Association of C-reactive protein with reduced forced vital capacity in a nonsmoking U.S. population with metabolic syndrome and diabetes

OBJECTIVE—A relationship between inflammation, measured by C-reactive protein (CRP), and forced vital capacity (FVC) in diabetes or metabolic syndrome (MetS) has not been established. We investigated whether high CRP is related to reduced FVC in MetS and diabetes.RESEARCH DESIGN AND METHODS—We examined the association of MetS/diabetes and CRP (normal ≤3 mg/l, high >3 mg/l) with predicted FVC in 4,272 nonsmoking U.S. adults aged 18–79 years without lung disease in the Third National Health and Nutrition Examination Survey. Logistic regression examined odds of FVC <80% by CRP and MetS/diabetes.RESULTS—Mean FVC in individuals with MetS and high CRP (95.7%) and those with diabetes and high CRP (93.7%) was lower than in those with no MetS/diabetes and normal CRP (101.7%) (P < 0.01) and was lower in those with MetS and high CRP (95.7%) than in those with MetS and normal CRP (98.5%) (P < 0.01). The odds ratio (95% CI) of FVC <80% was highest in individuals with MetS and high CRP (odds ratio 4.26 [95% CI 2.08–8.73], P < 0.01) compared with those with no MetS/diabetes and normal CRP.CONCLUSIONS—Elevated CRP is associated with lower FVC in people with MetS.Cross-sectional (1,2) and prospective (3) studies have demonstrated impaired lung function in individuals with diabetes and metabolic syndrome (MetS). Recent studies show that reduced lung function may be a precursor of diabetes (4). People with reduced lung function have greater levels of inflammation (5), and people with diabetes or MetS (6,7), including those with elevated C-reactive protein (CRP) (8), are at increased risk of cardiovascular disease. Although the interplay among MetS, diabetes, and insulin resistance has been thoroughly investigated and extensively published, their role in systemic inflammation and lung function impairment has not been firmly established. We examined whether increased levels of CRP may help identify lung function impairment in individuals with MetS/diabetes.     

The metabolic syndrome and concentrations of C-reactive protein among U.S. youth

OBJECTIVE: Adults with the metabolic syndrome show biochemical evidence of low-grade inflammation. We sought to examine whether this is true among U.S. youth with the metabolic syndrome. RESEARCH DESIGN AND METHODS: We used data from 1,366 participants aged 12-17 years from the National Health and Nutrition Examination Survey 1999-2000. A modification of the definition of the metabolic syndrome proposed by the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults was used. C-reactive protein (CRP) was measured by latex-enhanced nephelometry. RESULTS: Mean and median concentrations of CRP were higher among participants who had the metabolic syndrome (mean 3.8 mg/l, geometric mean 1.8 mg/l) than among those who did not (mean 1.4 mg/l, geometric mean 0.4 mg/l). The percentage of participants with a concentration of CRP >3.0 mg/l was 38.4% among those with the metabolic syndrome and 10.3% among those without the syndrome (P = 0.007). Of the five components of the syndrome, only abdominal obesity was significantly and independently associated with log-transformed concentrations of CRP in multiple linear regression analysis. CONCLUSIONS: Our results show that a large percentage of children and adolescents with the metabolic syndrome have elevated concentrations of CRP. Whether the elevated concentrations of CRP among children and adolescents who have the metabolic syndrome predict future adverse health events remains to be determined.     

Magnesium intake, C-reactive protein, and the prevalence of metabolic syndrome in middle-aged and older U.S. women

OBJECTIVE: The aim of this study was to examine whether and to what extent magnesium intake is related to systemic inflammation and the metabolic syndrome. RESEARCH DESIGN AND METHODS: We performed a cross-sectional analysis on data from 11,686 women > or =45 years of age participating in the Women's Health Study who were initially free of cardiovascular disease and cancer and had no use of postmenopausal hormones. RESULTS: In age- and BMI-adjusted analyses, magnesium intake was inversely associated with plasma C-reactive protein (CRP) concentrations; CRP concentrations were 12% lower in the highest intake quintile than in the lowest (P for trend <0.0001). This association was not appreciably altered by further adjustment for other potential confounding variables including dietary factors; the mean CRP concentrations for ascending quintiles of magnesium intake were 1.50, 1.39, 1.35, 1.34, and 1.31 mg/l (P for trend = 0.0003). This inverse association was stronger for women with a BMI > or =25 kg/m(2) (P < 0.0001 for interaction) and those who were current or past smokers (P = 0.0009 for interaction). After adjustment for confounding lifestyle and dietary factors, women in the highest quintile of magnesium intake had 27% lower risk of the metabolic syndrome (defined according to the National Cholesterol Education Program criteria) compared with those in the lowest quintile of intake (odds ratio 0.73 [95% CI 0.60-0.88], P for trend = 0.0008). CONCLUSIONS: Our results suggest that magnesium intake is inversely associated with systemic inflammation and the prevalence of the metabolic syndrome in middle-aged and older women.     

Body mass index, diabetes, and C-reactive protein among U.S. adults

OBJECTIVE: The author examined the relationship between C-reactive protein and BMI and diabetes status among 16,573 participants aged > or = 20 years of the Third National Health and Nutrition Examination Survey (1988-1994). RESEARCH DESIGN AND METHODS: The study had a cross-sectional design. RESULTS: Geometric mean concentrations of C-reactive protein were lowest among individuals with a BMI < 18.5 kg/m2 and increased with increasing BMI categories. Restricting the analysis to participants without various medical conditions did not change the relation. After adjusting for age, sex, race or ethnicity, and education, using logistic regression analysis, odds ratios for an elevated C-reactive protein concentration (> or = 85th percentile of the sex-specific C-reactive protein concentration distribution) among participants with a BMI of 25 to < 30, 30 to < 35, 35 to < 40, and > or = 40 kg/m2 were 1.51 (95% CI 1.23-1.86), 3.19 (2.60-3.91), 6.11 (4.67-7.98), and 9.30 (6.43-13.46), respectively, compared with participants with a BMI < 25 kg/m2. C-reactive protein concentrations were lowest among those individuals without diabetes or with impaired fasting glucose and highest among those with newly or previously diagnosed diabetes. Compared with participants with a normal fasting glucose, participants with impaired fasting glucose, newly diagnosed diabetes, and previously diagnosed diabetes had 0.99 (0.72-1.37), 1.84 (1.25-2.71), and 1.59 (1.25-2.01) odds of having an elevated C-reactive protein concentration after adjustment for age, sex, race or ethnicity, education, and BMI. CONCLUSIONS: These results confirm cross-sectional findings from previous studies that show elevated C-reactive protein concentrations among individuals who are obese or have diabetes. The implications of these findings, however, remain unclear.     

心血管疾病与C-反应蛋白

目的：总结并分析心房纤颤的发生机制，探讨C-反应蛋白在心房纤颤发生发展中的作用，为临床治疗心房纤颤提供新的启示。 资料来源：应用计算机检索PUBMED1990-01／2005-12关于C-反应蛋白和心房纤颤与C-反应蛋白及炎症关系的文章，检索词“C—reactive protein，Atrial fibrillation，inflammation”并限定文章语言为English。 资料选择：对资料进行仞审，纳入标准：①关于C-反应蛋白的结构，生物特性及功能。①对心房纤颤发生机制及心房纤颤与C-反应蛋白相关性研究。③关于炎症与C-反应蛋白的研究。排除标准：重复性研究。 资料提炼：共收集到符合上述要求的文献51篇，排除31篇重复性研究。20篇符合纳入标准，其中4篇关于C-反应蛋白生物特性研究，7篇关于心房纤颤的调查研究．9篇关于炎症与C-反应蛋白的研究。 资料综合：目对前于心房纤颤发生的机制有电重构和结构重构两种。炎症可能导致肺静脉放电增加，从而触发，也可能导致心脏机构重塑，而C-反应蛋白的升高和心房纤颤的联系表明一个新的机制，炎症可能导致心房纤颤的持续性。 结论：心房纤颤发生的原因是多方面的，炎症可能作为其中的一个因素而诱发，炎症与心房纤颤可能互为因果，互相促进。所以临床工作当中可以尝试采用降低C一反应蛋白的药物来预防和治疗.     

心血管疾病与C-反应蛋白

目的:总结并分析心房纤颤的发生机制,探讨C-反应蛋白在心房纤颤发生发展中的作用,为临床治疗心房纤颤提供新的启示。资料来源:应用计算机检索PUBMED1990-01/2005-12关于C-反应蛋白和心房纤颤与C-反应蛋白及炎症关系的文章,检索词“C-reactiveprotein,Atrialfibrillation,inflammation”并限定文章语言为English。资料选择:对资料进行初审,纳入标准:①关于C-反应蛋白的结构、生物特性及功能。②对心房纤颤发生机制及心房纤颤与C-反应蛋白相关性研究。③关于炎症与C-反应蛋白的研究。排除标准:重复性研究。资料提炼:共收集到符合上述要求的文献51篇,排除31篇重复性研究。20篇符合纳入标准,其中4篇关于C-反应蛋白生物特性研究,7篇关于心房纤颤的调查研究,9篇关于炎症与C-反应蛋白的研究。资料综合:目对前于心房纤颤发生的机制有电重构和结构重构两种。炎症可能导致肺静脉放电增加,从而触发,也可能导致心脏机构重塑,而C-反应蛋白的升高和心房纤颤的联系表明一个新的机制,炎症可能导致心房纤颤的持续性。结论:心房纤颤发生的原因是多方面的,炎症可能作为其中的一个因素而诱发,炎症与心房纤颤可能互为因果,互相促进。所以临床工作当中可以尝试采用降低C-反应蛋白的药物来预防和治疗。     

非ST段抬高急性冠脉综合征患者高敏C反应蛋白与抵抗素、脂联素的关系及临床意义

目的:探讨非ST段抬高急性冠脉综合征(ACS)患者高敏C反应蛋白(hs-CRP)与抵抗素、脂联素(Adp)的关系及临床意义。方法:选取非ST段抬高ACS的患者106例,分为不稳定性心绞痛(UA)组69例及急性非ST段抬高心肌梗死(NSTEMI)组37例;另入选稳定型心绞痛(SAP)组35例及健康对照组35例。所有入选患者行总胆固醇(TC)、低密度胆固醇(LDL)、高密度胆固醇(HDL)、甘油三酯(TG)及hs-CRP检测,并测定Adp及抵抗素水平。结果:与SAP组比较,UA组及NSTEMI组抵抗素水平增高,Adp减低(P<0.05)。NSTEMI组hs-CRP水平较健康对照组及SAP组明显增高(P<0.05)。非ST段抬高ACS患者中,高危险组hs-CRP及抵抗素水平增高,Adp减低(P<0.05);相关性分析显示,Adp与抵抗素呈负相关(r=-0.829,P<0.001),抵抗素与HDL呈负相关(r=-0.312,P=0.047),Adp与HDL呈正相关(r=0.304,P=0.053)。结论:高危非ST段抬高ACS患者hs-CRP、抵抗素水平明显高于低危险组,而Adp水平显著低于中低危险组;hs-CRP、抵抗素、Adp水平与冠状动脉斑块稳定性有关。     

Association of brominated flame retardants with diabetes and metabolic syndrome in the U.S. population, 2003-2004

OBJECTIVE—Chlorinated persistent organic pollutants (POPs), endocrine disruptors accumulated in adipose tissue, were associated with diabetes and metabolic syndrome. Brominated flame retardants (BFRs), such as polybrominated diphenyl ethers (PBDEs) or polybrominated biphenyls (PBBs), are another class of POPs for which body burden is increasing. Cross-sectional associations of serum concentrations of BFRs with diabetes and metabolic syndrome were studied.RESEARCH DESIGN AND METHODS—In the National Health and Nutrition Examination Survey 2003–2004, 1,367 adults were examined with respect to diabetes status. Five PBDEs and one PBB were selected, detectable in ≥60% of participants. For the outcome metabolic syndrome, we restricted the analysis to 637 participants with a morning fasting sample.RESULTS—Compared with subjects with serum concentrations below the limit of detection, prevalent diabetes had differing dose-response associations with serum concentrations of PBB-153 and PBDE-153. Adjusted odds ratios across quartiles of serum concentrations for PBB-153 or PBDE-153 were 1.0, 0.7, 1.4, 1.6, and 1.9 (P for trend <0.01) and 1.0, 1.6, 2.6, 2.7, and 1.8 (P for quadratic term <0.01), respectively. PBB-153 was also positively associated with the prevalence of metabolic syndrome with adjusted odds ratios of 1.0, 1.5, 3.1, 3.1, and 3.1 (P for trend<0.01). As in its association with diabetes, PBDE-153 showed an inverted U-shaped association with metabolic syndrome.CONCLUSIONS—Pending confirmation in prospective studies, lipophilic xenobiotics, including brominated POPs stored in adipose tissue, may be involved in the pathogenesis of diabetes and metabolic syndrome.We have recently reported strong cross-sectional associations of serum concentrations of chlorinated persistent organic pollutants (POPs) with diabetes (1,2). In addition to diabetes, POPs were associated with most components of metabolic syndrome, although specific associations differed depending on chemicals (3). Based on both these epidemiological and previous experimental findings, we have proposed that POPs stored in adipose tissue may play a key role in the pathogenesis of metabolic syndrome and type 2 diabetes (4). As well-known endocrine disruptors, their persistence in adipose tissue may disturb normal function of lipid and glucose metabolism in adipose tissue (4).These lipophilic pollutants are a mixture of several hundred chemicals with similar properties, such as resistance to biodegradation and bioaccumulation in adipose tissue. Aside from the chlorinated POPs we studied before (dioxins, furans, polychlorinated biphenyls [PCBs], or organochlorine pesticides), there are other important subclasses of POPs. Among them, chemicals belonging to brominated flame retardants (BFRs) are of special interest because of the recent marked increase in levels of polybrominated diphenyl ethers (PBDEs), the most well-known class of BFR, in humans as well as in the environment (5,6). PBDEs are extensively used in a variety of consumer products, such as home/office furnishings and electronics, as flame retardants, and their body burdens in North America are much higher than those of Europeans (5).Similar to chlorinated POPs, BFRs bioaccumulate in adipose tissue in living organisms and are suspected to be endocrine disruptors (7). Such lipophilic xenobiotics in adipose tissue have been suspected to disrupt hormonal signaling in adipose tissue as endocrine disruptors (8,9). They are chemically and toxicologically similar to PCBs, which were strongly associated with hyperglycemia and dyslipidemia in our previous studies (5). Thus, BFRs may also be associated with disturbance of lipid and glucose metabolism.Serum concentrations of biologically important BFRs were measured in subsamples of the National Health and Examination Survey (NHANES) 2003–2004 (10). Our analyses were performed to investigate associations of prevalence of diabetes and metabolic syndrome with the serum concentrations of BFRs.     

初诊2型糖尿病合并代谢综合征患者血清高分子量脂联素水平与胰岛素抵抗、C反应蛋白的相关性

目的观察初诊2型糖尿病(T2DM)合并代谢综合征(MS)患者血清高分子量脂联素(HMW-APN)水平及其与胰岛素抵抗(IR)、C反应蛋白(CRP)的相关性。方法选取研究对象168例,分为健康人对照组80例及初诊T2DM患者88例;初诊T2DM患者再根据是否合并MS分为单纯T2DM组45例和T2DM合并MS组43例。研究对象均行75 g口服葡萄糖耐量试验及胰岛素释放试验,并检测血清HMW-APN、CRP、血脂等相关生化指标。结果与健康人对照组比较,T2DM合并MS组及T2DM组血清HMW-APN水平降低(P0.01),以T2DM合并MS组最低。T2DM合并MS组及T2DM组血清CRP升高(P0.01),以T2DM合并MS组最高。简单相关分析显示,血清HMW-APN水平与体质指数(BMI)、腰围(WC)、腰臂比(WHR)、收缩压(SBP)、空腹血糖(FPG)、餐后2小时血糖(2h PG)、糖化血红蛋白Alc(Hb A1c)、三酰甘油(TG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)及CRP呈负相关(P均0.01),与高密度脂蛋白胆固醇(HDL-C)水平、胰岛β细胞功能指数(HOMA-β)呈正相关(P均0.01)。多元逐步回归分析显示,WC、2h PG及CRP是血清HMW-APN水平的独立影响因素(P均0.01)。Logistic回归分析显示,HMW-APN是T2DM发生MS的保护因素,BMI、FPG、SBP、TG是其危险因素(P0.01或P0.05)。结论血清HMW-APN水平在初诊T2DM合并MS患者中降低,其与IR及CRP密切相关,在初诊T2DM合并MS的发生、发展中起保护作用。     

Oxidative stress markers, C-reactive protein and heat shock protein 70 levels in subjects with metabolic syndrome.

BACKGROUND: The metabolic syndrome is a cluster of cardiovascular risk factors and essential components of metabolic syndrome are hyperglycemia, hypertension, visceral obesity, hypertriglyceridemia and low high-density lipoprotein cholesterol. Oxidative stress plays a critical role in the pathogenesis of metabolic syndrome components and insulin resistance. The aim of this study was to investigate the role of oxidative stress, C-reactive protein and heat shock protein 70 levels in the pathogenesis of this disease. METHODS: A total of 36 patients diagnosed with metabolic syndrome and 33 controls were included in the study. Malondialdehyde, carbonyl protein, C-reactive protein and heat shock protein 70 levels and xanthine oxidase and superoxide dismutase activities were measured in the serum of the subjects. RESULTS: Mean serum malondialdehyde, carbonyl protein, C-reactive protein (p<0.01, p<0.05 and p<0.001, respectively) and xanthine oxidase activity were significantly higher (p<0.01) in serum of the patients than the control group. Superoxide dismutase activity and heat shock protein 70 levels were significantly lower (p<0.01 and p<0.05, respectively) in serum of the patients. CONCLUSIONS: These results suggest that oxidative stress parameters and components of metabolic syndrome are closely related; therefore, significant alterations may occur in the antioxidant and inflammatory status. However, further studies are required to evaluate the possible molecular mechanisms of heat shock protein 70 levels in metabolic syndrome.     

超敏C反应蛋白与代谢综合征的相关性研究

目的 探讨超敏C反应蛋白(high sensitivity C-reactive protein,hsCRP)与代谢综合征(metabolic svndrome,Ms)的相关性.方法 选择2005年7月至2006年6月在浙江大学医学院附属邵逸夫医院住院体检的2453例;所有研究对象住院当天测量身高、体重、血压,于次日早晨空腹采血,用氧化物酶法检测血糖、血脂全套,采用免疫比浊法检测hsCRP,代谢综合征的诊断标准根据2004年中华医学会糖尿病学分会关于代谢综合征的建议.数据采用SPSS 13.0软件包分析,计量资料用均数±标准差((x)±s)表示,统计显著性用双侧检验,显著性水准定为α=0.05.组间差异分析应用t检验,多组间差异分析用单因素方差分析;hsCRP与代谢综合征各组分的相关性分析用斯比尔曼氏(Spearman)检验,并采用逐步回归(Stepwise)分析建立线性模型.对hsCRP发生代谢综合征的危险性用logistic分析.结果 2453例研究人群中,有代谢综合征者408例(占16.6%),代谢综合征者hsCRP水平(1.73±0.54 mg/L)与无代谢综合征者(1.46±0.58)mg/L比较,差异有统计学意义,P＜0.05;且随着代谢综合征组分的增加,hsCRP水平逐步升高(P＜0.05).相关分析显示hsCRP浓度和年龄、体重、收缩压、舒张压、空腹血糖、餐后2小时血糖、甘油三酯呈正相关,与HDL-C呈负相关.用逐步回归筛选变量,结果显示影响hsCRP水平的主要因素为体重指数、年龄、甘油三酯、高密度脂蛋白、舒张压,P＜0.05.其回归方程如下:y=0.172+0.237a+0.123b-0.111c+0.052d+0.045e.在调整年龄、性别及吸烟等影响因素后,hsCRP与代谢综合征的发生显著相关,(OR=1.126,P＜0.001).结论 代谢综合征者hsCRP水平高于无代谢综合征者;且随着代谢综合征组分的增加,hsCRP水平逐步升高.hsCRP水平的升高是发生代谢综合征的危险因素.     

Global coronary heart disease risk assessment of individuals with the metabolic syndrome in the U.S

OBJECTIVE—Although metabolic syndrome is related to an increased risk of coronary heart disease (CHD) events, individuals with metabolic syndrome encompass a wide range of CHD risk levels. This study describes the distribution of 10-year CHD risk among U.S. adults with metabolic syndrome.RESEARCH DESIGN AND METHODS—Metabolic syndrome was defined by the modified National Cholesterol Education Program (NCEP)/Third Adult Treatment Panel (ATP III) definition among 4,293 U.S. adults aged 20–79 years in the National Health and Nutrition Examination Survey 2003–2004. Low-, moderate-, moderately high–, and high-risk statuses were defined as <6, 6 to <10, 10–20, and >20% probability of CHD in 10 years (based on NCEP/ATP III Framingham risk score algorithms), respectively; those with diabetes or preexisting cardiovascular disease were assigned to high-risk status.RESULTS—The weighted prevalence of metabolic syndrome by NCEP criteria in our study was 29.0% overall (30.0% in men and 27.9% in women, P = 0.28): 38.5% (30.7% men and 46.9% women) were classified as low risk, 8.5% (7.9% men and 9.1% women) were classified as moderate risk, 15.8% (23.4% men and 7.6% women) were classified as moderately high risk, and 37.3% (38.0% men and 36.5% women) were classified as high risk. The proportion at high risk increased with age but was similar among Hispanics, non-Hispanic whites, and non-Hispanic blacks.CONCLUSIONS—Although many subjects with metabolic syndrome have a low calculated risk for CHD, about half have a moderately high or high risk, reinforcing the need for global risk assessment in individuals with metabolic syndrome to appropriately target intensity of treatment for underlying CHD risk factors.The metabolic syndrome is a cluster of risk factors often linked to insulin resistance that has been shown to increase the risk for development of cardiovascular disease (CVD). Individuals with metabolic syndrome have an increased risk of coronary heart disease (CHD) and CVD mortality (1,2). Global risk assessment using Framingham risk prediction algorithms is often the initial evaluation of CHD risk in subjects with multiple risk factors, including those with metabolic syndrome (3). Although it is often assumed that individuals with metabolic syndrome have a high risk of CVD, many have only borderline elevations in risk factors and thus may actually have either a low or intermediate risk of CVD (4). Therefore, assessment of global risk of CHD in individuals with metabolic syndrome may be helpful to most appropriately target the intensity of cardiometabolic risk factor interventions for prevention of diabetes or cardiovascular disease.The aim of this article was to calculate the global risk of CHD in adults with metabolic syndrome in the U.S. to better characterize the diversity in their risk of CHD using the data from the National Health and Nutrition Examination Survey (NHANES) 2003–2004. In addition, we will examine the global risk of CHD in individuals with metabolic syndrome across sex, ethnicity, and age-groups and examine goal attainment and distance to recommended levels for key CHD risk factors.     

2型糖尿病肾病患者C-反应蛋白及代谢指标临床分析

目的比较2型糖尿病（T2DM）肾病患者血清C-反应蛋白（CRP）水平变化并探讨其与代谢指标的关系。方法将148例T2DM患者设为糖尿病组（DM组）,并根据24 h尿微量白蛋白分为三组：无肾病组55例（B组）、早期肾病组58例（C组）、临床肾病组35例（D组）,30例健康体检者为对照组（A组）。测定血清CRP水平,同时检测血压、体质量指数（BM I）、空腹血糖（FPG）、血脂、尿酸（UA）、空腹胰岛素,计算胰岛素抵抗指数（HOMA-IR）,观察各组间CRP变化并进行相关分析。结果①DM组与A组相比,收缩压（SBP）、FPG、HOMA-IR、甘油三酯（TG）、低密度脂蛋白-胆固醇（LDL-C）升高、UA升高（P〈0.01或P〈0.05）,高密度脂蛋白-胆固醇（HDL-C）降低（P〈0.05）;D组与B组相比,SBP、UA升高（P〈0.05）,HDL-C降低（P〈0.05）;②B、C、D组CRP高于A组（P〈0.01）,C、D组CRP高于B组（P〈0.01）,D组CRP高于C组（P〈0.05）;③相关分析显示CRP与BM I、SBP、TG、LDL-C、HOMA-IR、UA存在显著正相关。结论 CRP与糖尿病肾病（DN）的发生相关,且随着DN进展而逐渐增高,可预测DN的进展;CRP水平升高与BM、ITG、LDL-C、UA、HOMA-IR等代谢指标密切相关,可作为T2DM患者心血管并发症的临床预测指标。     

Prediction of delirium in critically ill patients with elevated C-reactive protein

Background and Purpose

Delirium is thought to be associated with systemic inflammatory response. However, its association with the most widely used inflammatory biomarker C-reactive protein (CRP) has not been well established. We aimed to examine whether CRP on intensive care unit (ICU) entry was associated with subsequent development of delirium.

Design and Setting

This prospective observational study was conducted in a mixed 24-bed ICU in a tertiary teaching hospital.

Methods

All patients admitted to the ICU from February 2011 to June 2012 were screened for eligibility. Demographic data and clinical characteristics of included patients were recorded. Patients were screened for the presence of delirium by using the tool Confusion Assessment Method for the ICU (CAM-ICU). C-reactive protein was obtained on ICU entry and 24 hours thereafter. Eligible patients were followed up for 28 days or until death. Univariate and multivariate analyses were performed to evaluate independent risk factors for delirium. Clinical outcome included the length of stay (LOS) in the ICU, 28-day mortality, and duration of mechanical ventilation. Two-tailed P < .05 was considered statistically significant.

Results

A total of 223 patients were included during study period. In univariate analysis, patients with delirium showed significantly higher CRP values than those without (120.5 vs 57.5 mg/L; P = .0001). By adjusting for confounding variables (including age, sex, Acute Physiology and Chronic Health Evaluation II, intubation, living alone, physical restraint, alcohol drinking, smoking, type of medical condition, and hospital LOS before ICU admission) in logistic regression model, CRP remained an independent predictor of delirium (odds ratio, 1.07; 95% confidence interval, 1.01-1.15). As compared with nondelirious patients, those with delirium showed longer LOS in ICU (13 vs 5 days; P < .001) and duration of mechanical ventilation (6 vs 1 days; P < .001). An increase in CRP greater than 8.1 mg/L within 24 hours was associated with 4-fold increase in the risk of delirium (odds ratio: 4.47, 95% confidence interval, 1.28-15.60).

Conclusion

C-reactive protein measured on ICU entry and its changes within 24 hours are risk indicators of delirium. Further studies exploring the treatment of delirium according to CRP levels are warranted.     

高敏C反应蛋白与代谢综合征患者颈动脉粥样硬化的关系

目的探讨高敏C反应蛋白(hs-CRP)与代谢综合征(MS)及其颈动脉粥样硬化的关系。方法88例研究对象MS诊断标准分为MS组44例、亚MS组23例以及对照组21例。应用酶联免疫吸附法检测血清hs-CRP水平,多普勒超声测定受试者颈总动脉(CCA)内膜-中层厚度(IMT),并观察颈动脉斑块的有无。结果(1)与对照组比较,MS组血清hs-CRP水平显著升高(P<0.01)。随着MS代谢组分的增多,血清hs-CRP水平逐渐升高;(2)与对照组及MS亚组比较,MS组CCA-IMT明显增厚(P<0.05);(3)血清hs-CRP与体质量指数、腰臀比以及稳态模型胰岛素抵抗指数呈显著正相关,与高密度脂蛋白胆固醇(HDL-C)呈显著负相关(P<0.05);(4)颈动脉IMT增厚组(IMT≥0.9mm)血清hs-CRP水平显著高于颈动脉IMT正常组(IMT<0.9mm)(P<0.05),有颈动脉粥样斑块组hs-CRP水平明显高于无斑块组(P<0.05)。(5)hs-CRP是IMT的独立影响因素(P<0.05)。结论血清hs-CRP水平与MS代谢组分及其数量密切相关,血清hs-CRP水平增高是MS发病的危险因素。血清CRP水平升高可能参与了MS患者颈动脉粥样硬化的进程。     

Urinary albumin excretion and its relation with C-reactive protein and the metabolic syndrome in the prediction of type 2 diabetes

OBJECTIVE: To investigate urinary albumin excretion (UAE) and its relation with C-reactive protein (CRP) and the metabolic syndrome in the prediction of the development of type 2 diabetes. RESEARCH DESIGN AND METHODS: We used data from the Prevention of Renal and Vascular End Stage Disease (PREVEND) study, an ongoing, community-based, prospective cohort study initiated in 1997 in the Netherlands. The initial cohort consisted of 8,592 subjects. After 4 years, 6,894 subjects participated in a follow-up survey. Subjects with diabetes at baseline or missing data on fasting glucose were excluded, leaving 5,654 subjects for analysis. The development of type 2 diabetes, defined as a fasting glucose > or = 7.0 mmol/l and/or the use of antidiabetic medication, was used as the outcome measure. UAE was calculated as the mean UAE from two consecutive 24-h urine collections. Logistic regression models were used, with the development of type 2 diabetes as the dependent variable. RESULTS: Of the 5,654 subjects for whom data were analyzed, 185 (3.3%) developed type 2 diabetes during a mean follow-up period of 4.2 years. UAE, CRP, and the presence of the metabolic syndrome at baseline were significantly associated with the incidence of type 2 diabetes (P < 0.001 for all variables). In a univariate model, the odds ratio (OR) for UAE was 1.59 (95% CI 1.42-1.79). In our full model, adjusted for age, sex, number of criteria of metabolic syndrome, and other known risk factors for the development of type 2 diabetes (including fasting insulin), the association between UAE and type 2 diabetes remained significant (OR 1.53, 95% CI 1.25-1.88, P < 0.001). There was a significant interaction between UAE and CRP (P = 0.002). After CRP was stratified into tertiles, the ORs for the association between baseline UAE and the development of type 2 diabetes were 2.2 (1.47-3.3), 1.33 (0.96-1.84), and 1.04 (0.83-1.31) for the lowest to highest tertiles, respectively. CONCLUSIONS: UAE predicts type 2 diabetes independent of the metabolic syndrome and other known risk markers of development of type 2 diabetes. The predictive value of UAE was modified by the level of CRP.     

2型糖尿病合并周围神经病变与瘦素、白细胞介素-6、C-反应蛋白关系的探讨

目的 探讨2型糖尿病合并周围神经病变与瘦素(LEP)、白细胞介素-6(IL-6)、C-反应蛋白(CRP)的关系.方法 选择我院住院2型糖尿病患者99例,其中单纯2型糖尿病60例(A组),2型糖尿病合并周围神经病变39例(B组),2组均进行下肢振动觉定量检测;并设正常对照50例(C组).以上3组均测定相应生化指标,结合年龄、病程等进行分析.结果 ①B组病程、血清总胆固醇、明显高于A组、C组,差异有统计学意义(P＜0.01,P＜0.05).②A组、B组LEP、IL-6、CRP明显高于C组(P＜0.01,P＜0.05);B组LEP、IL-6和CRP显著高于A组(P＜0.01,P＜0.05).结论 2型糖尿病周围神经病变患者瘦素及炎症因子均增高.对于2型糖尿病病程长、血脂紊乱的患者应及早检测LEP、IL-6、CRP水平,有助于早期预防2型糖尿病合并周围神经病变的发生发展.     

超敏C反应蛋白与初诊2型糖尿病下肢血管病变的相关性研究

目的 探讨超敏C反应蛋白(hsCRP)与初诊2型糖尿病(T2DM)下肢血管病变发生的关系.方法 测定正常对照组(A组)、初诊T2DM患者(B组)、初诊T2DM下肢血管病变患者(C组)的hsCRP水平和踝肱指数(ABI)变化.结果 与ABI正常的A组相比,ABI正常的B组和ABI降低的C组hsCRP、体质量指数、腰臀围比、收缩压、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、糖化血红蛋白(HbA1 c)显著升高或增加(P＜0.01或P＜0.05)、高密度脂蛋白胆固醇(HDL-C)显著下降(P＜0.05);C组hsCRP(1.10±0.36)vs(0.88±0.36)、LDL-C(4.20±1.09)mmol/L vs(3.25±1.04)mmol/L、HbAlc(10.11± 3.92)%vs(8.10±1.51)%明显高于B组(P＜0.01或P＜0.05),HDL-C明显低于B组(1.24±0.32)mmol/L vs(1.36±0.26)mmol/L(P＜0.05).logisitic回归分析显示,hsCRP是初诊T2DM下肢血管病变独立的危险因子(P=0.029).结论 hsCRP与初诊T2DM的发生相关,升高的hsCRP是促使初诊T2DM并发下肢血管病变的独立危险因素.     

代谢综合征患者超敏C反应蛋白与尿微量白蛋白关系研究

目的:探讨代谢综合征(metabolic syndrome,MS)患者血清超敏C反应蛋白及尿微量白蛋白水平变化及二者之间的关系.方法:MS患者138例(MS组)和非MS患者95例(对照组),MS组根据尿白蛋白排泄率将MS患者分为正常蛋白尿组、微量白蛋白尿组和临床蛋白尿组,检测各组超敏C反应蛋白水平,并进行比较.结果:MS组血清超敏C反应蛋白及尿微量白蛋白水平较对照组明显升高;超敏c反应蛋白水平随尿白蛋白排泄率增高而增高.结论:MS患者血清超敏C反应蛋白及尿微量白蛋白水平明显升高,二者存在一定相关性.     

Serum ferritin and risk of the metabolic syndrome in U.S. adults

OBJECTIVE: We examined the relationship among iron stores, the metabolic syndrome, and insulin resistance. RESEARCH DESIGN AND METHODS: We conducted a cross-sectional study of 6,044 adults >20 years of age who participated in the Third National Health and Nutrition Examination Survey. Metabolic syndrome was defined as the presence of at least three of the following: elevated blood pressure, low HDL cholesterol, elevated serum triglycerides, elevated plasma glucose, and abdominal obesity. Insulin resistance was estimated using homeostasis model assessment (for insulin resistance), fasting insulin, and triglyceride-to-HDL cholesterol ratio. RESULTS: After excluding individuals with likely hemochromatosis, mean serum ferritin values in premenopausal women, postmenopausal women, and men were 33.6, 93.4, and 139.9 microg/l, respectively. Metabolic syndrome was more common in those with the highest compared with the lowest levels of serum ferritin in premenopausal women (14.9 vs. 6.4%, P = 0.002), postmenopausal women (47.5 vs. 28.2%, P < 0.001), and men (27.3 vs. 13.8%, P < 0.001). Insulin resistance also increased across quartiles of serum ferritin for men and postmenopausal women and persisted after adjustment for age, race/ethnicity, C-reactive protein, smoking, alcohol intake, and BMI. CONCLUSIONS: Elevated iron stores were positively associated with the prevalence of the metabolic syndrome and with insulin resistance.