Endocrinology Department, Shengjing Hospital of China Medical University, Shenyang, China.
Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, China.
Front Endocrinol (Lausanne). 2022 May 11;13:824279. doi: 10.3389/fendo.2022.824279. eCollection 2022.
To explore the association of the trajectory of serum Cystatin C (Cysc) with diabetic kidney disease (DKD), a retrospective cohort study of Chinese subjects was carried out.
A review of 2,928 diabetes mellitus (DM) patients admitted to the clinic and ward of the Endocrinology Department, Shengjing Hospital of China Medical University from January 1, 2014 to December 31, 2014 was performed. Subsequent visits to the hospital were followed until December 31, 2020. The primary endpoint was the incidence of DKD as diagnosed by urinary albumin/creatinine ratio ≥30 mg/g and/or estimated glomerular filtration rate <60 ml/min per 1.73 m. Healthy control subjects were identified from a health checkup database in Shengjing Hospital from 2016 to 2019. The latent class growth mixed modeling (LCGMM) method was used to analyze latent classes of serum Cysc in healthy and DM subjects. Finally, the hazard ratios (HRs) of latent classes of Cysc in DM subjects were analyzed by Cox regression analysis.
A total of 805 type 2 diabetes mellitus (T2DM) and 349 healthy subjects were included in the trial. The HRs of quartiles of baseline Cysc in T2DM subjects were 7.15 [95% confidence interval (CI), 2.79 to 25.57], 2.30 (95% CI, 1.25 to 4.24), and 2.05 (95% CI, 1.14 to 3.70), respectively, for quartile 4 (Q4), Q3, and Q2 when compared with Q1. Through LCGMM, a 1-class linear model was selected for the Cysc latent class in healthy subjects. In contrast, a 3-class linear model was selected for that in DM subjects. The slopes of the three latent classes in T2DM subjects were larger than the slope in healthy subjects. The HRs of incident DKD were 3.43 (95% CI, 1.93 to 6.11) for the high-increasing class and 1.80 (95% CI, 1.17 to 2.77) for the middle-increasing class after adjusting for confounding variables.
Patients with T2DM had a higher velocity of increase in Cysc than healthy subjects. Patients with high baseline Cysc values and high latent increasing velocity of Cysc had a higher risk of developing DKD in later life. More attention should be paid to patients with these high-risk factors.
探讨血清胱抑素 C（Cysc）轨迹与糖尿病肾病（DKD）的相关性，对中国人群进行了一项回顾性队列研究。
对 2014 年 1 月 1 日至 12 月 31 日期间在中国医科大学盛京医院内分泌科门诊和病房就诊的 2928 例糖尿病患者进行了回顾性分析。随后对患者进行了医院随访，随访时间截至 2020 年 12 月 31 日。主要终点为尿白蛋白/肌酐比值≥30mg/g 和/或估计肾小球滤过率<60ml/min·1.73m 时诊断的 DKD 发生情况。从 2016 年至 2019 年，我们从盛京医院的健康检查数据库中确定了健康对照受试者。采用潜在类别增长混合模型（LCGMM）方法分析健康和 DM 受试者血清 Cysc 的潜在类别。最后，通过 Cox 回归分析分析 DM 受试者 Cysc 潜在类别的风险比（HR）。
共纳入 805 例 2 型糖尿病（T2DM）和 349 例健康受试者。T2DM 受试者基线 Cysc 四分位数的 HR 分别为 7.15[95%置信区间（CI），2.79 至 25.57]、2.30（95%CI，1.25 至 4.24）和 2.05（95%CI，1.14 至 3.70），分别对应四分位数 4（Q4）、Q3 和 Q2 与 Q1 相比。通过 LCGMM，选择了健康受试者 Cysc 潜在类别的 1 类线性模型。相比之下，DM 受试者选择了 3 类线性模型。T2DM 受试者中三个潜在类别的斜率大于健康受试者的斜率。在校正混杂因素后，高升高组的 DKD 发生率为 3.43（95%CI，1.93 至 6.11），中升高组的发生率为 1.80（95%CI，1.17 至 2.77）。
与健康受试者相比，T2DM 患者 Cysc 的增加速度更高。基线 Cysc 值较高且 Cysc 潜在增加速度较高的患者在以后的生活中发生 DKD 的风险更高。应更加关注这些高危因素的患者。
