否与心血管事件的发展密切相关。
这项回顾性队列研究分析了 377 名患有 2 型糖尿病并经活检证实患有糖尿病肾病的患者，中位随访时间为 5.9 年（四分位距 2.0 至 13.5）。我们研究了两种血管性糖尿病肾病病变（即细动脉玻璃样变和动脉内膜增厚）以及肾小球和间质病变如何影响心血管事件的发生。
在 377 名患有糖尿病肾病的患者中，分别有 331 名（88%）和 295 名（78%）患者存在细动脉玻璃样变和动脉内膜增厚。在整个随访期间，未经校正的 Kaplan-Meier 分析显示，有细动脉玻璃样变的患者心血管事件发生率高于无这些病变的患者（P=0.005，对数秩检验）。在充分校正临床相关混杂因素后，细动脉玻璃样变独立预测心血管事件[风险比（HR）1.99；95%置信区间（CI）1.12，3.86]，但我们没有发现动脉内膜增厚与心血管事件之间存在任何关系（HR 0.89；95%CI 0.60，1.37）。此外，在充分校正模型中，肾小球和间质病变均与心血管事件无关。
在患有糖尿病肾病的患者中，细动脉玻璃样变而不是大动脉内膜增厚与心血管事件密切相关。
