血浆 hepcidin 浓度升高与 2 型糖尿病患者死亡和非致死性心血管事件风险增加相关：一项前瞻性研究。

Elevated plasma hepcidin concentrations are associated with an increased risk of mortality and nonfatal cardiovascular events in patients with type 2 diabetes: a prospective study.

机构信息

Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.

Department of Medicine, Section of Internal Medicine, EuroBloodNet Center, University of Verona and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.

出版信息

Cardiovasc Diabetol. 2024 Aug 17;23(1):305. doi: 10.1186/s12933-024-02377-x.

DOI:10.1186/s12933-024-02377-x

PMID:39154180

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11330614/

Abstract

BACKGROUND

The effect of plasma hepcidin concentrations on the long-term risk of developing adverse cardiovascular outcomes in people with type 2 diabetes mellitus (T2DM) is unclear.

METHODS

We followed for a median of 55.6 months 213 outpatients with established T2DM (45.5% women, mean age 69 ± 10 years; BMI 28.7 ± 4.7 kg/m; median diabetes duration 11 years). Baseline plasma ferritin and hepcidin concentrations were measured with an electrochemiluminescence immunoassay and mass spectrometry-based assay, respectively. The primary study outcome was a composite of all-cause mortality or incident nonfatal cardiovascular events (inclusive of myocardial infarction, permanent atrial fibrillation, ischemic stroke, or new hospitalization for heart failure).

RESULTS

42 patients developed the primary composite outcome over a median follow-up of 55.6 months. After stratifying patients by baseline hepcidin tertiles [1st tertile: median hepcidin 1.04 (IQR 0.50-1.95) nmol/L, 2nd tertile: 3.81 (IQR 3.01-4-42) nmol/L and 3rd tertile: 7.72 (IQR 6.37-10.4) nmol/L], the risk of developing the primary composite outcome in patients in the 3rd tertile was double that of patients in the 1st and 2nd tertile combined (unadjusted hazard ratio [HR] 2.32, 95%CI 1.27-4.26; p = 0.007). This risk was not attenuated after adjustment for age, sex, adiposity measures, smoking, hypertension, statin use, antiplatelet medication use, plasma hs-C-reactive protein and ferritin concentrations (adjusted HR 2.53, 95%CI 1.27-5.03; p = 0.008).

CONCLUSIONS

In outpatients with T2DM, higher baseline hepcidin concentrations were strongly associated with an increased long-term risk of overall mortality or nonfatal cardiovascular events, even after adjustment for established cardiovascular risk factors, plasma ferritin concentrations, medication use, and other potential confounders.

摘要

背景

血浆铁调素浓度对 2 型糖尿病（T2DM）患者发生不良心血管结局的长期风险的影响尚不清楚。

方法

我们对 213 例已确诊的 T2DM 门诊患者（45.5%为女性，平均年龄 69±10 岁；BMI 28.7±4.7 kg/m；中位糖尿病病程 11 年）进行了中位 55.6 个月的随访。分别采用电化学发光免疫分析法和基于质谱的检测法测定基线血浆铁蛋白和铁调素浓度。主要研究结局为全因死亡率或非致命性心血管事件（包括心肌梗死、永久性心房颤动、缺血性卒中和心力衰竭新住院）的复合终点。

结果

在中位 55.6 个月的随访期间，42 例患者发生了主要复合终点事件。按基线铁调素三分位值分层[第 1 分位值：中位铁调素 1.04（IQR 0.50-1.95）nmol/L，第 2 分位值：3.81（IQR 3.01-4.42）nmol/L，第 3 分位值：7.72（IQR 6.37-10.4）nmol/L]，第 3 分位值患者发生主要复合终点事件的风险是第 1 分位值和第 2 分位值患者的两倍（未经校正的危险比 [HR] 2.32，95%CI 1.27-4.26；p=0.007）。这种风险在调整年龄、性别、肥胖指标、吸烟、高血压、他汀类药物使用、抗血小板药物使用、血浆 hs-C 反应蛋白和铁蛋白浓度后并未减弱（校正 HR 2.53，95%CI 1.27-5.03；p=0.008）。