[ADA2015]中国研究口头报告：高胱抑素C水平可预测 足溃疡预后不良
2015年第75届美国 协会(ADA)科学年会在美国波士顿召开。上海交通大学附属第六人民医院内分泌代谢科刘芳教授团队的一项研究入选ADA2015年会口头报告(OralPresentations)。该研究发现血清胱抑素C(CysC)水平是 足溃疡预后的独立预测因素，当CysC>1.2mg/L时，提示 足溃疡不愈合风险增加2倍。
2015年第75届美国 协会(ADA)科学年会在美国波士顿召开。上海交通大学附属第六人民医院内分泌代谢科刘芳教授团队的一项研究入选ADA2015年会口头报告(OralPresentations)。该研究发现血清胱抑素C(CysC)水平是 足溃疡预后的独立预测因素，当CysC>1.2mg/L时，提示 足溃疡不愈合风险增加2倍。以下是研究摘要译文。
目的：胱抑素C(CysC)日益成为肾功能和心血管事件的一个理想指标。本研究的目的是探讨血清胱抑素C水平与 足(DF)预后之间的关系。
方法：共招募1072名2型 ，将之分为两组：非 足组(NDF，n=865，80.39%); 足组(DF，n = 207, 19.3%; 包括非溃疡 足组(NUDF，n = 60，29%)和 足溃疡组(DFU，n=147，71%)。1年后随访，根据临床预后将所有 足患者分为非治愈组(n = 45，21.7%)和治愈组(n = 162，78.3%)。对临床特点及影响溃疡愈合的因素进行对比分析。
结果：DF患者与无DF的患者相比，血清CysC水平显著较高(P <0.05)。NUDF组和DFU组非治愈患者血清CysC水平均显著高于治愈患者(P<0.01)。根据血清CysC水平对患者进行四分位分组。与四分位1组(参比组)相比，四分位4组患者DF不愈合率(OR = 10.061，95%CI 2.249-45.01，P <0.003)风险显著较高。Logistical回归分析进一步显示，CysC是DF不愈合率(β= 1.248)和DFU不愈合率的独立影响因子(β= 1.081)(P均<0.01)。校正了所有潜在混杂因素后，血清CysC仍然与DF不愈合率(OR=3.318, 95% CI: 1.605-6.857, P<0.01) 和DFU不愈合率(OR=2.841, 95% CI: 1.343-6.009)风险增加相关。CysC>1.2 mg/L提示 足预后不良。
结论： CysC与 足预后具有独立强相关，CysC>1.2mg/L提示 足溃疡不愈合的风险增加2倍。
【研究摘要】
| Abstract Number: | 141-OR |
| Title: | High Cystatin C Levels Predict Undesirable Outcome for Diabetic Foot Ulcerations |
| Authors: | LIGEN A, FANG LIU, RUI HE, JUNXI LU, JUNLING TANG, HUIJUAN LU, TAISHAN ZHANG, Shanghai, China |
| Abstract: | Objective: Cystatin C (CysC) is growing to be an ideal indicator for renal function and cardiovascular events. The aim of this study was to investigate the relationship between serum Cystatin C levels and the prognosis of diabetic foot (DF). Methods: In total, 1072 patients with type 2 diabetes were recruited and divided into two groups: non-diabetic-foot group (NDF, n=865, 80.39%); diabetic foot group (DF, n=207,19.3%; consist of non-ulcer diabetic foot group (NUDF, n=60, 29%) and diabetic foot ulcer group (DFU, n=147, 71%). After 1 year follow-up, all of the diabetic foot patients were grouped into non-healing group (n=45, 21.7%) and healing group (n=162, 78.3%), according to the clinical prognosis. Clinical characteristics and the impact factors of ulcer healing were compared and analyzed. Results: Serum CysC levels were significantly higher in patients complicated with DF than that without DF (P<0.05). Compared to the cured group, non-healing group had significantly higher serum Cys C concentrations in both NUDF group and DFU group (P<0.01). The patients were divided into quartiles according to serum CysC levels. Compared with quartile 1 (referent), the risk of DF non-healing rate (OR=10.061, 95% CI: 2.249-45.01, P<0.003) was significantly higher in quartile 4. Logistical regression analysis further revealed that CysC was an independent impact factor for DF non-healing rate (β=1.248) and DFU non-healing rate (β=1.081) (both P<0.01). After adjusting for all potential confounders, CysC was still associated with increased risk of DF non-healing rate (OR=3.318, 95% CI: 1.605-6.857, P<0.01) and DFU non-healing rate (OR=2.841, 95% CI: 1.343-6.009, P1.2 mg/L suggested the poor prognosis of foot disease. Conclusions: There is a strong and independent association between CysC and diabetic foot prognosis, and CysC >1.2 mg/L hints 2-fold increased risk of incurable ulceration for DF. |
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