2型糖尿病患者C反应蛋白与肾脏病变的相关性研究

Correlation Study between C-Reactive Protein and Renal Lesions in Patients with Type 2 Diabetes Mellitus

摘要: 目的：探讨2型糖尿病(diabetes mellitus type 2, T2DM)患者C反应蛋白(C-reactive protein, CRP)与肾脏病变的关系，探讨CRP是否与糖尿病患者肾功能下降相关。方法：青岛大学医学院附属医院共招募6238名T2DM患者。通过调整潜在混杂变异后的逻辑回归分析，得到了与CRP四分位数相关的优势比(OR)和相应的95%置信区间(CI)。结果：根据CRP的四分位数，以CRP等于0.5、1.5、3.11切点，将CRP分为Q1、Q2、Q3、Q4组，Q1中T2DM患者的肾小球滤过率发生下降的概率几乎都大于其他三组(CKD2组：46.2% vs 34.38%，32.18%，33.61%，p < 0.05；CKD3组：23.19% vs 4.98%，4.37%，13.08%，p < 0.05；CKD4组：3.38% vs 2.17%，1.3%，2.85%，p < 0.05)。与Q4相比，Q1在CKD2、3、4组的OR值分别为2.613、3.37、2.259，p均< 0.05；而Q3在2、3、4组的OR值分别为0.797、0.276、0.378，p均< 0.05。调整收缩压、舒张压、年龄、高密度脂蛋白、低密度脂蛋白、胆固醇、尿酸后，与Q4相比，Q1在CKD2、3、4组的OR值分别为2.701、3.363、2.201，p值均< 0.05；而Q2、Q3在CKD2、3、4组的OR值均小于1且p < 0.05。在研究人群中，CRP与T2DM患者肾小球滤过率的水平呈U型关系。结论：在研究人群中，CRP水平与肾小球滤过率下降呈密切相关，这可能意味着，当CRP < 0.5 mg/L或>3.11 mg/L时是独立危险因素。

Abstract: Objective: To investigate the relationship between C-reactive protein (CRP) and renal lesions in type 2 diabetes mellitus (T2DM), and whether CRP is associated with the renal function decline in dia-betic patients. Methods: A total of 6238 T2DM patients were recruited from the Affiliated Hospital of Qingdao University School of Medicine. The odds ratio (OR) and the corresponding 95% confidence interval (CI) were obtained by logistic regression analysis after adjusting for potential confounding variants. Results: According to the quartile of the CRP, with CRP equal to 0.5, 1.5, 3.11 cut-points, CRP in groups Q1, Q2, Q3 and Q4, the probability of a decline in T2DM patients in Q1 was almost all greater than that in the other three groups (CKD2:46.2% vs34.38%, 32.18%, 33.61%, P < 0.05; CKD3 group: 23.19% vs 4.98%, 4.37%, 13.08%, p < 0.05; CKD4 group: 3.38% vs 2.17%, 1.3%, 2.85%, p < 0.05). Compared with Q4, the OR of Q1 in CKD2, 3 and 4 was 2.613, 3.37 and 2.259 re-spectively, all p < 0.05, while the OR of Q3 in groups 2, 3 and 4 was 0.797, 0.276 and 0.378 respec-tively and p < 0.05. After adjusting for systolic blood pressure, diastolic blood pressure, age, HDL, LDL, cholesterol, and uric acid, Q1 in CKD2 were 2.701 and 2.201 and 3.363, respectively, with p values < 0.05, compared with the Q4, while the Q 1 and Q2 in CKD2, 3 and 4 groups were less than 1 and p < 0.05. CRP and the level of glomerular filtration rate in T2DM patients in the study popula-tion. Conclusions: CRP levels were strongly associated with decreased glomerular filtration rate in the study population, which could be an independent risk factor when CRP < 0.5 mg/L or >3.11 mg/L.