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腾讯登录Diabetes Care：代谢标志物改善糖尿病预测准确性
| 导读 | 7月11日，《糖尿病护理》（<em>Diabetes Care</em>）发表了美国学者的一项研究成果，在胰岛细胞抗体（ICA）阳性且代谢异常的人群中，由口服葡萄糖耐量试验衍生的代谢标志物组合可改善1型糖尿病进展的预测准确性。
此项研究共纳入339例受试者，受试者基线时均伴有ICA阳性、初相胰岛素反应（FPIR）和（或）糖耐量异常。随访受试者至临床糖尿病始发或随访结束... |
7月11日，《糖尿病护理》（<em>Diabetes Care</em>）发表了美国学者的一项研究成果，在胰岛细胞抗体（ICA）阳性且代谢异常的人群中，由口服葡萄糖耐量试验衍生的代谢标志物组合可改善1型糖尿病进展的预测准确性。
此项研究共纳入339例受试者，受试者基线时均伴有ICA阳性、初相胰岛素反应（FPIR）和（或）糖耐量异常。随访受试者至临床糖尿病始发或随访结束（5年）。利用受试者工作特征（ROC）曲线分析评估生物标志物的预测表现，并利用ROC曲线面积非参数检验加以对比。利用皮尔森相关系数评估标志物的相关性。
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结果显示，就个体而言，胰岛素抗体滴度、ICA512A滴度、C肽峰值、2小时血糖、FPIR和FPIR/内稳态模型评估胰岛素抵抗可为5年糖尿病风险提供适度但具有显著意义的预测值，并伴有相似的ROC曲线下面积。与独立指数相比，2小时血糖、C肽峰值和C肽曲线下面积可显著改善预测准确性，ROC曲线下面积为0.76。添加抗体滴度和/或IVGTT标志物未能进一步升高预测准确性。
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<img src="http://www.bioon.com/biology/UploadFiles/201207/2012071821283804.gif" alt="" width="113" height="149" border="0" hspace="0" />
<a title="" href="http://dx.doi.org/10.2337/dc12-0183" target="_blank">doi:10.2337/dc12-0183</a>
PMC:
PMID:
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<br/><strong>Prognostic Accuracy of Immunologic and Metabolic Markers for Type 1 Diabetes in a High-Risk Population: Receiver operating characteristic analysis.</strong><br/>
Xu P, Beam CA, Cuthbertson D, Sosenko JM, Skyler JS, Krischer JP; and the DPT-1 Study Group.
OBJECTIVETo establish and compare the prognostic accuracy of immunologic and metabolic markers in predicting onset of type 1 diabetes in those with high risk in a prospective study.RESEARCH DESIGN AND METHODSA total of 339 subjects from the Diabetes Prevention Parenteral Trial-Type 1, who were islet cell antibody (ICA)-positive, with low first-phase insulin response (FPIR) and/or abnormal glucose tolerance at baseline, were followed until clinical diabetes onset or study end (5-year follow-up). The prognostic performance of biomarkers was estimated using receiver operating characteristic (ROC) curve analysis and compared with nonparametric testing of ROC curve areas. Pearson correlation was used to assess the relationship between the markers.RESULTSIndividually, insulin autoantibody titer, ICA512A titer, peak C-peptide, 2-h glucose, FPIR, and FPIR/homeostasis model assessment insulin resistance provided modest but significant prognostic values for 5-year risk with a similar level of area under ROC curve ranging between 0.61 and 0.67. The combination of 2-h glucose, peak C-peptide, and area under the curve C-peptide significantly improved the prognostic accuracy compared with any solitary index (P < 0.05) with an area under ROC curve of 0.76 (range 0.70-0.81). The addition of antibody titers and/or IVGTT markers did not increase the prognostic accuracy further (P = 0.46 and P = 0.66, respectively).CONCLUSIONSThe combination of metabolic markers derived from the oral glucose tolerance test improved accuracy in predicting progression to type 1 diabetes in a population with ICA positivity and abnormal metabolism. The results indicate that the autoimmune activity may not alter the risk of type 1 diabetes after metabolic function has deteriorated. Future intervention trials may consider eliminating IVGTT measurements as an effective cost-reduction strategy for prognostic purposes.
<br/>来源：医学论坛网
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此项研究共纳入339例受试者，受试者基线时均伴有ICA阳性、初相胰岛素反应（FPIR）和（或）糖耐量异常。随访受试者至临床糖尿病始发或随访结束（5年）。利用受试者工作特征（ROC）曲线分析评估生物标志物的预测表现，并利用ROC曲线面积非参数检验加以对比。利用皮尔森相关系数评估标志物的相关性。
<!--more-->
结果显示，就个体而言，胰岛素抗体滴度、ICA512A滴度、C肽峰值、2小时血糖、FPIR和FPIR/内稳态模型评估胰岛素抵抗可为5年糖尿病风险提供适度但具有显著意义的预测值，并伴有相似的ROC曲线下面积。与独立指数相比，2小时血糖、C肽峰值和C肽曲线下面积可显著改善预测准确性，ROC曲线下面积为0.76。添加抗体滴度和/或IVGTT标志物未能进一步升高预测准确性。
<div id="ztload">
<div>
<div>
<img src="http://www.bioon.com/biology/UploadFiles/201207/2012071821283804.gif" alt="" width="113" height="149" border="0" hspace="0" />
<a title="" href="http://dx.doi.org/10.2337/dc12-0183" target="_blank">doi:10.2337/dc12-0183</a>
PMC:
PMID:
</div>
<div>
<br/><strong>Prognostic Accuracy of Immunologic and Metabolic Markers for Type 1 Diabetes in a High-Risk Population: Receiver operating characteristic analysis.</strong><br/>
Xu P, Beam CA, Cuthbertson D, Sosenko JM, Skyler JS, Krischer JP; and the DPT-1 Study Group.
OBJECTIVETo establish and compare the prognostic accuracy of immunologic and metabolic markers in predicting onset of type 1 diabetes in those with high risk in a prospective study.RESEARCH DESIGN AND METHODSA total of 339 subjects from the Diabetes Prevention Parenteral Trial-Type 1, who were islet cell antibody (ICA)-positive, with low first-phase insulin response (FPIR) and/or abnormal glucose tolerance at baseline, were followed until clinical diabetes onset or study end (5-year follow-up). The prognostic performance of biomarkers was estimated using receiver operating characteristic (ROC) curve analysis and compared with nonparametric testing of ROC curve areas. Pearson correlation was used to assess the relationship between the markers.RESULTSIndividually, insulin autoantibody titer, ICA512A titer, peak C-peptide, 2-h glucose, FPIR, and FPIR/homeostasis model assessment insulin resistance provided modest but significant prognostic values for 5-year risk with a similar level of area under ROC curve ranging between 0.61 and 0.67. The combination of 2-h glucose, peak C-peptide, and area under the curve C-peptide significantly improved the prognostic accuracy compared with any solitary index (P < 0.05) with an area under ROC curve of 0.76 (range 0.70-0.81). The addition of antibody titers and/or IVGTT markers did not increase the prognostic accuracy further (P = 0.46 and P = 0.66, respectively).CONCLUSIONSThe combination of metabolic markers derived from the oral glucose tolerance test improved accuracy in predicting progression to type 1 diabetes in a population with ICA positivity and abnormal metabolism. The results indicate that the autoimmune activity may not alter the risk of type 1 diabetes after metabolic function has deteriorated. Future intervention trials may consider eliminating IVGTT measurements as an effective cost-reduction strategy for prognostic purposes.
<br/>来源：医学论坛网
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