背景:高胰岛素血症患者最初可能不符合代谢综合征的任何诊断标准,尽管显示出心血管并发症与肥胖的风险更高,糖尿病,和高血压。
目的:本研究的主要目的是评估高胰岛素血症儿童和青少年中各种心血管风险指数的诊断准确性;次要目的是评估这些指数的最佳临界值。
方法:这项回顾性单中心研究对139名患者进行,年龄为12.1±2.9岁,管理高胰岛素血症。
结果:我们发现胰岛素抵抗指数(HOMA-IR)的稳态模型评估存在统计学上的显着差异,甘油三酯葡萄糖指数(TyG),TyG-体重指数,内脏肥胖指数,脂质积累产物指数,脂肪肝指数,和肝脂肪变性指数。在线性逻辑回归评估中,我们发现胰岛素生长因子-1(IGF-1),HOMA-IR,ALT/AST比值与证实的高胰岛素血症独立相关。在多变量分析中,超过203ng/mL的IGF-1水平和高于6.2的HOMA-IR分别与高胰岛素血症的9倍和18倍的比值比相关。其他研究参数与高胰岛素血症没有显着相关,并且无法预测我们患者的高胰岛素血症或随后的心血管风险。
结论:成人心血管危险的常用指标不能被认为是准确的,以确认儿童高胰岛素血症,除了HOMA-IR。需要进一步的研究来验证特定心血管风险指数在高胰岛素血症儿童和青少年中的有用性。
BACKGROUND: Individuals with hyperinsulinemia may initially not meet any diagnostic criteria for metabolic syndrome, though displaying a higher risk of cardiovascular complications combined with obesity, diabetes, and hypertension.
OBJECTIVE: The main objective of our study was to assess the diagnostic accuracy of various cardiovascular risk indices in hyperinsulinemic children and adolescents; a secondary objective was to estimate the optimal cut-offs of these indices.
METHODS: This retrospective single-center study was conducted on 139 patients aged 12.1 ± 2.9 years, managed for
hyperinsulinism.
RESULTS: We found statistically significant differences in homeostasis model assessment of insulin resistance index (HOMA-IR), triglyceride glucose index (TyG), TyG-body mass index, visceral adiposity index, lipid accumulation product index, fatty liver index, and hepatic steatosis index. At the linear logistic regression assessment, we found that insulin growth factor-1 (IGF-1), HOMA-IR, and ALT/AST ratio were independently associated with confirmed
hyperinsulinism. At the multivariate analysis, IGF-1 levels over 203 ng/mL and HOMA-IR higher than 6.2 were respectively associated with a 9- and 18-times higher odds ratio for
hyperinsulinism. The other investigated parameters were not significantly related to
hyperinsulinism, and could not predict either the presence of hyperinsulinemia or a subsequent cardiovascular risk in our patients.
CONCLUSIONS: Commonly used indices of cardiovascular risk in adults cannot be considered accurate in confirming
hyperinsulinism in children, with the exception of HOMA-IR. Further studies are needed to verify the usefulness of specific cardiovascular risk indices in hyperinsulinemic children and adolescents.