Harlianto Netanja I, Foppen Wouter, Mohamed Hoesein Firdaus A A, Hol Marjolein E, Verlaan Jorrit-Jan, de Jong Pim A, Westerink Jan
Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
Department of Orthopedic Surgery, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands.
Rheumatology (Oxford). 2025 Oct 1;64(10):5287-5294. doi: 10.1093/rheumatology/keaf268.
DISH is a common incidental finding in medical imaging characterized by continuous vertebral ossification, which is associated with prevalent type 2 diabetes mellitus (T2DM). We hypothesized that incidental screen-detected DISH may be an actionable marker for incident diabetes screening and aimed to assess the absolute incidence rate (ratio) for T2DM in cardiovascular patients with and without DISH.
Cardiovascular disease patients without diabetes (n = 3395) were included via the prospective Second Manifestation of ARTerial disease cohort. DISH was evaluated at baseline on chest radiographs using Resnick criteria. Incident T2DM was assessed by an adjudication committee. Adjusted incidence rate ratios (IRRs) and numbers needed to screen were calculated.
DISH was present in 263 (7.7%) patients. After a median follow-up of 11.1 years (IQR: 7.1-15.2), 317 patients developed T2DM. Patients with DISH had a higher incidence rate for T2DM compared with no-DISH patients (17.1 vs. 7.8 T2DM per 1000 person-years). DISH was associated with incident T2DM in multivariate analyses (IRR: 1.47; 95% CI: 1.03-2.06), with the highest IRR in the DISH group with the most extensive ossification (IRR: 2.01; 95% CI: 1.15-3.29). The number needed to screen for T2DM in patients with screen-detected DISH for 11.1 years was 7, similar to accepted risk markers overweight (n = 8), obesity (n = 5), hypertension (n = 9) and hyperlipidaemia (n = 13).
DISH is associated with higher rates of incident T2DM in cardiovascular disease patients, independent of accepted risk markers. DISH could be used as an imaging marker to identify cardiovascular disease patients with an increased risk for subsequent T2DM.
弥漫性特发性骨肥厚（DISH）是医学影像中常见的偶然发现，其特征为椎体连续骨化，与2型糖尿病（T2DM）的流行有关。我们假设偶然筛查发现的DISH可能是糖尿病筛查的一个可采取行动的标志物，并旨在评估有和没有DISH的心血管疾病患者中T2DM的绝对发病率（比率）。
通过前瞻性动脉疾病队列研究的第二次表现纳入无糖尿病的心血管疾病患者（n = 3395）。使用雷斯尼克标准在基线胸部X线片上评估DISH。由一个判定委员会评估新发T2DM。计算调整后的发病率比（IRR）和筛查所需人数。
263例（7.7%）患者存在DISH。中位随访11.1年（四分位间距：7.1 - 15.2）后，317例患者发生T2DM。与无DISH的患者相比，有DISH的患者T2DM发病率更高（每1000人年17.1例对7.8例）。在多变量分析中，DISH与新发T2DM相关（IRR：1.47；95%可信区间：1.03 - 2.06），在骨化最广泛的DISH组中IRR最高（IRR：2.01；95%可信区间：1.15 - 3.29）。筛查发现有DISH的患者11.1年筛查T2DM所需人数为7，与公认的风险标志物超重（n = 8）、肥胖（n = 5）、高血压（n = 9）和高脂血症（n = 13）相似。
在心血管疾病患者中，DISH与更高的新发T2DM发生率相关，独立于公认的风险标志物。DISH可用作一种影像标志物，以识别随后发生T2DM风险增加的心血管疾病患者。
