糖尿病与糖尿病前期人群胱抑素C与心血管疾病早期病变的相关性  

Elevated cystatin C is associated with cardiovascular risk factors and predicted risk of cardiovascular disease in Chinese prediabetes and diabetes

作　　者：黄小琳 高沛 王龙[1] 吴阳[1] 周佳雁[1] 蒋晓红[1] 华飞[1] HUANG Xiao-Lin;GAO Pei;WANG Long(Department of Endocrine and Metabolic Diseases,the Third Affiliated Hospital of Soochow University,Changzhou 213000,Jiangsu,China)

机构地区：[1]常州市第一人民医院内分泌代谢科,江苏常州213000

出　　处：《中国老年学杂志》2021年第7期1378-1382,共5页Chinese Journal of Gerontology

基　　金：国家自然科学基金青年基金项目(81900768);常州市应用基础研究项目(CJ2018044)。

摘　　要：目的探讨中国中老年糖尿病与糖尿病前期人群胱抑素C与心血管疾病早期病变患病风险的相关性。方法选取常州市永红街道40岁以上常住居民中糖尿病前期与糖尿病患者1083例作为研究对象。所有研究对象进行标准化问卷调查、体格检查、血清同型半胱氨酸、肝肾功能和血脂检查。高脂血症采用美国国家胆固醇教育计划成人治疗组第3次报告(NCEP-ATPⅢ)诊断标准,高同型半胱氨酸血症定义为同型半胱氨酸≥15μmol/L。Framingham危险评分参照NCEP-ATPⅢ,将Framingham危险评分≥20%定义为10年心血管疾病高危风险。结果胱抑素C水平与三酰甘油、同型半胱氨酸、Framingham危险评分呈显著正相关,与高密度脂蛋白胆固醇呈负相关(均P<0.05)。将胱抑素C三分位,从第一分位到第三分位,高脂血症、高同型半胱氨酸血症、10年心血管疾病高危风险的患病率逐渐升高(趋势P值<0.05)。多元Logistic回归分析显示胱抑素C水平每增加1个标准差,高脂血症、高同型半胱氨酸血症和10年心血管疾病高危风险的患病风险分别增加60%、2.16倍及47%。将胱抑素C第一个三分位为参照,第二个三分位高同型半胱氨酸血症患病风险增加88%;第三个三分位研究对象高脂血症患病风险增加69%,高同型半胱氨酸血症风险增加353%,10年心血管疾病高危风险增加141%。结论在中国中老年糖尿病及糖尿病前期人群中,高水平胱抑素C与高脂血症、高同型半胱氨酸血症、10年心血管疾病高危风险的患病风险增加密切相关,显著增加心血管疾病早期病变的患病风险。Objective To investigate the association of cystatin C with cardiovascular risk factors〔10-year Framingham risk for coronary heart disease(CHD)〕in Chinese prediabetes and diabetes.Methods The cross-sectional study included 1083 aged≥40 years old prediabetes and diabetes recruited from communities in Zhonglou District,Changzhou,China.With an interviewer-assisted questionnaire,social demographic information,lifestyle,and medical history of all participants were collected.Serum cystatin C,lipid,homocysteine and other biochemical features were collected by a standard protocol.Dyslipidemia was defined according to the modified National Cholesterol Education Program-Adult Treatment PanelⅢ,while homocysteinemia was defined as homocysteine≥15μmol/L.The Framingham Risk Score(FRS)equation was calculated to estimate the 10-year risk of developing CHD.Results Serum cystatin C was positively correlated with levels of triglyceride,homocysteine,whereas the FRS was negatively correlated with levels of high-density lipoprotein(HDL)(all P<0.05).With the increasing of cystatin C,more prediabetes and diabetes patients suffered dyslipidemia and homocysteinemia,had high 10-year risk of developing CHD(P for trend<0.05).Multiple logistic regression showed that with one standard deviation increasing in cystatin C,the risk of dyslipidemia and homocysteinemia increased 60%(95%CI 1.15~2.22)and 216%(95%CI 2.30~4.39),moreover,the high 10-year risk of developing CHD increased 47%(95%CI 1.03~2.28).Conclusions In Chinese prediabetes and diabetes,higher level of serum cystatin C is associated with increasing risk of dyslipidemia and homocysteinemia,and elevating 10-year Framingham risk for CHD.

关 键 词：胱抑素C 心血管疾病 糖尿病 糖尿病前期 

分 类 号：R587.1[医药卫生—内分泌]