Diabetes Care:C肽水平与全因及心血管死亡独立相关

2012-12-12 Diabetes Care Diabetes Care

C肽全因死亡心血管死亡冠脉造影

　　德国学者的一项研究表明，在接受冠脉造影的患者中，C肽水平与全因和心血管死亡率以及冠脉疾病严重度呈独立相关。论文于2012年11月30日在线发表于《糖尿病护理》（Diabetes Care）杂志。 　　C肽为胰腺释放的胰岛素原裂解产物。在胰岛素抵抗和早期糖尿病患者中C肽水平升高，并且C肽可能在血管疾病的病理生理学过程中发挥因果作用。此项研究共纳入2306例基线接受冠脉造影的患者，并对

　　德国学者的一项研究表明，在接受冠脉造影的患者中，C肽水平与全因和心血管死亡率以及冠脉疾病严重度呈独立相关。论文于2012年11月30日在线发表于《糖尿病护理》（Diabetes Care）杂志。

　　C肽为胰腺释放的胰岛素原裂解产物。在胰岛素抵抗和早期糖尿病患者中C肽水平升高，并且C肽可能在血管疾病的病理生理学过程中发挥因果作用。此项研究共纳入2306例基线接受冠脉造影的患者，并对C肽与心血管性死亡和总体死亡的相关性进行了评估。

　　结果显示，在平均随访7.6年间共出现440例死亡，其中252例（10.9%）为心血管性死亡。C肽水平处于最高和最低三分位患者相比得出的全因死亡年龄和性别校正危险比（HR）为1.46，心血管死亡HR为1.58。对常见危险因素和糖代谢标志物进一步校正后，上述HR分别为1.46（P=0.008）和1.55（P=0.022）。此外，在C肽水平处于较高三分位的患者中内皮功能障碍和动脉粥样硬化标志物水平较高，并且冠脉病变程度更为严重。



OBJECTIVE 
C-peptide is a proinsulin cleavage product released from the pancreas in amounts equimolar to insulin, and elevated levels of C-peptide have been found in patients with insulin resistance and early type 2 diabetes mellitus. Recent data suggest that C-peptide could play a causal role in the pathophysiology of vascular disease, but nothing is known about the prognostic value of C-peptide concentrations in the circulation.
RESEARCH DESIGN AND METHODS 
We examined whether C-peptide is associated with cardiovascular and total mortality in 2,306 patients from the Ludwigshafen Risk and Cardiovascular Health Study who underwent coronary angiography at baseline (1997–2000).
RESULTS 
During a mean follow-up of 7.6 years, 440 deaths (19.1%) occurred, 252 (10.9%) of which were due to cardiovascular causes. Age- and sex-adjusted hazard ratios (HRs) in the third compared with the first tertile of C-peptide were 1.46 (95% CI 1.15–1.85; P = 0.002) for all cause and 1.58 (1.15–2.18; P = 0.005) for cardiovascular mortality. After further adjustment for common risk factors as well as markers of glucose metabolism, these HRs remained significant at 1.46 (1.10–1.93; P = 0.008) and 1.55 (1.07–2.24; P = 0.022), respectively. Moreover, patients in higher tertiles of C-peptide exhibited higher levels of markers of endothelial dysfunction and atherosclerosis as well as a more severe extent of coronary lesions.
CONCLUSIONS 
In patients undergoing coronary angiography, C-peptide levels are independently associated with all cause and cardiovascular mortality as well as presence and severity of coronary artery disease. Further studies are needed to examine a potential causal role of C-peptide in atherogenesis in humans.
    



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