Diabetes Care：低水平高密度脂蛋白胆固醇升高糖尿病肾病风险

高密度脂蛋白胆固醇（HDL-C）是糖尿病肾病发生的一个独立危险因素，但并不是2型糖尿病患者视网膜病变发生的诱发危险因子，相关研究论文发表在8月13日的Diabetes Care杂志上。

悉尼心脏研究所内外全科医学士Jamie Morton和同事们追访研究11140例参试人员，参与者患有2型糖尿病并至少有一个额外的血管危险因素。研究的目的是评估HDL-C和微血管病变（复合肾脏和视网膜的事件）之间的关联。

超过平均五年的随访研究，研究人员发现28％的患者会经历肾病事件，6％的患者会经历视网膜病变事件。相对于那些最高水平的HDL-C患者来说，最低水平的HDL-C患者中并发肾病的风险有19％（肾病同时出现视网膜微血管事件的风险足足高出了17％）。但HDL-C的水平和视网膜事件之间没有任何关联（P = 0.9）。

研究作者在论文中写道，总之，对人口众多的2型糖尿病患者来说，低水平的HDL-C被证明是糖尿病肾病的发生和发展的一个独立危险因素，因此测量此脂质馏分对于疾病的筛查和治疗可能是有用的。

编译自：Low HDL cholesterol ups risk of diabetic nephropathy

doi:10.2337/dc12-0306
PMC:
PMID:

Low HDL Cholesterol and the Risk of Diabetic Nephropathy and Retinopathy Results of the ADVANCE study

Jamie Morton, MBBS1,2, Sophia Zoungas, PHD3,4?, Qiang Li, MBIOSTAT3, Anushka A. Patel, PHD3, John Chalmers, PHD3, Mark Woodward, PHD3, David S. Celermajer, PHD1,2,5, Joline W.J. Beulens, PHD6, Ronald P. Stolk, PHD6,7, Paul Glasziou, PHD8, Martin K.C. Ng, PHD1,2,5? and on behalf of the ADVANCE Collaborative Group

OBJECTIVE Although low HDL cholesterol (HDL-C) is an established risk factor for atherosclerosis, data on HDL-C and the risk of microvascular disease are limited. We tested the association between HDL-C and microvascular disease in a cohort of patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS A total of 11,140 patients with type 2 diabetes and at least one additional vascular risk factor were followed a median of 5 years. Cox proportional hazards models were used to assess the association between baseline HDL-C and the development of new or worsening microvascular disease, defined prospectively as a composite of renal and retinal events.

RESULTS The mean baseline HDL-C level was 1.3 mmol/L (SD 0.45 mmol/L [range 0.1–4.0]). During follow-up, 32% of patients developed new or worsening microvascular disease, with 28% experiencing a renal event and 6% a retinal event. Compared with patients in the highest third, those in the lowest third had a 17% higher risk of microvascular disease (adjusted hazard ratio 1.17 [95% CI 1.06–1.28], P = 0.001) after adjustment for potential confounders and regression dilution. This was driven by a 19% higher risk of renal events (1.19 [1.08–1.32], P = 0.0005). There was no association between thirds of HDL-C and retinal events (1.01 [0.82–1.25], P = 0.9).

CONCLUSIONS In patients with type 2 diabetes, HDL-C level is an independent risk factor for the development of microvascular disease affecting the kidney but not the retina.