载脂蛋白 CIII 和 N 端脑利钠肽前体 B 型对 2 型糖尿病患者心血管疾病的独立预测作用。
Apolipoprotein CIII and N-terminal prohormone b-type natriuretic peptide as independent predictors for cardiovascular disease in type 2 diabetes.
机构信息
University of Edinburgh, UK.
Diabetes Epidemiology and Clinical Research Section, National Institutes of Health, 1550 E Indian School Road, Phoenix, AZ 85014, USA.
出版信息
Atherosclerosis. 2018 Jul;274:182-190. doi: 10.1016/j.atherosclerosis.2018.05.014. Epub 2018 May 25.
BACKGROUND AND AIMS
Developing sparse panels of biomarkers for cardiovascular disease in type 2 diabetes would enable risk stratification for clinical decision making and selection into clinical trials. We examined the individual and joint performance of five candidate biomarkers for incident cardiovascular disease (CVD) in type 2 diabetes that an earlier discovery study had yielded.
METHODS
Apolipoprotein CIII (apoCIII), N-terminal prohormone B-type natriuretic peptide (NT-proBNP), high sensitivity Troponin T (hsTnT), Interleukin-6, and Interleukin-15 were measured in baseline serum samples from the Collaborative Atorvastatin Diabetes trial (CARDS) of atorvastatin versus placebo. Among 2105 persons with type 2 diabetes and median age of 62.9 years (range 39.2-77.3), there were 144 incident CVD (acute coronary heart disease or stroke) cases during the maximum 5-year follow up. We used Cox Proportional Hazards models to identify biomarkers associated with incident CVD and the area under the receiver operating characteristic curves (AUROC) to assess overall model prediction.
RESULTS
Three of the biomarkers were singly associated with incident CVD independently of other risk factors; NT-proBNP (Hazard Ratio per standardised unit 2.02, 95% Confidence Interval [CI] 1.63, 2.50), apoCIII (1.34, 95% CI 1.12, 1.60) and hsTnT (1.40, 95% CI 1.16, 1.69). When combined in a single model, only NT-proBNP and apoCIII were independent predictors of CVD, together increasing the AUROC using Framingham risk variables from 0.661 to 0.745.
CONCLUSIONS
The biomarkers NT-proBNP and apoCIII substantially increment the prediction of CVD in type 2 diabetes beyond that obtained with the variables used in the Framingham risk score.
背景和目的
在 2 型糖尿病患者中开发用于心血管疾病的稀疏生物标志物面板将能够进行风险分层，以用于临床决策并选择进入临床试验。我们检查了早期发现研究产生的五种用于 2 型糖尿病患者心血管疾病（CVD）事件的候选生物标志物的个体和联合表现。
方法
阿托伐他汀与安慰剂的协作阿托伐他汀糖尿病试验（CARDS）的基线血清样本中测量载脂蛋白 CIII（apoCIII），B 型利钠肽前体（NT-proBNP），高敏肌钙蛋白 T（hsTnT），白细胞介素-6 和白细胞介素-15。在 2105 名中位年龄为 62.9 岁（范围为 39.2-77.3）的 2 型糖尿病患者中，在最长 5 年的随访期间，有 144 例发生 CVD（急性冠状动脉心脏病或中风）。我们使用 Cox 比例风险模型来确定与 CVD 事件相关的生物标志物，并使用接受者操作特征曲线下的面积（AUROC）来评估整体模型预测。
结果
在三个生物标志物中，有三个独立于其他危险因素与 CVD 事件相关；NT-proBNP（标准化单位每增加一个单位的风险比为 2.02，95％置信区间[CI]为 1.63，2.50），apoCIII（1.34，95％CI为 1.12，1.60）和 hsTnT（1.40，95％CI为 1.16，1.69）。当将它们组合在一个单一模型中时，只有 NT-proBNP 和 apoCIII 是 CVD 的独立预测因子，同时将使用 Framingham 风险变量获得的 CVD 预测 AUC 从 0.661 提高到 0.745。
结论
在 2 型糖尿病患者中，与 Framingham 风险评分中使用的变量相比，生物标志物 NT-proBNP 和 apoCIII 大大提高了 CVD 的预测能力。
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