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【原著論文】腎性糖尿は心血管イベントのリスクとはならない(循環器グループ:多田隼人助教)

2017.09.29 | Publications |

Renal glucosuria is not associated with atherosclerotic cardiovascular disease outcome in a general Japanese community

Tada H, Kawashiri MA, Sakata K, Yoneda T, Yasuda K, Yamagishi M, Hayashi K.
Atherosclerosis. 2017 Jun;261:111-116.  
Impact Factor (2016): 4.239

 

腎性糖尿(Renal glucosuria)は高血糖を伴わずに尿中にグルコースが認められる病態であり、遺伝性やその他の尿細管疾患に伴って発生するとされていますが、心血管系に与える影響は不明です。

私たちは金沢市の4万7千人を超える検診データを用い、この課題に取り組みました。結果、腎性糖尿の頻度は1.4%で、腎性糖尿を有する群では冠動脈疾患や脳卒中が有意に多いという結果が得られました。しかしながら、多変量解析においては腎性糖尿とこれらイベントとの関連性は認められず、腎性糖尿そのものは心血管イベントのリスクとはならない、と結論付けました。

従来より散発性腎性糖尿は良性であり、介入は不要とされていましたが、このようなスタンダードは科学的データに裏付けされていないことが多く、これからも個々の検証が必要とされています。

 

Abstract

BACKGROUND AND AIMS:

Renal glucosuria is defined as the excretion of detectable amounts of glucose in the urine without diabetes or hyperglycemia. Few data exist regarding the prevalence of renal glucosuria and its clinical impact on atherosclerotic cardiovascular diseases.

 

METHODS:

This study included 47,842 subjects (16,913 men, 35.4%) aged ≥40 years who underwent the Japanese specific health checkup in Kanazawa City during 2014. We defined renal glucosuria as fulfillment of all of the following three criteria: 1) detectable glucosuria; 2) the absence of diabetes; 3) normal blood glucose (<110 mg/dl fasting, and <140 mg/dl non-fasting). The presence of renal glucosuria and of factors associated with atherosclerotic cardiovascular diseases, including coronary artery disease and stroke, was assessed.

 

RESULTS:

The criteria for renal glucosuria were met by 665 (1.4%) subjects. Significantly higher proportions of subjects with renal glucosuria exhibited coronary artery disease, stroke, or either outcome than those without (14.9% vs. 12.1%, p = 0.0305; 9.9% vs. 6.9%, p = 0.00255; 22.3% vs. 17.0%, p = 4.0 × 10-4, respectively), but multivariate logistic regression analyses revealed that renal glucosuria was not associated with coronary artery disease (odds ratio [OR] = 0.940, 95% confidence interval [CI] = 0.748-1.171, not significant), stroke (OR = 1.122, 95% CI = 0.853-1.453, not significant), or atherosclerotic cardiovascular diseases (OR = 1.122, 95% CI = 0.853-1.453, not significant).

 

Characteristics of the subjects with renal glucosuria

Variable All (N = 47,842)

Renal glucosuria
YES (N = 665)

Renal glucosuria
NO (N = 47,177)

p value
Coronary artery disease (%) 5787 (12.1) 99 (14.9) 5688 (12.1)  0.03054
Stroke (%) 3303 (6.9) 66 (9.9) 3237 (6.9) 0.002551 
ASCVD (%) 8159 (17.1) 148 (22.3) 8011 (17.0) 4.0 × 10−4

 

Trends of the amount of renal glucosuria and cardiovascular outcomes

Orange markers indicate CAD. Red markers indicate stroke. Yellow markers indicate ASCVD.

 

CONCLUSIONS:

These results indicate that the prevalence of renal glucosuria in the Japanese general population was 1.4%, and that renal glucosuria was not associated with atherosclerotic cardiovascular diseases per se.

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