Inflammation and progressive nephropathy in type 1 diabetes in the diabetes control and complications trial.
Inflammation and progressive nephropathy in type 1 diabetes in the diabetes control and complications trial.
复制标题
糖尿病控制和并发症试验中1型糖尿病的炎症和进行性肾病。
DOI：
10.2337/dc08-0277
复制
发表时间：
2008-12
期刊：
影响因子：
16.2
通讯作者：
Schaumberg, Debra A.
中科院分区：
文献类型：
--
作者：
Lin, Julie;Glynn, Robert J.;Rifai, Nader;Manson, JoAnn E.;Ridker, Paul M.;Nathan, David M.;Schaumberg, Debra A.
进展性肾病是1型糖尿病发病率和死亡率的重要来源。白蛋白尿增加是进行性肾功能不全和心血管风险增加的强预测因子。早期白蛋白尿可能反映了血管内皮功能障碍，这可能部分由慢性炎症介导。研究设计和方法--我们测量了糖尿病控制和并发症试验（DCCT）1,441名参与者储存血液样本中4种炎症生物标志物（高敏C反应蛋白、可溶性细胞间粘附分子-1 [sICAM-1]、可溶性血管细胞粘附分子-1和可溶性肿瘤坏死因子-α受体-1）的基线水平。我们使用混合效应回归模型来确定每个生物标志物三分位数的尿白蛋白排泄率（AER）的平均年变化。我们还使用了考克斯比例风险模型，根据每种生物标志物的水平来估计事件持续性微量白蛋白尿的相对风险。经基线年龄、性别、糖尿病病程、A1 C和随机治疗分配调整后，我们观察到，与基线sICAM-1最低三分位数相比，基线sICAM-1最高三分位数患者的AER增加了5.9 μg · min-1 ·年-1（P = 0.04）。sICAM-1最高三分位数的患者发生持续性微量白蛋白尿的校正相对危险度为1.67（95% CI 0.96-2.92）（Ptrend = 0.03）。结论：较高的sICAM-1基线水平预示着1型糖尿病进展性肾病的风险增加，可能是反映血管内皮功能障碍在这种长期并发症中重要作用的早期风险标志物。
OBJECTIVE—Progressive nephropathy represents a substantial source of morbidity and mortality in type 1 diabetes. Increasing albuminuria is a strong predictor of progressive renal dysfunction and heightened cardiovascular risk. Early albuminuria probably reflects vascular endothelial dysfunction, which may be mediated in part by chronic inflammation. RESEARCH DESIGN AND METHODS—We measured baseline levels of four inflammatory biomarkers (high-sensitivity C-reactive protein, soluble intercellular adhesion molecule-1 [sICAM-1], soluble vascular cell adhesion molecule-1, and soluble tumor necrosis factor-α receptor-1) in stored blood samples from the 1,441 participants of the Diabetes Control and Complication Trial (DCCT). We used mixed-effects regression models to determine the average annual change in urinary albumin excretion rate (AER) by tertiles of each biomarker. We also used Cox proportional hazards models to estimate the relative risk of incident sustained microalbuminuria according to levels of each biomarker. RESULTS—After adjustment for baseline age, sex, duration of diabetes, A1C, and randomized treatment assignment, we observed a significantly higher 5.9 μg · min−1 · year−1 increase in AER among those in the highest compared with the lowest tertile of baseline sICAM-1 (P = 0.04). Those in the highest tertile of sICAM-1 had an adjusted relative risk of 1.67 (95% CI 0.96–2.92) of developing incident sustained microalbuminuria (Ptrend = 0.03). CONCLUSIONS—Higher baseline sICAM-1 levels predicted an increased risk of progressive nephropathy in type 1 diabetes and may represent an early risk marker that reflects the important role of vascular endothelial dysfunction in this long-term complication.
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影响因子：
7.7
作者：
Okada, S;Shikata, K;Makino, H
通讯作者：
Makino, H
影响因子：
5.8
作者：
Mohanty, P;Hamouda, W;Dandona, P
通讯作者：
Dandona, P
DOI：
10.1016/0006-291x(92)91234-h
发表时间：
1992-09-16
影响因子：
3.1
作者：
PIGOTT, R;DILLON, LP;GEARING, AJH
通讯作者：
GEARING, AJH
影响因子：
8.2
作者：
Saraheimo, M;Teppo, AM;Groop, PH
通讯作者：
Groop, PH
影响因子：
4.2
作者：
Williams, Michael D;Nadler, Jerry L
通讯作者：
Nadler, Jerry L