| Summary: | 碩士 === 國立臺灣大學 === 臨床醫學研究所 === 99 === Background Various micro- and macro-vascular diabetic complications cause major impacts on patients with diabetes. Plasma YKL-40 concentration had been found to correlate with severity of albuminuria in type 1 and type 2 diabetic patients. In this study, we evaluated the association among plasma concentration of YKL-40, PAOD, proteinuria and mortality in type 2 diabetic patients.
Methods The study cohort consisted of 232 male and 241 female type 2 diabetic patients who participated in previous study of functional genomic and proteomics in metabolic disorders from July, 1996 to June, 2003. The mean age was 61.71 9.67 years old Presence of proteinuria was determined by semi-quantitative Multistix test. Presence of peripheral arterial occlusive disease (PAOD) was determined by Ankle-brachial index (ABI). The plasma YKL-40 level was measured by a commercial ELISA assay with samples stored at -80℃. The cohort was followed subsequently till December 31st, 2008 with the vital status recorded. The participants were divided into 4 subgroups according to plasma YKL-40 quartile (Q1: 11.29-52.92 ng/dl; Q2: 53.40-87.02 ng/dl; Q3: 87.20-150.71 ng/dl, and Q4: 151.69-417.35 ng/dl).
Results The prevalence of proteinuria in Q1 to Q4 were 10.62%, 16.24%, 16.38% and 32.48%, respectively (p<0.01). After adjusting possible confounding variables, the odds ratio of proteinuria for Q4 group was 2.63 (95% CI: 1.10-6.28, p<0.05) compared with Q1 group. The mortality rate of quartile groups were 12.61%, 13.56%, 29.66% and 40.68%, respectively (p<0.01). After adjusting possible confounding variables, the hazard ratio (HR) of all-cause mortality in Q4 group was 2.03 fold (95% CI: 1.07-3.84, p<0.05) higher compared with Q1 group. In subgroup analysis without history of previous admission due to cardiovascular diseases (CVDs), the HR for CVD-specific mortality in those YKL-40 above median (86.49 ng/dl) was 3.45 fold (95% CI 1.28-9.30, p<0.05) higher compared with those YKL-40 below median.
Conclusion In our study, we demonstrated that elevation of plasma YKL-40 level in type 2 diabetic patients was correlated with increased risk of proteinuria, all-cause and CVD-specific mortality. Further study should focus on the pathological role of YKL-40 in diabetic endothelial dysfunction.
|
|---|
