Chao Chun, Song Yiqing, Cook Nancy, Tseng Chi-Hong, Manson JoAnn E, Eaton Charles, Margolis Karen L, Rodriguez Beatriz, Phillips Lawrence S, Tinker Lesley F, Liu Simin
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, USA.
Arch Intern Med. 2010 Sep 27;170(17):1557-65. doi: 10.1001/archinternmed.2010.312.
Recent studies have linked plasma markers of inflammation and endothelial dysfunction to type 2 diabetes mellitus (DM) development. However, the utility of these novel biomarkers for type 2 DM risk prediction remains uncertain.
The Women's Health Initiative Observational Study (WHIOS), a prospective cohort, and a nested case-control study within the WHIOS of 1584 incident type 2 DM cases and 2198 matched controls were used to evaluate the utility of plasma markers of inflammation and endothelial dysfunction for type 2 DM risk prediction. Between September 1994 and December 1998, 93 676 women aged 50 to 79 years were enrolled in the WHIOS. Fasting plasma levels of glucose, insulin, white blood cells, tumor necrosis factor receptor 2, interleukin 6, high-sensitivity C-reactive protein, E-selectin, soluble intercellular adhesion molecule 1, and vascular cell adhesion molecule 1 were measured using blood samples collected at baseline. A series of prediction models including traditional risk factors and novel plasma markers were evaluated on the basis of global model fit, model discrimination, net reclassification improvement, and positive and negative predictive values.
Although white blood cell count and levels of interleukin 6, high-sensitivity C-reactive protein, and soluble intercellular adhesion molecule 1 significantly enhanced model fit, none of the inflammatory and endothelial dysfunction markers improved the ability of model discrimination (area under the receiver operating characteristic curve, 0.93 vs 0.93), net reclassification, or predictive values (positive, 0.22 vs 0.24; negative, 0.99 vs 0.99 [using 15% 6-year type 2 DM risk as the cutoff]) compared with traditional risk factors. Similar results were obtained in ethnic-specific analyses.
Beyond traditional risk factors, measurement of plasma markers of systemic inflammation and endothelial dysfunction contribute relatively little additional value in clinical type 2 DM risk prediction in a multiethnic cohort of postmenopausal women.
近期研究已将炎症和内皮功能障碍的血浆标志物与2型糖尿病（DM）的发生联系起来。然而，这些新型生物标志物用于预测2型DM风险的效用仍不确定。
女性健康倡议观察性研究（WHIOS）是一项前瞻性队列研究，在该研究中进行了一项巢式病例对照研究，纳入1584例2型DM新发病例和2198例匹配对照，以评估炎症和内皮功能障碍的血浆标志物用于预测2型DM风险的效用。1994年9月至1998年12月期间，93676名年龄在50至79岁的女性纳入了WHIOS。使用基线时采集的血样测量空腹血浆葡萄糖、胰岛素、白细胞、肿瘤坏死因子受体2、白细胞介素6、高敏C反应蛋白、E选择素、可溶性细胞间黏附分子1和血管细胞黏附分子1的水平。基于整体模型拟合、模型辨别力、净重新分类改善以及阳性和阴性预测值，评估了一系列包括传统危险因素和新型血浆标志物的预测模型。
尽管白细胞计数以及白细胞介素6、高敏C反应蛋白和可溶性细胞间黏附分子1的水平显著增强了模型拟合，但与传统危险因素相比，炎症和内皮功能障碍标志物均未改善模型辨别力（受试者操作特征曲线下面积，0.93对0.93）、净重新分类或预测值（阳性，0.22对0.24；阴性，0.99对0.99[以15%的6年2型DM风险为临界值]）。在种族特异性分析中也获得了类似结果。
除传统危险因素外，在绝经后女性的多民族队列中，测量全身炎症和内皮功能障碍的血浆标志物在临床预测2型DM风险方面几乎没有额外价值。
