Metabolic Syndrome Biomarkers Predict Lung Function Impairment A Nested Case-Control Study
Metabolic Syndrome Biomarkers Predict Lung Function Impairment A Nested Case-Control Study
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DOI：
10.1164/rccm.201109-1672oc
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发表时间：
2012-02-15
影响因子：
24.7
通讯作者：
Nolan, Anna
中科院分区：
文献类型：
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作者：
Naveed, Bushra;Weiden, Michael D.;Nolan, Anna
理论基础：横断面研究表明代谢综合征和肺功能受损之间存在关联。目的：确定代谢综合征生物标志物是否是刺激性暴露后肺功能丧失的危险因素。方法：对纽约消防局人员进行嵌套病例对照研究，研究对象为9.11 FEV1前正常的纽约消防局人员，以及2008年3月10日之前提交专科肺部评估的人员。我们将世贸中心粉尘暴露后6个月内获得的代谢综合征生物标志物与随后的FEV1进行了关联。测量和主要结果：2001年9月11日起6个月内首次监测时采集的临床资料和血清，测定体重指数、心率、血糖、甘油三酯、高密度脂蛋白、瘦素、胰多肽和胰淀素。在调整了年龄、种族、体重指数和到达世贸中心时间的多生物标记物模型中，高密度脂蛋白低于40 mg/dl、甘油三酯大于或等于150 mg/dl、心率大于或等于66次/分、瘦素大于或等于10,300 pg/ml的患者和对照组之间存在显著差异。在调整了年龄、种族、体重指数和到达世贸中心时间的多生物标记物模型中，每个患者在肺部评估时FEV1异常的几率增加了两倍以上，而胰淀素大于或等于116 pg/ml的几率降低了84%。该模型的敏感度为41%，特异度为86%，受试者操作特征面积低于0.77。结论：甘油三酯和高密度脂蛋白异常、心率和瘦素升高是9·11事件后易患肺功能损害的独立危险因素，而胰淀素升高具有保护作用。代谢生物标志物是肺部疾病的预测因子，可能有助于评估吸入颗粒物导致肺功能受损的风险。
Rationale: Cross-sectional studies demonstrate an association between metabolic syndrome and impaired lung function.Objectives: To define if metabolic syndrome biomarkers are risk factors for loss of lung function after irritant exposure.Methods: A nested case-control study of Fire Department of New York personnel with normal pre-September 11th FEV1 and who presented for subspecialty pulmonary evaluation before March 10, 2008. We correlated metabolic syndrome biomarkers obtained within 6 months of World Trade Center dust exposure with subsequent FEV1. FEV1 at subspecialty pulmonary evaluation within 6.5 years defined disease status; cases had FEV1 less than lower limit of normal, whereas control subjects had FEV1 greater than or equal to lower limit of normal.Measurements and Main Results: Clinical data and serum sampled at the first monitoring examination within 6 months of September 11, 2001, assessed body mass index, heart rate, serum glucose, triglycerides and high-density lipoprotein (HDL), leptin, pancreatic polypeptide, and amylin. Cases and control subjects had significant differences in HDL less than 40 mg/dl with triglycerides greater than or equal to 150 mg/dl, heart rate greater than or equal to 66 bpm, and leptin greater than or equal to 10,300 pg/ml. Each increased the odds of abnormal FEV1 at pulmonary evaluation by more than twofold, whereas amylin greater than or equal to 116 pg/ml decreased the odds by 84%, in a multibiomarker model adjusting for age, race, body mass index, and World Trade Center arrival time. This model had a sensitivity of 41%, a specificity of 86%, and a receiver operating characteristic area under the curve of 0.77.Conclusions: Abnormal triglycerides and HDL and elevated heart rate and leptin are independent risk factors of greater susceptibility to lung function impairment after September 11, 2001, whereas elevated amylin is protective. Metabolic biomarkers are predictors of lung disease, and may be useful for assessing risk of impaired lung function in response to particulate inhalation.