Serum fetuin-A in nondialyzed patients with diabetic nephropathy: Relationship with coronary artery calcification
Serum fetuin-A in nondialyzed patients with diabetic nephropathy: Relationship with coronary artery calcification
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DOI：
10.1111/j.1523-1755.2005.00172.x
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发表时间：
2005-03-01
影响因子：
19.6
通讯作者：
Adler, S
中科院分区：
文献类型：
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作者：
Mehrotra, R;Westenfeld, R;Adler, S
背景资料。胎球蛋白-A是钙磷沉淀最有效的循环抑制剂，也可能是胰岛素抵抗的重要介导物。为了确定胎球蛋白-A在未透析的糖尿病肾病患者冠状动脉钙化(CAC)负荷中的作用，对88例2型糖尿病患者的横断面研究收集的数据进行了事后分析[年龄，40-65岁；正常白蛋白尿，N=30(拉丁裔)；DN，N=58(拉丁裔和非裔美国人)]。与患有糖尿病肾病的非裔美国人或正常白蛋白尿的拉丁裔糖尿病患者相比，患有糖尿病肾病的拉丁裔糖尿病患者的血清胎球蛋白-A水平显著升高。在调整了种族和民族因素后，在研究队列中，血清胎球蛋白-A水平与CAC评分之间有很强的直接关系(r=0.22，P=0.038)；然而，肾病状况与血清胎球蛋白-A水平与CAC评分之间存在很强的交互作用(糖尿病组：r=0.36，P=0.006；糖尿病对照组，r=0.0P=0.98)。在糖尿病肾病患者中，即使在控制了CAC其他预测因素的数据后，这种关联的意义仍然存在(偏相关系数r=0.33，P=0.018)。血清胎球蛋白A与甘油三酯(偏r=0.2 7，P=0.0 1)、白蛋白(偏r=0.30，P=0.005)呈显著正相关，与肾小球滤过率(r=-0.2 4，P=0.0 3)呈负相关。这项在糖尿病慢性肾脏疾病早期阶段的首次研究表明，血清胎球蛋白-A的作用可能比之前描述的复杂得多。糖尿病肾病患者透析前血清胎球蛋白-A水平与CAC评分呈正相关。肾病患者存在这种关联的原因尚不清楚，但可能继发于致动脉粥样硬化的胰岛素抵抗。
Background. Fetuin-A is the most potent circulating inhibitor of calcium phosphorus precipitation and, possibly, an important mediator of insulin resistance.Methods. In order to determine the role of fetuin-A in the high coronary artery calcification (CAC) burden seen in nondialyzed individuals with diabetic nephropathy (DN), post-hoc analyses of data collected from a cross-sectional study of 88 patients with type 2 diabetes mellitus was done [age, 40-65 years; normoalbuminuria, N = 30 (Latinos); DN, N = 58 (Latinos and African Americans)].Results. The serum levels of fetuin-A were significantly higher among Latinos with DN when compared to either African Americans with DN or Latino diabetics with normoalbuminuria. Upon adjusting the data for race/ethnicity, there was a strong, direct relationship between serum fetuin-A levels and the CAC score (r = 0.22, P = 0.038) in the study cohort; however, a strong interaction between the nephropathy status and relationship of serum fetuin-A levels with CAC score was present (DN: r = 0.36, P = 0.006; diabetic controls, r = 0.0, P = 0.98). Among individuals with DN, the significance of the association persisted even after controlling the data for other predictors of CAC (partial r = 0.33, P = 0.018). Furthermore, there was a significant direct relationship between serum fetuin-A and serum triglycerides (partial r = 0.27, P = 0.01) and albumin (partial r = 0.30, P = 0.005), and an inverse relationship with glomerular filtration rate (r = -0.24, P = 0.03).Conclusion. This first study in early stages of diabetic chronic kidney disease shows that the role of serum fetuin-A may be far more complex than previously described. During predialysis stage of DN, there is a direct relationship between serum fetuin-A levels and CAC score. The reasons for this association in the presence of nephropathy are unclear, but may be secondary to proatherogenic insulin resistance.