Association of urinary transferrin with new-onset cardiovascular disease in type 2 diabetes mellitus

doi:10.3969/j.issn.1004-583X.2024.08.004

Abstract

Abstract:

Objective To explore the correlation between urinary transferrin to urinary creatinine ratio (uTRF/Cr) and new onset cardiovascular disease (CVD) in type 2 diabetes mellitus (T2DM). Methods A total of 8 163 T2DM patients who participated in the 6th health examination in Kailuan and underwent urinary transferrin and urinary creatinine detection were recruited. Subjects were divided into the first group (n=2 721), the second group (n=2 721), and the third group (n=2 721) based on baseline uTRF/Cr. The effects of uTRF/Cr on the risk of CVD were analyzed by multivariate Cox regression model. Results The baseline age of the study population was (60.46±9.96) years, with 78.30% of males, and 0.24(0.16-0.47) mg/mmol of baseline uTRF/Cr. The median follow-up time was 3.85(3.43-4.22) years, with 411(6.79%) of CVD events occurred. The cumulative incidence of total CVD events in the first, second and third groups was 3.81%, 4.65%, and 7.29%, respectively. After adjusting for relevant influencing factors, the risk of total CVD events in the second and third groups of uTRF/Cr was 1.12(95%CI 0.86-1.46) times and 1.52(95%CI 1.18-1.97) times that in the first group, respectively. Conclusion Increased uTRF/Cr is an independent risk factor for CVD in T2DM populations, and the risk of CVD increases with increased uTRF/Cr, even before the onset of macroalbuminuria.

Key words: diabetes mellitus, type 2, cardiovascular diseases, transferrin to urinary creatinine ratio, proteinuria

CLC Number:

R587.1
R54

Ma Jiannan, Tao Jie, Sang Dasen, Wu Shouling, Zhang Qi. Association of urinary transferrin with new-onset cardiovascular disease in type 2 diabetes mellitus[J]. Clinical Focus, 2024, 39(8): 700-705.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2024.08.004

https://huicui.hebmu.edu.cn/EN/Y2024/V39/I8/700

Figures/Tables 6

Tab.1 Baseline data among the three groups

组别		例数	年龄(岁)		男性 [例(%)]		收缩压 (mmHg)			舒张压 (mmHg)			心率 (次/min)		BMI (kg/m²)
总人群		8 163	60.46±9.96		6 392(78.30)		146.08±20.60			82.92±10.91			77.47± 12.82		25.80±3.47
第一分位组		2 721	58.77±9.93		2 326(85.48)		141.77±19.34			82.07±10.48			58.77±9.93		25.73±3.34
第二分位组		2 721	60.68±9.66		2 063(75.78)		145.42±20.22			82.43±10.57			76.83±12.48		25.64±3.38
第三分位组		2 721	61.92±10.03		2 003(73.65)		151.03±21.15			84.26±11.52			79.06±13.14		26.04±3.66
$F$ / $H$ /χ²值			24.650		24.660		34.987			14.435			49.789		13.897
$P$ 值			<0.001		<0.001		<0.001			<0.001			<0.001		<0.001
组别	uACR (mg/mmol)			uTRF/Cr (mg/mmol)				FBG (mmol/L)		HbA₁c (%)		TG (mmol/L)				LDL-C (mmol/L)
总人群	1.67(0.81~4.50)			0.24(0.16~0.47)				9.11±3.17		7.59±1.66		1.54(1.05~2.34)				3.25±0.96
第一分位组	0.98(0.65~1.54)			0.13(0.11~0.16)				8.38±2.60		7.20±1.44		1.44(1.01~2.16)				3.22±0.94
第二分位组	1.50(0.79~2.71)			0.24(0.21~0.29)				8.82±2.93		7.47±1.59		1.49(1.01~2.28)				3.22±0.93
第三分位组	7.46(3.10~20.00)			0.70(0.47~1.48)				10.12±3.67		8.11±1.81		1.70(1.15~2.63)				3.32±1.01
$F$ / $H$ /χ²值	87.580			33.890				25.340		37.990		1.479				39.380
$P$ 值	<0.001			<0.001				<0.001		<0.001		0.207				<0.001
组别	eGFR [ml/(min·1.73 m²)]					吸烟 [例(%)]			高血压 [例(%)]		降压治疗 [例(%)]			降糖治疗 [例(%)]
总人群	92.20±16.34					2 707(33.16)			4 647(56.93)		3 361(41.17)			3 590(43.98)
第一分位组	93.28±16.62					1 042(38.29)			1 371(50.39)		1 073(39.43)			1 033(37.96)
第二分位组	92.56±14.43					872(32.05)			1 509(55.46)		1 068(39.25)			1 166(42.85)
第三分位组	90.74±17.69					793(29.14)			1 767(64.94)		1 220(44.84)			1 391(51.12)
$F$ / $H$ /χ²值	7.890					20.776			28.980		14.768			29.987
$P$ 值	<0.001					<0.001			<0.001		<0.001			<0.001

Tab.1 Baseline data among the three groups

组别		例数	年龄(岁)		男性 [例(%)]		收缩压 (mmHg)			舒张压 (mmHg)			心率 (次/min)		BMI (kg/m²)
总人群		8 163	60.46±9.96		6 392(78.30)		146.08±20.60			82.92±10.91			77.47± 12.82		25.80±3.47
第一分位组		2 721	58.77±9.93		2 326(85.48)		141.77±19.34			82.07±10.48			58.77±9.93		25.73±3.34
第二分位组		2 721	60.68±9.66		2 063(75.78)		145.42±20.22			82.43±10.57			76.83±12.48		25.64±3.38
第三分位组		2 721	61.92±10.03		2 003(73.65)		151.03±21.15			84.26±11.52			79.06±13.14		26.04±3.66
$F$ / $H$ /χ²值			24.650		24.660		34.987			14.435			49.789		13.897
$P$ 值			<0.001		<0.001		<0.001			<0.001			<0.001		<0.001
组别	uACR (mg/mmol)			uTRF/Cr (mg/mmol)				FBG (mmol/L)		HbA₁c (%)		TG (mmol/L)				LDL-C (mmol/L)
总人群	1.67(0.81~4.50)			0.24(0.16~0.47)				9.11±3.17		7.59±1.66		1.54(1.05~2.34)				3.25±0.96
第一分位组	0.98(0.65~1.54)			0.13(0.11~0.16)				8.38±2.60		7.20±1.44		1.44(1.01~2.16)				3.22±0.94
第二分位组	1.50(0.79~2.71)			0.24(0.21~0.29)				8.82±2.93		7.47±1.59		1.49(1.01~2.28)				3.22±0.93
第三分位组	7.46(3.10~20.00)			0.70(0.47~1.48)				10.12±3.67		8.11±1.81		1.70(1.15~2.63)				3.32±1.01
$F$ / $H$ /χ²值	87.580			33.890				25.340		37.990		1.479				39.380
$P$ 值	<0.001			<0.001				<0.001		<0.001		0.207				<0.001
组别	eGFR [ml/(min·1.73 m²)]					吸烟 [例(%)]			高血压 [例(%)]		降压治疗 [例(%)]			降糖治疗 [例(%)]
总人群	92.20±16.34					2 707(33.16)			4 647(56.93)		3 361(41.17)			3 590(43.98)
第一分位组	93.28±16.62					1 042(38.29)			1 371(50.39)		1 073(39.43)			1 033(37.96)
第二分位组	92.56±14.43					872(32.05)			1 509(55.46)		1 068(39.25)			1 166(42.85)
第三分位组	90.74±17.69					793(29.14)			1 767(64.94)		1 220(44.84)			1 391(51.12)
$F$ / $H$ /χ²值	7.890					20.776			28.980		14.768			29.987
$P$ 值	<0.001					<0.001			<0.001		<0.001			<0.001

Fig.1 Cumulative incidence rate of CVD events in the three groups

Tab.2 Multivariate COX regression model for uTRF/Cr and newly occurred CVD

变量	回归系数	标准误	Wald χ²值	$H R$ 值	95% $C I$	$P$ 值
分组
第一分位组	-	-	-	1	-	-
第二分位组	0.112	0.137	0.673	1.12	0.86~1.46	0.412
第三分位组	0.418	0.131	10.250	1.52	1.18~1.97	0.001
年龄	0.030	0.007	20.356	1.03	1.02~1.04	<0.001
性别(男)	0.125	0.138	0.815	1.13	0.86~1.49	0.367
收缩压	0.011	0.002	19.904	1.01	1.01~1.02	<0.001
BMI	-0.013	0.015	0.775	0.99	0.96~1.02	0.379
LDL-C	0.023	0.052	0.192	1.02	0.92~1.13	0.661
FBG	0.061	0.014	18.959	1.06	1.03~1.09	<0.001
eGFR	0.001	0.004	0.165	1.00	0.99~1.01	0.685
吸烟	0.283	0.113	6.291	1.33	1.06~1.66	0.012
使用降压药	0.354	0.100	12.470	1.42	1.17~1.73	<0.001
使用降糖药	0.029	0.103	0.078	1.03	0.84~1.26	0.779

Tab.2 Multivariate COX regression model for uTRF/Cr and newly occurred CVD

变量	回归系数	标准误	Wald χ²值	$H R$ 值	95% $C I$	$P$ 值
分组
第一分位组	-	-	-	1	-	-
第二分位组	0.112	0.137	0.673	1.12	0.86~1.46	0.412
第三分位组	0.418	0.131	10.250	1.52	1.18~1.97	0.001
年龄	0.030	0.007	20.356	1.03	1.02~1.04	<0.001
性别(男)	0.125	0.138	0.815	1.13	0.86~1.49	0.367
收缩压	0.011	0.002	19.904	1.01	1.01~1.02	<0.001
BMI	-0.013	0.015	0.775	0.99	0.96~1.02	0.379
LDL-C	0.023	0.052	0.192	1.02	0.92~1.13	0.661
FBG	0.061	0.014	18.959	1.06	1.03~1.09	<0.001
eGFR	0.001	0.004	0.165	1.00	0.99~1.01	0.685
吸烟	0.283	0.113	6.291	1.33	1.06~1.66	0.012
使用降压药	0.354	0.100	12.470	1.42	1.17~1.73	<0.001
使用降糖药	0.029	0.103	0.078	1.03	0.84~1.26	0.779

Fig.2 Correlation between uTRF/Cr and newly occurred CVD

Fig.3 Subgroup analysis of the correlation between uTRF/Cr and newly occurred CVD

Tab.3 Multivariate Cox regression model for the correlation between uTRF/Cr and newly occurred CVD after adjusting for relevant factors and excluding a large population of albuminuria

变量	回归系数	标准误	Wald χ²值	$H R$ 值	95% $C I$	$P$ 值
分组
第一分位组	-	-	-	1	-	-
第二分位组	0.033	0.142	0.053	1.03	0.78~1.37	0.818
第三分位组	0.294	0.137	4.643	1.34	1.03~1.76	0.031
年龄	0.029	0.007	15.946	1.03	1.02~1.04	<0.001
性别(男)	0.109	0.150	0.525	1.12	0.83~1.50	0.367
收缩压	0.010	0.003	13.539	1.01	1.01~1.02	<0.001
BMI	-0.020	0.016	1.422	0.98	0.95~1.01	0.223
LDL-C	0.013	0.057	0.054	1.01	0.91~1.13	0.817
FBG	0.056	0.016	12.592	1.06	1.03~1.09	<0.001
eGFR	0.002	0.004	0.323	1.00	0.99~1.01	0.570
吸烟	0.317	0.120	6.926	1.37	1.08~1.740	0.009
使用降压药	0.309	0.108	8.231	1.36	1.10~1.68	0.004
使用降糖药	0.081	0.111	0.530	1.08	0.87~1.35	0.467

Tab.3 Multivariate Cox regression model for the correlation between uTRF/Cr and newly occurred CVD after adjusting for relevant factors and excluding a large population of albuminuria

变量	回归系数	标准误	Wald χ²值	$H R$ 值	95% $C I$	$P$ 值
分组
第一分位组	-	-	-	1	-	-
第二分位组	0.033	0.142	0.053	1.03	0.78~1.37	0.818
第三分位组	0.294	0.137	4.643	1.34	1.03~1.76	0.031
年龄	0.029	0.007	15.946	1.03	1.02~1.04	<0.001
性别(男)	0.109	0.150	0.525	1.12	0.83~1.50	0.367
收缩压	0.010	0.003	13.539	1.01	1.01~1.02	<0.001
BMI	-0.020	0.016	1.422	0.98	0.95~1.01	0.223
LDL-C	0.013	0.057	0.054	1.01	0.91~1.13	0.817
FBG	0.056	0.016	12.592	1.06	1.03~1.09	<0.001
eGFR	0.002	0.004	0.323	1.00	0.99~1.01	0.570
吸烟	0.317	0.120	6.926	1.37	1.08~1.740	0.009
使用降压药	0.309	0.108	8.231	1.36	1.10~1.68	0.004
使用降糖药	0.081	0.111	0.530	1.08	0.87~1.35	0.467

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