Association between mannose-binding lectin, high-sensitivity C-reactive protein and the progression of diabetic nephropathy in type 1 diabetes
Association between mannose-binding lectin, high-sensitivity C-reactive protein and the progression of diabetic nephropathy in type 1 diabetes
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DOI：
10.1007/s00125-010-1742-8
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发表时间：
2010-07-01
期刊：
影响因子：
8.2
通讯作者：
Groop, P. -H.
中科院分区：
文献类型：
--
作者：
Hansen, T. K.;Forsblom, C.;Groop, P. -H.
在横断面研究中，糖尿病肾病与低度炎症和补体系统的激活有关。来自前瞻性研究的数据很稀少。在芬兰糖尿病肾病(FinnDiane)研究中对1型糖尿病患者进行的一项大型前瞻性研究中，我们调查了补体激活物甘露糖结合凝集素(MBL)和炎症标志物高敏C反应蛋白(HsCRP)与肾病发生的关系。芬兰Diane研究对1,564名1型糖尿病患者进行了基线MBL和hsCRP检测，其中1,010名白蛋白排泄率正常，236名微量白蛋白尿，318名大量白蛋白尿。主要结果是肾脏疾病的进展。基线mBL(p=0.038)和超敏C反应蛋白(p<；0.001)都随着蛋白尿水平的增加而增加。在5.8+/-2.2年的随访中，201名患者进展到更高的蛋白尿水平或发生终末期肾病(ESRD)。在所有进展阶段，进展者的MBL水平均高于非进展者，在协变量调整的多变量COX回归分析中，高于中位数的MBL水平与大量白蛋白尿进展到终末期肾病显著相关(危险比1.88，95%可信区间1.06-3.32，p=0.030)。在单变量分析中，超敏C反应蛋白水平高于中位数与从正常白蛋白排泄率到微量白蛋白尿的进展显著相关，但只有在调整协变量后这种相关性才接近显著(危险比1.56，95%可信区间0.97-2.51，p=0.068)。这项研究表明，高脂蛋白和超敏C反应蛋白浓度与1型糖尿病肾脏疾病的进展有关。
Diabetic nephropathy has been associated with low-grade inflammation and activation of the complement system in cross-sectional studies. Data from prospective studies are sparse. We investigated the associations of the complement activator mannose-binding lectin (MBL) and the inflammatory marker high-sensitivity C-reactive protein (hsCRP) with the development of nephropathy in a large prospective study of patients with type 1 diabetes from the Finnish Diabetic Nephropathy (FinnDiane) Study.Baseline MBL and hsCRP were measured in 1,564 type 1 diabetes patients from the FinnDiane study, of whom 1,010 had a normal albumin excretion rate, 236 had microalbuminuria and 318 had macroalbuminuria. The main outcome was progression in renal disease during follow-up.Both baseline MBL (p = 0.038) and hsCRP (p < 0.001) increased with increasing level of albuminuria. During 5.8 +/- 2.2 years of follow-up, progression to a higher albuminuria level or end-stage renal disease (ESRD) occurred in 201 patients. MBL levels were higher in progressors compared with non-progressors at all steps of progression, and in a covariate adjusted multivariate Cox-regression analysis MBL levels above the median were significantly associated with progression from macroalbuminuria to ESRD (hazard ratio 1.88, 95% CI 1.06-3.32, p = 0.030). In a univariate analysis, hsCRP levels above the median were significantly associated with progression from normal albumin excretion rate to microalbuminuria, but the association was only borderline significant after adjustment for covariates (hazard ratio 1.56, 95% CI 0.97-2.51, p = 0.068).This study demonstrates that concentrations of both MBL and hsCRP are associated with the progression of renal disease in type 1 diabetes.