Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Via Tronto 10/A, 60126, Ancona, Italy.
Laboratory Medicine Unit, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Via Conca 71, 60126, Ancona, Italy.
Cardiovasc Diabetol. 2022 Sep 10;21(1):180. doi: 10.1186/s12933-022-01616-3.
Patients with type 2 diabetes (T2DM) present an increased risk of cardiovascular (CV) disease and excess CV-related mortality. Beyond the established role of brain natriuretic peptide (BNP) and cardiac troponins (cTn), other non-cardiac-specific biomarkers are emerging as predictors of CV outcomes in T2DM.
Serum levels of soluble suppression of tumorigenesis 2 (sST2), high-sensitivity (hs)-cTnI, and N-terminal (NT)-proBNP were assessed in 568 patients with T2DM and 115 healthy controls (CTR). Their association with all-cause mortality and the development of diabetic complications was tested in T2DM patients over a median follow-up of 16.8 years using Cox models and logistic regressions.
sST2 followed an increasing trend from CTR to uncomplicated T2DM patients (T2DM-NC) to patients with at least one complication (T2DM-C), while hs-cTnI was significantly higher in T2DM-C compared to CTR but not to T2DM-NC. A graded association was found between sST2 (HR 2.76 [95% CI 1.20-6.33] for ≥ 32.0 ng/mL and 2.00 [1.02-3.94] for 16.5-32.0 ng/mL compared to < 16.5 ng/mL, C-statistic = 0.729), NT-proBNP (HR 2.04 [1.90-4.55] for ≥ 337 ng/L and 1.48 [1.05-2.10] for 89-337 ng/L compared to < 89 ng/L, C-statistic = 0.741), and 15-year mortality in T2DM, whereas increased mortality was observed in patients with hs-cTnI ≥ 7.8 ng/L (HR 1.63 [1.01-2.62]). A 'cardiac score' based on the combination of sST2, hs-cTnI, and NT-proBNP was significantly associated with all-cause mortality (HR 1.35 [1.19-1.53], C-statistic = 0.739) and development of CV events.
sST2, hs-cTnI, and NT-proBNP are associated with 15-year mortality and onset of CV events in T2DM. The long-term prognostic value of sST2 and its ability to track variables related to insulin resistance and associated metabolic disorders support its implementation into routine clinical practice.
2 型糖尿病（T2DM）患者存在心血管（CV）疾病风险增加和 CV 相关死亡率过高的情况。除了脑利钠肽（BNP）和心脏肌钙蛋白（cTn）的既定作用外，其他非心脏特异性生物标志物也正在成为 T2DM 患者 CV 结局的预测指标。
评估了 568 例 T2DM 患者和 115 例健康对照者（CTR）的可溶性抑制肿瘤生成 2（sST2）、高敏（hs）-cTnI 和 N 端（NT）-proBNP 的血清水平。使用 Cox 模型和逻辑回归在 T2DM 患者中位随访 16.8 年后测试了这些标志物与全因死亡率和糖尿病并发症发生的关系。
sST2 从 CTR 到无并发症的 T2DM 患者（T2DM-NC）再到至少有一种并发症的患者（T2DM-C）呈递增趋势，而 hs-cTnI 在 T2DM-C 中明显高于 CTR，但与 T2DM-NC 相比则不然。sST2（HR 2.76 [95%CI 1.20-6.33]，≥32.0ng/ml 与<16.5ng/ml 相比，2.00 [1.02-3.94]，16.5-32.0ng/ml 与<16.5ng/ml 相比，C 统计量=0.729）、NT-proBNP（HR 2.04 [1.90-4.55]，≥337ng/L 与<89ng/L 相比，1.48 [1.05-2.10]，89-337ng/L 与<89ng/L 相比，C 统计量=0.741）和 15 年死亡率呈梯度相关，而 hs-cTnI≥7.8ng/L 的患者死亡率增加（HR 1.63 [1.01-2.62]）。基于 sST2、hs-cTnI 和 NT-proBNP 的组合的“心脏评分”与全因死亡率（HR 1.35 [1.19-1.53]，C 统计量=0.739）和 CV 事件的发生显著相关。
sST2、hs-cTnI 和 NT-proBNP 与 T2DM 患者的 15 年死亡率和 CV 事件的发生相关。sST2 的长期预后价值及其跟踪与胰岛素抵抗和相关代谢紊乱相关变量的能力支持其纳入常规临床实践。
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