根据斯滕诺1型风险评估引擎的评分，胰岛素抵抗在评估1型糖尿病患者心血管风险中的作用。
Utility of Insulin Resistance in Estimating Cardiovascular Risk in Subjects with Type 1 Diabetes According to the Scores of the Steno Type 1 Risk Engine.
作者信息
Cano Albert, Llauradó Gemma, Albert Lara, Mazarico Isabel, Astiarraga Brenno, González-Sastre Montserrat, Martínez Laia, Fernández-Veledo Sonia, Simó Rafael, Vendrell Joan, González-Clemente José-Miguel
机构信息
Department of Endocrinology and Nutrition, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Spain.
Department of Endocrinology and Nutrition, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Pg. Marítim 25-29, 08003 Barcelona, Spain.
出版信息
J Clin Med. 2020 Jul 11;9(7):2192. doi: 10.3390/jcm9072192.
BACKGROUND
We sought to assess the potential of insulin resistance (IR) for estimating cardiovascular disease (CVD) risk in adults with type 1 diabetes (T1DM) according to the scores of the Steno Type 1 Risk Engine (ST1RE).
METHODS
A total of 179 adults with T1DM (50.8% men, age 41.2 ± 13.1 years, duration of T1DM 16 (12-23) years) without established CVD were evaluated. IR was assessed by the estimation of insulin sensitivity (eIS) using two validated prediction equations: the estimated insulin sensitivity developed from the Pittsburgh Epidemiology of Diabetes Complications Study (eIS-EDC) and the estimated insulin sensitivity developed from Coronary Artery Calcification in T1DM Study (eIS-CACTI) ST1RE was used to estimate 10-year CVD risk and to classify subjects into three groups according to their risk: low (<10%; = 105), moderate (10-20%; = 53), and high (≥20%; = 21).
RESULTS
Both eIS-EDC and eIS-CACTI correlated negatively with ST1RE scores (eIS-EDC: r = -0.636, < 0.001; eIS-CACTI: r = -0.291, < 0.001). The C-statistic for predicting moderate/high risk and high risk was 0.816 (95% confidence interval (CI): 0.754-0.878) and 0.843 (95% CI: 0.772-0.913), respectively, for the eIS-EDC equation, and was 0.686 (95% CI: 0.609-0.763) and 0.646 (95% CI: 0.513-0.778), respectively, for the eIS-CACTI equation. The eIS-EDC equation had a significantly higher C-statistic both for moderate-/high-risk ( = 0.001) and high-risk ( = 0.007) subjects. Two cut-off points of eIS-EDC were identified for detecting moderate/high risk (8.52 mg·kg·min; sensitivity 74% and specificity 76%) and high risk (8.08 mg·kg·min; sensitivity 65% and specificity 95%) with potential applicability in clinical practice.
CONCLUSIONS
eIS negatively correlates with the score of CVD risk in the ST1RE. Two cut-off points of eIS are reported with potential utility in clinical practice for detecting adults with T1DM with the highest CVD risk.
背景
我们试图根据斯滕诺1型风险引擎（ST1RE）评分评估胰岛素抵抗（IR）在1型糖尿病（T1DM）成人患者中估算心血管疾病（CVD）风险的潜力。
方法
对179例无CVD确诊的T1DM成人患者（男性占50.8%，年龄41.2±13.1岁，T1DM病程16（12 - 23）年）进行评估。使用两个经过验证的预测方程通过估算胰岛素敏感性（eIS）来评估IR：从匹兹堡糖尿病并发症流行病学研究得出的估算胰岛素敏感性（eIS - EDC）和从T1DM研究中的冠状动脉钙化得出的估算胰岛素敏感性（eIS - CACTI）。ST1RE用于估算10年CVD风险，并根据风险将受试者分为三组：低风险（<10%；n = 105）、中度风险（10 - 20%；n = 53）和高风险（≥20%；n = 21）。
结果
eIS - EDC和eIS - CACTI均与ST1RE评分呈负相关（eIS - EDC：r = - 0.636，P < 0.001；eIS - CACTI：r = - 0.291，P < 0.001）。对于eIS - EDC方程，预测中度/高风险和高风险的C统计量分别为0.816（95%置信区间（CI）：0.754 - 0.878）和0.843（95%CI：0.772 - 0.913）；对于eIS - CACTI方程，分别为0.686（95%CI：0.609 - 0.763）和0.646（95%CI：0.513 - 0.778）。eIS - EDC方程在中度/高风险（P = 0.001）和高风险（P = 0.007）受试者中均具有显著更高的C统计量。确定了eIS - EDC的两个截断点用于检测中度/高风险（8.52 mg·kg·min；敏感性74%，特异性76%）和高风险（8.08 mg·kg·min；敏感性65%，特异性95%），在临床实践中具有潜在适用性。
结论
eIS与ST1RE中的CVD风险评分呈负相关。报告了eIS的两个截断点，在临床实践中对于检测具有最高CVD风险的T1DM成人患者具有潜在效用。
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