Association of C-reactive protein with type 2 diabetes: prospective analysis and meta-analysis
Association of C-reactive protein with type 2 diabetes: prospective analysis and meta-analysis
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DOI：
10.1007/s00125-009-1338-3
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发表时间：
2009-06-01
期刊：
影响因子：
8.2
通讯作者：
Wareham, N. J.
中科院分区：
文献类型：
--
作者：
Lee, C. C.;Adler, A. I.;Wareham, N. J.
我们在一项前瞻性研究中检验了血清C反应蛋白(CRP)与糖尿病发病的关系，并将这些数据添加到基于文献的荟萃分析中，以探索研究之间的潜在异质性来源。我们分析了一项嵌套在欧洲癌症前瞻性调查(EPIC)-诺福克队列中的病例对照研究，包括293例糖尿病发病病例和708名对照。我们在随机效应荟萃分析中结合了16项关于C反应蛋白和糖尿病发病的研究。在EPIC-诺福克队列中，在调整了年龄、性别、体重指数、糖尿病家族史、吸烟和体力活动后，血清C反应蛋白与更高的糖尿病风险相关(OR 1.49，比较C反应蛋白分布的极端三分之一[95%可信区间1.03-2.15]，p=0.03)。然而，在进一步调整腰臀比、血清谷氨酰转移酶和血清脂联素后，这种相关性完全减弱(OR 1.00；95%CI 0.66-1.51，p=1.0)。在对3,920例糖尿病患者和24,914例对照的16项已发表研究的荟萃分析中，RR为1.72(95%可信区间为1.54-1.92)，与C反应蛋白分布的极端三分之一相比，研究之间的异质性很大(I(2)=52.8%，p=0.007)。尽管在Meta分析中总体呈正相关，但研究之间存在相当大的异质性。中心性肥胖和基线血糖的调整程度解释了这种异质性的部分原因，提示CRP可能不是2型糖尿病的独立危险因素。
We examined the association between serum C-reactive protein (CRP) and incident diabetes in a prospective study, and added these data to a literature-based meta-analysis to explore potential sources of heterogeneity between studies.We analysed a case-control study nested within the European Prospective Investigation of Cancer (EPIC)-Norfolk cohort, including 293 incident diabetes cases and 708 controls. We combined 16 published studies on CRP and incident diabetes in a random-effect meta-analysis.In the EPIC-Norfolk cohort, serum CRP was associated with a higher risk of diabetes after adjusting for age, sex, BMI, family history of diabetes, smoking and physical activity (OR 1.49, comparing the extreme thirds of CRP distribution [95% CI 1.03-2.15], p = 0.03). However, the association was completely attenuated after further adjustment for WHR, serum gamma-glutamyltransferase and serum adiponectin (OR 1.00; 95% CI 0.66-1.51, p = 1.0). In a meta-analysis of 16 published studies with 3,920 incident diabetes cases and 24,914 controls, the RR was 1.72 (95% CI 1.54-1.92), comparing the extreme thirds of CRP distribution, with substantial heterogeneity between studies (I (2) = 52.8%, p = 0.007).Initial evidence of association between CRP and incident diabetes was confounded by central adiposity, markers of liver dysfunction and adiponectin in the primary analysis. Despite an overall positive association in the meta-analysis, considerable heterogeneity existed between studies. The degree of adjustment for central adiposity and baseline glycaemia explained some of this heterogeneity and suggests that CRP may not be an independent risk factor for type 2 diabetes.