Interactive effect of retinopathy and macroalbuminuria on all-cause mortality, cardiovascular and renal end points in Chinese patients with Type 2 diabetes mellitus
Interactive effect of retinopathy and macroalbuminuria on all-cause mortality, cardiovascular and renal end points in Chinese patients with Type 2 diabetes mellitus
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DOI：
10.1111/j.1464-5491.2007.02145.x
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发表时间：
2007-07-01
影响因子：
3.5
通讯作者：
Cockram, C. S.
中科院分区：
文献类型：
--
作者：
Tong, P. C. Y.;Kong, A. P.;Cockram, C. S.
目的研究蛋白尿和视网膜病变对2型糖尿病患者心血管和肾脏事件风险以及全因死亡率的影响。方法对4416例基线无大血管并发症的中国患者（年龄57.6 ± 13.3岁）进行事后分析。肾小球滤过率（eGFR）通过简化的肾脏疾病饮食改良研究组公式估计，并根据中国种族进一步校正。临床终点为全因死亡率、心血管事件（心力衰竭或心绞痛、心肌梗死、下肢截肢、血运重建术和卒中）和肾脏终点（eGFR降低超过50%或eGFR < 15 ml/min/1.73 m（2）或由于肾脏原因或需要透析而死亡）。有视网膜病变和大量白蛋白尿的受试者有更高的心血管事件（14.1 vs. 2.4%）、肾脏事件（40.0 vs. 0.8%）和死亡（9.3 vs. 1.7%，P < 0.001）发生率。对于死亡、心血管和肾脏事件的复合事件，视网膜病变、单独微量白蛋白尿、单独大量白蛋白尿、视网膜病变伴微量白蛋白尿或视网膜病变伴大量白蛋白尿使风险[风险比（95% CI）]增加1.61（1.05 - 2.47; P = 0.04），1.93（1.38 ~ 2.69; P < 0.001）、4.34（3.02 ~ 6.22; P < 0.001）、2.59（1.76 ~ 3.81; P < 0.001）和6.83（4.89 ~ 9.55; P < 0.001）倍。视网膜病变和大量白蛋白尿之间的相互作用的结果的相对超额风险为15.31，这意味着生物学的相互作用，在发展中的肾脏events.Conclusions在中国2型糖尿病患者，视网膜病变与大量白蛋白尿相互作用，增加复合心肾事件的风险。
Aims To examine the effect of albuminuria and retinopathy on the risk of cardiovascular and renal events, and all-cause mortality in patients with Type 2 diabetes.Methods A post-hoc analysis of 4416 Chinese patients without macrovascular complications at baseline (age 57.6 +/- 13.3 years). Glomerular filtration rate (eGFR) was estimated by the abbreviated Modification of Diet in Renal Disease Study Group Formula, further adjusted for Chinese ethnicity. Clinical end points were all-cause mortality, cardiovascular events (heart failure or angina, myocardial infarction, lower limb amputation, re-vascularization procedures and stroke) and renal end points (reduction in eGFR by more than 50% or eGFR < 15 ml/min/1.73 m(2) or death as a result of renal causes or need for dialysis).Results Compared with individuals without complications, subjects with retinopathy and macroalbuminuria had higher rates of cardiovascular events (14.1 vs. 2.4%), renal events (40.0 vs. 0.8%) and death (9.3 vs. 1.7%, P < 0.001). For composite event of death, cardiovascular and renal events, the presence of retinopathy, microalbuminuria alone, macroalbuminuria alone, retinopathy with microalbuminuria or retinopathy with macroalbuminuria increased the risk [hazard ratio (95% CI)] by 1.61 (1.05 to 2.47; P = 0.04), 1.93 (1.38 to 2.69; P < 0.001), 4.34 (3.02 to 6.22; P < 0.001), 2.59 [1.76 to 3.81; P < 0.001) and 6.83 (4.89 to 9.55; P < 0.001) fold, respectively. The relative excess risk as a result of interaction between retinopathy and macroalbuminuria was 15.31, implying biological interaction in the development of renal events.Conclusions In Chinese patients with Type 2 diabetes, retinopathy interacts with macroalbuminuria to increase the risk of composite cardio-renal events.