高胰岛素-正葡萄糖钳夹技术在不同人群中的建立条件比较  

Different establishing conditions of hyperinsulinemic-euglycemic clamp technique among different groups

作　　者：杨光[1] 李春霖[1] 田慧[1] 程时武[1] 李一君[1] 程晓玲[1] 方福生[1] 

机构地区：[1]解放军总医院南楼内分泌科,北京100853

出　　处：《中华医学杂志》2012年第34期2410-2414,共5页National Medical Journal of China

摘　　要：目的比较高胰岛素-正常葡萄糖钳夹技术在正常糖代谢（NGT）、正常血糖高胰岛素血症（HINS）和糖耐量低减（IGT）3组不同糖代谢人群中建讧条件的差异。方法应用高胰岛素一正常葡萄糖钳夹技术对10名NGT、11例HINS及10例IGT进行方法学研究，通过方差分析比较在3组人群中建立该技术的条件差异，用逐步回归分析探讨导致这种差异的影响因素。结果钳夹试验开始后，三组峰值和稳态期胰岛素浓度均〉100mU／L，稳态时期血糖变异系数均〈5％，且内源性胰岛素和肝糖输出得到完全抑制。NGT组、HINS组和IGT组的稳态时期平均葡萄糖输注率（M值）分别为（11．6±1．7）、（6．1±1．9）和（6．0±1．5）mg·kg-1·min-1。钳夹过程中，峰值及稳态期胰岛素浓度在IGT组和HINS组均显著高于NGT组，而HINS组和IGT组间差异无统计学意义（P=0．34、0．11）。影响峰值胰岛素浓度的独立危险因素为腰臀比，影响稳态时期胰岛素浓度的独立危险因素为胰岛素代谢清除率和体质指数，但M值并不受峰值和稳态时期胰岛素浓度的影响。结论在高胰岛素正葡萄糖钳夹实验建立过程中，NGT、HINS、IGT的峰值及稳态时期体内胰岛素水平存在差异，但并不影响M值对胰岛素抵抗水平的评估。Objective To compare the different establishing conditions of hyperinsulinemic- euglycemic clamp technique among the groups of normal glucose tolerance （ NGT）, hyperinsulinemia with normal glucose （HINS） and impaired glucose tolerance （IGT）. Methods The hyperinsulinemic-euglycemic clamp technique was applied to the study of methodology in 10 NGT, ll HINS and lO IGT subjects. Different establishing conditions were compared through variance analysis （ANOVA） among three groups. And the influencing factors resulting in these differences were analyzed through stepwise regression analysis. Results The serum insulin concentration of three groups were acutely raised and maintained at above 100 mU/L. During the steady stage, the blood glucose level remained stable and all coefficient variations were under 5% . The secretion of endogenous insulin and hepatic glucose production were completely inhibited during the test. Under these steady-state hyperinsulinemic-euglycemic conditions, the glucose infusion rate （M value） was equal to glucose disposal rate by all tissues in body, M value of three groups were as follows ： （ 11.6 ＋_ 1.7 ） , （ 6. 1 ＋ 1.9） and （6.0 ~ 1.5 ）mg ~ kg - i . min - i. During clamping, the peak and steady-state serum insulin concentrations of IGT and HINS groups were significantly higher than those of NGT group. Although the peak and steady-state serum insulin concentration of HINS group were higher than those of IGT group, the differences had no statistical significance （ P -- 0. 34, 0. 11 ）. The independent influencing factor of peak serum insulin concentration was waist-to-hip ratio （WHR） while the independent influencing factors of steady-state serum insulin concentration included insulin metabolic clearance rate （MCR） and body mass index （BMI）. The peak and steady-state serum insulin concentrations were not the independent influencing factors of M value. Conclusion During the establishment of hyperinsulinemic-euglycemie clamp technique, the differ

关 键 词：胰岛素抗药性 葡萄糖钳制技术 葡萄糖代谢障碍 胰岛素敏感性 

分 类 号：R587.1[医药卫生—内分泌]