State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510000, Guangdong Province, China; Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510000, Guangdong Province, China; Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510000, Guangdong Province, China.
Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
Diabetes Metab Syndr. 2023 Nov;17(11):102882. doi: 10.1016/j.dsx.2023.102882. Epub 2023 Oct 23.
The association between serum cystatin C level and vascular outcomes has not been fully elucidated in diabetes and is unclear in prediabetes. We aim to evaluate whether cystatin C level predicts future risk for mortality and vascular outcomes in prediabetes and diabetes.
A total of 85,371 participants with prediabetes and diabetes, and available baseline cystatin C in the UK biobank were included with a 14-year follow-up. Cox hazards models were used to calculate the associations between cystatin C level, mortality (all-cause, cause-specfic mortality) and vascular outcomes (myocardial infarction [MI], stroke, end-stage renal disease [ESRD] and diabetic retinopathy [DR]). The 1136 diabetes subjects in Guangzhou Diabetic Eye Study (GDES) were included for examing the impact of cystatin C on in vivo retinal degeneration and microvascular changes by using SS-OCT and OCTA.
The highest cystatin C quartile had increased risks of all-cause (hazard ratio [HR], 2.02; 95% confidence interval [CI] 1.86-2.19), cardiovascular (HR, 2.29; 95% CI 1.97-2.67), cancer (HR, 1.86; 95% CI 1.65-2.10) and other-cause mortality (HR, 2.24; 95% CI 1.90-2.64), MI (HR, 1.40; 95% CI 1.26-1.55), stroke (HR, 1.88; 95% CI, 1.57-2.26), ESRD (HR, 7.33; 95% CI, 5.02-10.71), DR (HR, 1.17; 95% CI 1.03-1.32) than those in the lowest quartile. Adding cystatin C to the conventional model improved C-statistic for all-cause (0.699-0.724), cardiovascular (0.762-0.789), cancer (0.661-0.674) and other-cause mortality (0.675-0.715), MI (0.748-0.750), stroke (0.712-0.718), and ESRD (0.808-0.827). The GDES analysis identified a strong association between increased cystatin C levels and diminished retinal neural layers, as well as microvascular rarefaction in both macular and optic disc regions (all P < 0.05).
Serum cystatin C refines the risk stratification for mortality and vascular outcomes among patients with prediabetes or diabetes.
血清胱抑素 C 水平与血管结局之间的关系在糖尿病中尚未完全阐明，在糖尿病前期也不清楚。我们旨在评估胱抑素 C 水平是否可预测糖尿病前期和糖尿病患者未来的死亡和血管结局风险。
共纳入英国生物库中 85371 例糖尿病前期和糖尿病患者，基线时可检测到胱抑素 C，并随访 14 年。使用 Cox 风险模型计算胱抑素 C 水平与死亡率（全因、病因特异性死亡率）和血管结局（心肌梗死 [MI]、中风、终末期肾病 [ESRD] 和糖尿病视网膜病变 [DR]）之间的相关性。纳入广州糖尿病眼病研究（GDES）中的 1136 例糖尿病患者，使用 SS-OCT 和 OCTA 检查胱抑素 C 对体内视网膜变性和微血管变化的影响。
最高四分位胱抑素 C quartile 的全因（风险比 [HR]，2.02；95%置信区间 [CI]，1.86-2.19）、心血管（HR，2.29；95% CI，1.97-2.67）、癌症（HR，1.86；95% CI，1.65-2.10）和其他原因死亡率（HR，2.24；95% CI，1.90-2.64）、心肌梗死（HR，1.40；95% CI，1.26-1.55）、中风（HR，1.88；95% CI，1.57-2.26）、ESRD（HR，7.33；95% CI，5.02-10.71）、DR（HR，1.17；95% CI，1.03-1.32）的风险均高于最低四分位。将胱抑素 C 添加到常规模型中，可提高全因（0.699-0.724）、心血管（0.762-0.789）、癌症（0.661-0.674）和其他原因死亡率（0.675-0.715）、心肌梗死（0.748-0.750）、中风（0.712-0.718）和 ESRD（0.808-0.827）的 C 统计量。GDES 分析表明，胱抑素 C 水平升高与视网膜神经层变薄以及黄斑和视盘区域微血管稀疏均有很强的相关性（均 P<0.05）。
血清胱抑素 C 可改善糖尿病前期或糖尿病患者的死亡和血管结局风险分层。
