Insulin Resistance and Risk Factors for Cardiovascular Disease in Young Adult Survivors of Childhood Acute Lymphoblastic Leukemia
Insulin Resistance and Risk Factors for Cardiovascular Disease in Young Adult Survivors of Childhood Acute Lymphoblastic Leukemia
复制标题
DOI：
10.1200/jco.2008.19.7251
复制
发表时间：
2009-08-01
影响因子：
45.3
通讯作者：
Vega, Gloria Lena
中科院分区：
文献类型：
--
作者：
Oeffinger, Kevin C.;Adams-Huet, Beverley;Vega, Gloria Lena
目的了解儿童急性淋巴细胞白血病（ALL）年轻成人幸存者中胰岛素抵抗及心血管疾病（CVD）危险因素的患病率。患者和方法在这项对118名儿童ALL幸存者（中位年龄23.0岁，范围18 - 37岁）的横断面评估中，使用胰岛素抵抗评估的稳态模型（HOMA-IR）估计胰岛素抵抗。在达拉斯心脏研究（DHS, N = 782）中，对来自同一地区的30- 37岁个体进行了性别特异性比较。所有幸存者根据有无颅放射治疗（CRT）进行分层。结果ALL女性幸存者的HOMA-IR （CRT，平均4.6,95% CI, 3.6 - 5.7；无CRT，平均3.3,95% CI, 2.8 - 3.8）明显高于DHS女性（平均2.4,95% CI, 2.2 - 2.7）。80%接受CRT治疗的女性至少有六种心血管疾病危险因素中的三种，与DHS女性相比，她们更有可能有三种或更多的危险因素（优势比[or]， 5.96; 95% CI， 2.15至16.47）。男性ALL幸存者的HOMA-IR （CRT，平均4.0,95% CI， 2.8至5.6；无CRT，平均3.4,95% CI， 2.9至3.9）明显高于DHS男性（平均2.3,95% CI， 2.1至2.6），但不太可能有多种心血管疾病危险因素。结论：与来自同一社区的老年人队列相比，所有幸存者的胰岛素抵抗患病率增加。重要的是，接受CRT治疗的女性似乎有多种心血管疾病危险因素的患病率增加，需要密切监测和降低风险的策略。中华临床杂志，27(3):398 -3704。(C) 2009年美国临床肿瘤学会
PurposeTo determine the prevalence of insulin resistance and other risk factors for cardiovascular disease (CVD) in young adult survivors of childhood acute lymphoblastic leukemia (ALL).Patients and MethodsIn this cross-sectional evaluation of 118 survivors of childhood ALL (median age, 23.0 years; range, 18 to 37 years), insulin resistance was estimated using the homeostasis model for assessment of insulin resistance (HOMA-IR). Sex-specific comparisons were made with a cohort of 30-to 37-year-old individuals from the same region participating in the Dallas Heart Study (DHS, N = 782). ALL survivors were stratified by treatment with and without cranial radiotherapy (CRT).ResultsFemale ALL survivors had a significantly higher HOMA-IR (CRT, mean 4.6, 95% CI, 3.6 to 5.7; no CRT, mean 3.3, 95% CI, 2.8 to 3.8) in comparison with DHS women (mean 2.4, 95% CI, 2.2 to 2.7). Eighty percent of women treated with CRT had at least three of six CVD risk factors, and they were significantly more likely to have three or more risk factors compared with DHS women (odds ratio [OR], 5.96; 95% CI, 2.15 to 16.47). Male ALL survivors had a significantly higher HOMA-IR (CRT, mean 4.0, 95% CI, 2.8 to 5.6; no CRT, mean 3.4, 95% CI, 2.9 to 3.9) in comparison with DHS men (mean 2.3, 95% CI, 2.1 to 2.6), but were not more likely to have multiple CVD risk factors.ConclusionALL survivors had an increased prevalence of insulin resistance in comparison with a cohort of older individuals from the same community. Importantly, women treated with CRT seem to have an increased prevalence of multiple CVD risk factors, warranting close monitoring and riskreducing strategies. J Clin Oncol 27: 3698-3704. (C) 2009 by American Society of Clinical Oncology