Elevation of circulating TNF receptors 1 and 2 increases the risk of end-stage renal disease in American Indians with type 2 diabetes.
Elevation of circulating TNF receptors 1 and 2 increases the risk of end-stage renal disease in American Indians with type 2 diabetes.
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DOI：
10.1038/ki.2014.330
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发表时间：
2015-04
影响因子：
19.6
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中科院分区：
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在白种人2型糖尿病患者中，循环TNF受体1（TNFR 1）和2（TNFR 2）可预测终末期肾病（ESRD）。在这里，我们在一项对患有2型糖尿病的美国印第安人进行的纵向队列研究中检查了这种关系，测量了肾小球滤过率（mGFR，碘酞酸盐）和尿白蛋白/肌酐比值。终末期肾病定义为透析、肾移植或糖尿病肾病导致的死亡。采用Mantel-Haenszel分层法计算ESRD的性别校正发病率和发病率比。在校正基线年龄、性别、平均血压、HbA 1c、白蛋白/肌酐比值和mGFR后，根据每种TNFR分布的四分位数范围增加评估ESRD的风险比。在193名参与者中，62名发展为ESRD，25名在中位随访9.5年期间死亡。在TNFR 1（6.6，95% CI 3.3-13.3）或TNFR 2（8.8，95% CI 4.3 -18.0）的最高四分位数与最低四分位数的参与者中，ESRD的年龄-性别校正发病率比更高。在完全校正的模型中，TNFR 1和TNFR 2的ESRD风险/四分位距增加分别为1.6倍（95% CI 1.1-2.2）和1.7倍（95% CI 1.2-2.3）。因此，在考虑了包括白蛋白/肌酐比值和mGFR在内的传统危险因素后，TNFR 1或TNFR 2血清浓度升高与2型糖尿病美国印第安人ESRD风险增加相关
In Caucasians with type 2 diabetes, circulating TNF receptors 1 (TNFR1) and 2 (TNFR2) predict end-stage renal disease (ESRD). Here we examined this relationship in a longitudinal cohort study of American Indians with type 2 diabetes with measured glomerular filtration rate (mGFR, iothalamate) and urinary albumin-to-creatinine ratio. ESRD was defined as dialysis, kidney transplant, or death attributed to diabetic kidney disease. Age-gender-adjusted incidence rates and incidence rate ratios of ESRD were computed by Mantel-Haenszel stratification. The hazard ratio of ESRD was assessed per interquartile range increase in the distribution of each TNFR after adjusting for baseline age, gender, mean blood pressure, HbA1c, albumin-to-creatinine ratio, and mGFR. Among the 193 participants, 62 developed ESRD and 25 died without ESRD during a median follow-up of 9.5 years. The age-gender-adjusted incidence rate ratio of ESRD was higher among participants in the highest vs. lowest quartile for TNFR1 (6.6, 95% CI 3.3–13.3) or TNFR2 (8.8, 95% CI 4.3–18.0). In the fully adjusted model, the risk of ESRD per interquartile range increase was 1.6 times (95% CI 1.1–2.2) as high for TNFR1 and 1.7 times (95% CI 1.2–2.3) as high for TNFR2. Thus, elevated serum concentrations of TNFR1 or TNFR2 are associated with increased risk of ESRD in American Indians with type 2 diabetes after accounting for traditional risk factors including albumin-to-creatinine ratio and mGFR