血清高敏C反应蛋白（hs-CRP）和胰岛素抵抗与2型糖尿病早期肾功能损害的关系
Associations of Serum High-Sensitivity C-Reactive Protein (hs-CRP) And Insulin Resistance With Early Renal Impairment In Type 2 Diabetes.
摘要(中文译文)
2型糖尿病早期糖尿病肾病以尿白蛋白排泄增加为特征，而估算肾小球滤过率（eGFR）尚保持正常。此阶段全身性炎症和胰岛素抵抗的作用仍未完全明确。本研究评估了高敏C反应蛋白（hs-CRP）和胰岛素抵抗（HOMA-IR）与早期肾损伤的关联。在这项单中心回顾性横断面研究中，纳入126例eGFR≥60 mL/min/1.73 m的2型糖尿病患者；未使用外源性胰岛素的患者构成亚组（n=97）。主要结局为自然对数转换的尿白蛋白与肌酐比值（ln-UACR）。采用Spearman相关分析和多变量线性回归评估关联，并校正年龄、性别、糖尿病病程、收缩压和糖化血红蛋白（HbA1c）。研究还考察了剂量-反应关系、联合暴露效应、替代结局指标和敏感性分析。统计分析使用R软件（版本4.3.2）进行。在总体样本中，ln-UACR与hs-CRP呈正相关（ρ=0.28，p=0.001）；在亚组中，ln-UACR与HOMA-IR呈正相关（ρ=0.26，p=0.009）。校正后，hs-CRP在总体样本（βstd=0.23）和亚组（βstd=0.22）中仍与ln-UACR相关，HOMA-IR在亚组中仍相关（βstd=0.17，p=0.018）。ln-UACR随两种暴露指标的三分位数升高而增加（趋势p<0.01）。高hs-CRP/高HOMA-IR组与低/低组相比，ln-UACR更高（平均差0.64，95% CI 0.37-0.88），交互作用无统计学意义（p=0.173）。各替代结局指标和敏感性分析结果一致。在eGFR保持正常的2型糖尿病患者中，hs-CRP和HOMA-IR与早期肾损伤标志物独立相关。这些发现提示其可能有助于早期风险分层，但仍需前瞻性研究证实其临床实用性。
Abstract
Early diabetic kidney disease in type 2 diabetes is characterized by increased urinary albumin excretion despite preserved estimated glomerular filtration rate (eGFR). The roles of systemic inflammation and insulin resistance at this stage remain incompletely defined. This study evaluated the associations of high-sensitivity C-reactive protein (hs-CRP) and insulin resistance (HOMA-IR) with early renal impairment. In this single-center retrospective cross-sectional study, 126 patients with type 2 diabetes and eGFR ≥60 mL/min/1.73 m were included; patients not using exogenous insulin formed a subgroup (n=97). The primary outcome was natural log-transformed urine albumin-to-creatinine ratio (ln-UACR). Associations were assessed using Spearman correlation and multivariable linear regression adjusted for age, sex, diabetes duration, systolic blood pressure, and glycated hemoglobin (HbA1c). Dose-response relationships, joint exposure effects, surrogate outcomes, and sensitivity analyses were also examined. Statistical analyses were performed using R (version 4.3.2). ln-UACR was positively correlated with hs-CRP in the overall sample (ρ=0.28, p=0.001) and with HOMA-IR in the subgroup (ρ=0.26, p=0.009). After adjustment, hs-CRP remained associated with ln-UACR in both the overall sample (βstd=0.23) and subgroup (βstd=0.22), and HOMA-IR remained associated in the subgroup (βstd=0.17, p=0.018). ln-UACR increased across tertiles of both exposures (p for trend <0.01). The high hs-CRP/high HOMA-IR group showed higher ln-UACR compared with the low/low group (mean difference 0.64, 95% CI 0.37-0.88), without significant interaction (p=0.173). Associations were consistent across surrogate outcomes and sensitivity analyses. In patients with type 2 diabetes and preserved eGFR, hs-CRP and HOMA-IR were independently associated with markers of early renal impairment. These findings suggest potential relevance for early risk characterization, although prospective studies are required to confirm clinical utility.
如何引用
AMA
Guo Xiaowen, Wei Wei, Xiao Yahe, Zhang Rui. Associations of Serum High-Sensitivity C-Reactive Protein (hs-CRP) And Insulin Resistance With Early Renal Impairment In Type 2 Diabetes.. Journal of visualized experiments : JoVE. 2026; doi:10.3791/70993.
APA
Guo Xiaowen, Wei Wei, Xiao Yahe, Zhang Rui (2026). Associations of Serum High-Sensitivity C-Reactive Protein (hs-CRP) And Insulin Resistance With Early Renal Impairment In Type 2 Diabetes.. Journal of visualized experiments : JoVE. https://doi.org/10.3791/70993
GB/T 7714
Guo Xiaowen, Wei Wei, Xiao Yahe, Zhang Rui. Associations of Serum High-Sensitivity C-Reactive Protein (hs-CRP) And Insulin Resistance With Early Renal Impairment In Type 2 Diabetes.[J]. Journal of visualized experiments : JoVE, 2026 doi:10.3791/70993.
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