胰岛素抵抗体内检测方法的探讨  

A methodological study on the evaluation of insulin resistance in vivo

作　　者：李芳萍[1] 程桦[1] 傅祖植[1] 杨桂芳[1] 刘顺莲[1] 

机构地区：[1]中山医科大学孙逸仙纪念医院内分泌科

出　　处：《中华内科杂志》1999年第5期316-319,共4页Chinese Journal of Internal Medicine

基　　金：广东省重点科研基金

摘　　要：目的探讨几种常用胰岛素抵抗（ＩＲ）体内检测方法的优缺点，并试图进行改良。方法分别用三种最小模型技术（ＭＭＴ），三种基础状态法，四种口服葡萄糖耐量试验（ＯＧＴＴ）法对１６例葡萄糖耐量正常（ＮＧＴ）者和１３例非胰岛素依赖型糖尿病（ＮＩＤＤＭ）病人计算胰岛素敏感性指数（ＩＳＩ），并以经典ＭＭＴ得出的ＩＳＩ为标准，其余方法得出ＩＳＩ与之进行比较和相关分析。结果除空腹血糖、空腹胰岛素比值（ＦＳＧ／ＦＩｎｓ）和ＯＧＴＴ葡萄糖、胰岛素曲线下面积比值（ＡＵＣｇ／ＡＵＣｉ）作为ＩＳＩ外，其余方法得出的ＩＳＩ均显示ＮＧＴ组高于ＮＩＤＤＭ组（Ｐ＜０．０５，ＩＳＩ相对值为１和０．４４～０．７０），与经典ＭＭＴ得出的ＩＳＩ相关性强（ｒ＝０．４５～０．９２，Ｐ＜０．０５）。结论ＭＭＴ取血时间点数减至１０～１２个，时间缩至１２０分钟是可行的。李光伟提出的基础状态法和自我平衡模型分析法是同效的，均非常简单，可粗略评估ＩＲ。Ｃｅｄｅｒｈｏｌｍ的ＯＧＴＴ法是一种简便、能正确评估ＩＲ的方法。本研究提出的两种ＯＧＴＴ法可能是较准确评估ＩＲ的方法。ＦＳＧ／ＦＩｎｓ和ＡＵＣｇ／ＡＵＣｉ作为ＩＳＩ均不是可靠的检测ＩＲ方法。Objective To investigate the advantage and disadvantage of several methods often used to evaluate insulin resistance and to attempt to modify the disadvantage. Methods Three protocols of minimal model technique (MMT), three protocols of basal state approach and four protocols of oral glucose tolerance test (OGTT) were used respectively to calculate insulin sensitivity index (ISI) in 16 subjects with normal glucose tolerance (NGT) and 13 patients with noninsulindependent diabetes mellitus (NIDDM) . ISI of classical MMT was regarded as standard ; ISI of other protocols were analyzed, assessed and compared with that of classical MMT. Results Except the ISI expressed by the ratio of fasting serum glucose to insulin concentration (FSG/FIns)and the ratio between area under curve (AUC) of glucose and insulin (AUCg/AUCi) in OGTT, ISI of other protocols was significantly higher in NGT group than in NIDDM group (P<0.05, ISI relative values were 1 and 0.440.70 respectively) and had stronger relationships as compared with ISI of classical MMT (r=0.450.92, P<0.05). Conclusion The modifications that reduce the samples to 12 or 10 and shorten the time to 120 min for MMT are feasible. Both the homeostasis model assessment and the basal state method designed by LI Guangwei are very simple; they can roughly evaluate insulin sensitivity. OGTT designed by Cederholm is a relatively simple and precise method of measuring IR.Two protocols of OGTT designed by the authors may be accurate methods for evaluating IR. Both FSG/FIns and AUCg/AUCi can not reliably evaluate insulin sensitivity.

关 键 词：糖尿病 非胰岛素依赖型 胰岛素 敏感性指数 ISI 

分 类 号：R587.102[医药卫生—内分泌]