糖尿病人群基线超敏C反应蛋白水平对肌酐倍增的预测价值  

Predictive value of high sensitivity C-reactive protein in baseline for doubling of serum creatinine in diabetic population

作　　者：王丽晔[1] 刘运秋[1] 朱晨蕊[2] 安利杰[2] 周艳茹[3] 阎秀纵[3] 李冬青[2] 高竞生[2] 刘秀荣[2] 王剑利[4] 吴寿岭[2] 

机构地区：[1]华北理工大学附属开滦总医院呼吸内科,河北省唐山市063000 [2]华北理工大学附属开滦总医院心内科,河北省唐山市063000 [3]华北理工大学附属开滦总医院内分泌科,河北省唐山市063000 [4]华北理工大学附属开滦总医院肾内科,河北省唐山市063000

出　　处：《中国综合临床》2016年第2期130-134,共5页Clinical Medicine of China

摘　　要：目的探讨糖尿病人群基线超敏C反应蛋白（hs—CRP）水平对肌酐倍增的预测价值。方法本研究采用前瞻性队列研究方法，选择FBG≥7．0mmol／L或〈7．0mmol／L但已确诊为糖尿病，正在使用降糖药物并具有完整查体资料（包括个人生活习惯、健康状况、体格检查、实验室检查）且基线肾功能正常的5921例糖尿病人群作为观察队列，平均随访（25．36±5．10）个月。以肌酐倍增为观测指标，分析基线血清hs—CRP水平与糖尿病人群2年后发生肾功能减退的相关性。结果（1）随访2年后，与基线hs-CRP〈3mg／L组相比，hs—CRP≥3mg／L组发生肌酐倍增率增高[χ^2=33．001，P=0．000，发病风险（OR）值为3．375，95％CI 2．175—5．248，P=0．000]；而两组间肾功能不全发生率差异无统计学意义（χ^2=0．019，P=0．889）；多变量Logistic回归分析结果显示校正年龄、性别、BMI、SBP、DBP、FBG、TC、TG、LDL-C、HDL—C后，基线hs-CRP≥3mg／L组发生肌酐倍增的OR值是hs—CRP〈3mg／L组的3．261倍（95％CI 2．037～5．231，P=0．000）。（2）与hs—CRP〈3mg／L组相比，基线hs—CRP≥3mg／L组研究对象的平均年龄高、人群中女性比例大、SBP、DBP、FBG、TG水平和eGFR水平高；而新发糖尿病比例低、HDL-C和血清肌酐水平低，差异均有统计学意义（P均〈0．05）。结论基线hs—CRP≥3mg／L者发生肌酐倍增的危险增加，hs—CRP可能是发生糖尿病患者发生肾功能减退的一个独立预测因子。Objective To study the predictive value of serum high sensitivity C-reactive protein （hs- CRP） in baseline for doubling of serum creatinine in the population with diabetes. Methods This was a prospective cohort study. Five thousand nine hundred and twenty-one subjects whose fasting plasma glucose was ≥ 7. 0 mmol/L or 〈 7.0 mmol/L and were diagnosed diabetes mellitus, while using insulin or hypoglycemic drugs, and with complete health examination data （including personal habits, health status, physical examination, laboratory examination） , and had normal renal function in baseline were selected as the observation population, and followed up average （25. 36±5.10） months. Doubling of serum creatinine as the observation index, the relationship between hs-CRP in baseline and renal hypofunction in the population with diabetes after 2 years was studied. Results （ 1 ） After follow-up 2 years, compared with hs-CRP 〈 3 mg/L group in baseline, the incidence of doubling of serum creatinine increased in hs-CRP ≥ 3 mg/L group （χ^2 = 33. 001, P = 0. 000, OR was 3. 375, 95% CI was 2. 175 - 5. 248, P = 0. 000）, the incidence of renal dysfunction was not different significantly in two groups （χ^2 = 0. 019, P = 0. 889） . A multivariate Logistic regression analysis indicated that after adjusting for age, gender, body mass index （BMI） diastolic blood pressure（SBP） , systolic blood pressure （ DBP ） , fasting blood glucose （FBG） , total cholesterol （ TC ）, triglyceride（ TG）, low density lipoprotein cholesterol （ LDL-C）, high density lipoprotein cholesterol （ HDL-C ）, the individuals in hs-CRP ≥ 3 mg/L group had an increased risk of doubling of serum creatinine （ OR was 3. 261, 95% CI was 2. 037- 5. 231, P〈 0.01 ） , compared with compared with hs-CRP 〈 3 mg/L group in baseline. （2） The average age of the individuals was oIder, the proportion of female individuals in the total population and SBP, DBP, FBG, TG and eGFR levels were increased, the differences

关 键 词：超敏C反应蛋白 糖尿病人群 肌酐倍增 肾功能减退 预测价值 

分 类 号：R541.4[医药卫生—心血管疾病]