血清C反应蛋白与糖尿病发病风险的关系

Association between C-reactive protein and the risk of diabetes

目的 探讨社区人群中基线非糖尿病人群血清C反应蛋白水平与随访期间糖尿病发病风险的关系。 方法研究对象源自于2009年在上海市浦东新区某社区建立的35-74岁社区居民糖尿病前瞻性队列调查。对基线非糖尿病人群按基线C反应蛋白进行分组（C反应蛋白〈1.00 mg/L、1.00-1.99 mg/L、2.00-2.99 mg/L、≥3.00 mg/L），采用方差分析、Kruskal-Wallis H非参数检验以及卡方检验对各组人群的基线特征进行比较，采用COX风险比例回归模型分析不同水平的C反应蛋白与糖尿病发病风险的关联。 结果798名研究对象平均随访时间为（2.7±0.5）年。基线C反应蛋白〈1.00 mg/L、1.00-1.99 mg/L、2.00-2.99 mg/L、≥3.00 mg/L组的糖尿病发病密度分别为14.68／千人年、21.30/千人年、28.92/千人年、46.38/千人年，糖尿病发病率随基线C反应蛋白水平升高而升高（χ趋势2＝13.63，P〈 0.001）。进一步控制糖尿病家族史、高血压疾病史、年龄、体质指数、甘油三酯、基线血糖状态混杂因素后，基线血清C反应蛋白≥3 mg/L人群糖尿病发病风险是基线〈1 mg/L人群的3.26倍（95%CI：1.39- 7.64），基线C反应蛋白判定是否发生糖尿病，受试者工作特征曲线下面积为0.604 （95%CI：0.522- 0.686）。 结论C反应蛋白是糖尿病发生的独立危险因素，但预测糖尿病发生的效果不佳，可考虑结合其他影响因素联合预测。

Objective To explore the association between C-reactive protein（CRP） level at baseline and the risk of diabetes mellitus（DM） during follow-up in a community cohort. Methods Subjects were the residents （35-74 years old） derived from a community-based diabetes prospective cohort study in Pudong New Area in Shanghai, which began in 2009 and followed up in 2012. Baseline non-diabetic population was divided into four groups according to the level of baseline CRP （CRP〈1.00 mg/L, 1.00-1.99 mg/L, 2.00-2.99 mg/L or≥3.00 mg/L）. Analysis of variance, Kruskal Wallis H nonparametric test and Chi-square test were used to compare the baseline characteristics, and COX regression model was used to analyze the association between baseline CRP level and DM risk during follow-up. Results The mean follow-up time was （2.7±0.5） years. For those with CRP〈1.00, 1.00-1.99, 2.00-2.99 and/〉3.00 mg/L, the incidence rate of DM was 14.68/1 000, 21.30/1 000, 28.92/1 000 or 46.38/1 000 person-years, respectively; the incidence rate of DM increased with baseline CRP levels （ X2 =13.63, P〈0.001）. After adjusting for family history of diabetes, history of hypertension, age, body mass index, triglycerides, and the baseline blood glucose status, the risk of DM in group with CRP level ≥3.00 mg/L was 3.26 times （95%CI： 1.39- 7.64） that of group with CRP level〈 1.00 mg/L. The areas under the receiver operating characteristic curvesof baseline CRP level in predicting the incidence of DM was 0.604 （95% CI：0.522-0.686）. Conclusions Baseline CRP level is an independent risk factor of diabetes; however, the predict power of CRP is poor. Therefore, combiding CRP with other factors may be a good choice to predict diabetes.