Plasma prekallikrein - A risk marker for hypertension and nephropathy in type 1 diabetes
Plasma prekallikrein - A risk marker for hypertension and nephropathy in type 1 diabetes
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DOI：
10.2337/diabetes.52.5.1215
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发表时间：
2003-05-01
期刊：
影响因子：
7.7
通讯作者：
Schmaier, AH
中科院分区：
文献类型：
--
作者：
Jaffa, AA;Durazo-Arvizu, R;Schmaier, AH
血浆激肽释放酶/激肽系统作为血管发生的危险因素的相关性和意义。在一项横断面研究中探讨了糖尿病患者的并发症。我们测量了来自糖尿病控制和并发症试验/流行病学和糖尿病干预和并发症研究队列的636例I型糖尿病患者血浆中血浆前激肽释放酶（PK）活性、因子XII和高分子量激肽原的循环水平。结果表明，与血压< 140/90的I型糖尿病患者相比，血压大于或等于140/90 mmHg的I型糖尿病患者的PK水平升高（1.53 +/- 0.07 vs. 1.27 +/- 0.02单位/ml; P < 0.0001）。回归分析还确定血浆PK水平与作为连续变量的舒张压（DBP）和收缩压（SBP）呈显著正相关（r分别为0.17和0.18; P < 0.0001）。多因素回归分析显示，PK的半偏r（2）值SBP为2.93%，DBP为2.92%（P < 0.0001）。血浆PK水平与尿白蛋白排泄率（AER）呈正相关（r = 0.16，P < 0.0001）。在分类分析中，大量白蛋白尿患者的血浆PK水平显著高于正常白蛋白尿患者（1.45 +/- 0.08 vs. 1.27 +/- 0.02单位/ml; P < 0.01），而微量白蛋白尿患者的PK值居中（1.38 +/- 0.05单位/ml; P = NS）。在微量白蛋白尿亚组中，我们观察到PK与AER在单因素和多因素回归分析中呈正相关和独立相关（r = 0.27，P < 0.03; n = 63）。我们得出结论，在1型糖尿病中，1）PK水平升高与血压升高相关; 2）PK水平与AER独立相关，并且在大量白蛋白尿患者中明显升高;和3）尽管在微量白蛋白尿患者亚组中PK和AER之间的正相关性表明PK可能是进行性肾病的标志物，要解决这一问题，需要进行纵向研究。
The relevance and significance of the plasma kallikrein/ kinin system as a risk factor for the development of vascular. complications in diabetic patients was explored in a cross-sectional study. We measured the circulating levels of plasma prekallikrein (PK) activity, factor XII, and high-molecular weight kininogen in the plasma of 636 type I diabetic patients from the Diabetes Control and Complications Trial/Epidemiology and Diabetes Intervention and Complications Study cohort. The findings demonstrated that type 1 diabetic patients with blood pressure greater than or equal to140/90 mmHg have increased PK levels compared with type I diabetic patients with blood pressure < 140/90 (1.53 +/- 0.07 vs. 1.27 +/- 0.02 units/ml; P < 0.0001). Regression analysis also determined that plasma PK levels positively and significantly correlated with diastolic (DBP) and systolic blood pressures (SBP) as continuous variables (r = 0.17 and 0.18, respectively; P < 0.0001). In multivariate regression analysis, the semipartial r(2) value for PK was 2.93% for SBP and 2.92% for DBP (P < 0.0001). A positive correlation between plasma PK levels and the urinary albumin excretion rate (AER) was also observed (r = 0.16, P < 0.0001). In categorical analysis, patients with macroalbuminuria had a significantly higher level of plasma PK than normoalbuminuric patients (1.45 +/- 0.08 vs. 1.27 +/- 0.02 units/ml; P < 0.01), whereas microalbuminuric patients had an intermediate PK value (1.38 +/- 0.05 units/ml; P = NS). Among patients in the microalbuminuric subgroup, we observed a positive and independent correlation between PK and AER in univariate and multivariate regression analysis (r = 0.27, P < 0.03; n = 63). We concluded that in type 1 diabetes, 1) PK levels are elevated in association with increased blood pressure; 2) PK levels are independently correlated with AER and are categorically elevated in patients with macroalbuminuria; and 3) although the positive correlation between PK and AER within the subgroups of patients with microalbuminuria suggest that PK could be a marker for progressive nephropathy, longitudinal studies will be necessary to address this issue.