2 型糖尿病患者严重白蛋白尿与股动脉亚临床动脉粥样硬化的增加相关，以 Na [F]F 活性作为替代指标 - DETERMINE 研究。
Severely increased albuminuria in patients with type 2 diabetes mellitus is associated with increased subclinical atherosclerosis in femoral arteries with Na [F]F activity as a proxy - The DETERMINE study.
机构信息
University of Groningen, University Medical Center Groningen, Dept. Internal Medicine, div. Vascular Medicine, the Netherlands.
University of Groningen, University Medical Center Groningen, Dept. Internal Medicine, div. Vascular Medicine, the Netherlands.
出版信息
Atherosclerosis. 2024 Jul;394:117199. doi: 10.1016/j.atherosclerosis.2023.117199. Epub 2023 Jul 29.
BACKGROUND AND AIMS
Sodium [F]fluoride (Na [F]F) positron emission tomography imaging allows detailed visualization of early arterial micro-calcifications. This study aims to investigate atherosclerosis manifested by micro-calcification, macro-calcification, and aortic stiffness in patients with type 2 diabetes mellitus (T2DM) with and without albuminuria and severely decreased kidney function.
METHODS
A cohort was stratified in four groups (N = 10 per group), based on KDIGO categories (G1-5 A1-3). G1-2A1 non-diabetic controls (median [IQR] estimated glomerular filtration rate (eGFR) in mL/min/1.73 m 91 [81-104]), G1-2A1 with T2DM (eGFR 87 [84-93], and albumin-creatinin-ratio (ACR) in mg/mmol 0.35 [0.25-0.75]), G1-2A3 with T2DM (eGFR 85 [60-103], and ACR 74 [62-122], and G4A3 with T2DM (eGFR 19 [13-27] and ACR 131 [59-304]).
RESULTS
Na [F]F femoral artery grading score differed significantly in the groups with the highest Na [F]F activity in A3 groups with T2DM (G1-2A3 with T2DM 228 [100-446] and G4A3 with T2DM 198 [113-578]) from the lowest groups of the G1-2A1 with T2DM (33 [0-93]) and in G1-2A1 non-diabetic controls (75 [0-200], p = 0.001). Aortic Na [F]F activity and femoral artery computed tomography (CT)-assessed macro-calcification was increased in G4A3 with T2DM compared with G1-2A1 with T2DM (47.5 [33.8-73.8] vs. 17.5 [8.8-27.5] (p = 0.006) and 291 [170-511] vs. 12.2 [1.41-44.3] mg (p = 0.032), respectively). Carotid-femoral pulse wave velocity (PWV)-assessed aortic stiffness was significantly higher in both A3 groups with T2DM compared with G1-2A1 with T2DM (11.15 and 12.35 vs. 8.86 m/s, respectively (p = 0.009)).
CONCLUSIONS
This study indicates that the presence of severely increased albuminuria in patients with T2DM is cross-sectionally associated with subclinical arterial disease in terms of micro-calcification and aortic stiffness. Additional decrease in kidney function was associated with advanced macro-calcifications.
背景与目的
钠离子[F]氟（Na[F]F）正电子发射断层扫描成像允许对早期动脉微钙化进行详细可视化。本研究旨在研究 2 型糖尿病（T2DM）患者中表现为微钙化、大钙化和主动脉僵硬的动脉粥样硬化，以及伴有和不伴有白蛋白尿和严重肾功能下降的患者。
方法
根据 KDIGO 类别（G1-5 A1-3），将队列分为四组（每组 10 人）。G1-2A1 非糖尿病对照组（中位 [IQR] 估计肾小球滤过率（eGFR）以 mL/min/1.73m2 计为 91 [81-104]），G1-2A1 伴 T2DM（eGFR 87 [84-93]，和白蛋白肌酐比（ACR）为 0.35 [0.25-0.75]），G1-2A3 伴 T2DM（eGFR 85 [60-103]，和 ACR 74 [62-122]，和 G4A3 伴 T2DM（eGFR 19 [13-27]，和 ACR 131 [59-304]）。
结果
Na[F]F 股动脉分级评分在 T2DM 患者 A3 组中具有最高 Na[F]F 活性的组中（G1-2A3 伴 T2DM 228 [100-446]和 G4A3 伴 T2DM 198 [113-578]）与 T2DM 患者的 G1-2A1 最低组（33 [0-93]）和 G1-2A1 非糖尿病对照组（75 [0-200]）有显著差异，p=0.001）。与 G1-2A1 伴 T2DM 相比，G4A3 伴 T2DM 患者的主动脉 Na[F]F 活性和股动脉计算机断层扫描（CT）评估的大钙化增加（47.5 [33.8-73.8] vs. 17.5 [8.8-27.5]，p=0.006）和 291 [170-511] vs. 12.2 [1.41-44.3]mg，p=0.032）。与 G1-2A1 伴 T2DM 相比，T2DM 患者的颈动脉-股动脉脉搏波速度（PWV）评估的主动脉僵硬在两个 A3 组中均显著升高（11.15 和 12.35 vs. 8.86m/s，分别为 p=0.009）。
结论
本研究表明，2 型糖尿病患者严重白蛋白尿的存在与亚临床动脉疾病（微钙化和主动脉僵硬）存在横断面关联。肾功能进一步下降与晚期大钙化有关。
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