肾功能正常患者血清胱抑素C与2型糖尿病血管并发症的关系

Relationship between Serum Cystatin C and Vascular Complications in Type 2 Diabetes Mellitus Patients with Normal Renal Function

目的探讨2型糖尿病肾功能正常患者血清胱抑素C(CysC)水平与血管并发症的关系。方法选取2017年1月至2018年5月承德医学院附属医院内分泌科住院2型糖尿病患者共218例,根据血清CysC水平的四分位数分为4组,分别为G1组:≤0.56 mg/L,共58例;G2组:0.57~0.73 mg/L,共52例;G3组:0.74~1.11 mg/L,共56例;G4组:≥1.12 mg/L,共52例。比较一般资料、生化指标、糖化白蛋白、糖化血红蛋白、CysC水平,以及随着CysC水平升高2型糖尿病患者血管并发症的风险。结果4组间颈动脉粥样硬化比较显示:G4组与G1组比较差异有统计学意义(χ^2=-20.022,P=0.001),其余各组比较差异无统计学意义。4组间2型糖尿病视网膜病变比较:G3组和G4组与G1组比较差异均有统计学意义(G3组:χ^2=-23.827,P=0.000;G4组:χ^2=-24.576,P=0.000),其余各组比较差异无统计学意义。Logistic回归分析显示,与G1组相比,随着CysC水平升高,2型糖尿病视网膜病变风险显著增加(G2:OR=3.619,95%CI=1.539~8.510,P=0.003;G3:OR=5.524,95%CI=2.214~13.718,P=0.000;G4:OR=5.661,95%CI=2.321~13.806,P=0.000);血清最高CysC水平是颈动脉粥样硬化的一个重要危险因素(OR=9.842,95%CI=3.324~29.145,P=0.000)。结论血清CysC是2型糖尿病正常肾功能患者2型糖尿病视网膜病变、颈动脉粥样硬化发生的独立危险因素。

Objective To investigate the relationship between serum cystatin C(CysC)level and vascular complications in type 2 diabetes mellitus(T2DM)patients with normal renal function.Methods Totally 218 T2DM patients who were treated in the Department of Endocrinology,Affiliated Hospital of Chengde Medical College from January 2017 to May 2018 were enrolled.All subjects were divided into four groups based on the quartiles of serum CysC levels:G1 group:≤0.56 mg/L,58 cases;G2 group:0.57-0.73 mg/L,52 cases;G3 group:0.74-1.11 mg/L,56 cases;G4 group:≥1.12 mg/L,52 cases.The general data,biochemical indicators,glycated albumin,hemoglobin A 1c,CysC were compared among these four groups,and the risk of vascular complications with increasing CysC levels was analyzed.Results The carotid atherosclerosis showed significant difference between G4 group and G1 group(χ^2=-20.022,P=0.001),while no statistically significant difference was seen among other groups.The risk of diabetic retinopathy was significantly higher in G3 group and G4 group than in G1 group(G3 group:χ^2=-23.827,P=0.000;G4 group:χ^2=-24.576,P=0.000).It was found that the risk of diabetic retinopathy significantly increased with the increase of CysC quartile compared with G1 group(G2:OR=3.619,95%CI=1.539-8.510,P=0.003;G3:OR=5.524,95%CI=2.214-13.718,P=0.000;G4:OR=5.661,95%CI=2.321-13.806,P=0.000).Serum highest CysC level was an important risk factor for atherosclerosis(OR=9.842,95%CI=3.324-29.145,P=0.000).Conclusion Serum CysC is an independent risk factor for diabetic retinopathy and carotid atherosclerosis in T2DM patients with normal renal function.