关于优化胰岛素低血糖-生长激素刺激试验中胰岛素用量计算方法的初步探索  

Optimizing the method in calculating the insulin dosages in the insulin hypoglycemia-growth hormone stimulation test： preliminary exploration

作　　者：张豫文[1] 孙首悦[1] 陈宇红[1] 贾慧英[1] 齐研[1] 郁忠勤[1] 王卫庆[2] 宁光[2] 

机构地区：[1]上海交通大学医学院附属瑞金医院北院内分泌科,201801 [2]上海市内分泌代谢病临床医学中心、上海市内分泌代谢病研究所、上海交通大学医学院附属瑞金医院内分泌代谢病科

出　　处：《中华内分泌代谢杂志》2017年第1期29-33,共5页Chinese Journal of Endocrinology and Metabolism

基　　金：中华医学会临床医学科研专项资金-下丘脑垂体研究项目（13050930478）;上海申康医院发展中心新兴前沿技术项目（SHDC12012102）

摘　　要：目的初步探索更适用于临床的胰岛素低血糖-生长激素刺激试验（ITT）中胰岛素用量的计算方法。方法56例疑似生长激素缺乏症患者，按原发性与继发性分为2组，2组患者均完善口服葡萄糖耐量-胰岛素释放试验及ITT。计算稳态模型评估的胰岛素抵抗指数（HOMA-IR）、胰岛素敏感指数（ISI）、胰岛素释放曲线下面积（AUCINS）、葡萄糖曲线下面积（AUCPG）。比较ITT中组间胰岛素用量的差异，并分析影响胰岛素用量的主要因素。结果原发组与继发组在ITT中的胰岛素用量无明显差异。指南中的胰岛素初始用量与本研究人群实际胰岛素用量有显著性差异；多元线性回归分析发现AUCINS及体重指数是影响胰岛素用量的独立因素，并得到ITT优化系数（γ）的计算方程式。结论临床上ITT中实际使用的胰岛素量与指南中的推荐用量存在差异，因而为了使ITT试验进行得更加高效而安全，本研究探索性提出了用更优化的计算方法以帮助提高ITT中胰岛素诱发低血糖的一次成功率。Objective To explore more suitable calculation method of the insulin dosage in insulin hypoglycemia-growth hormone stimulation test（insulin tolerance test, ITT）.Methods Fifty-six subjects suspected of growth hormone deficiency were divided into primary and secondary onset groups. All the patients took oral glucose tolerance test and ITT. Homeostasis model of assessment for insulin resistance index（HOMA-IR）and insulin sensitivity index（ISI）, area under insulin curve（AUCINS）and the area under glucose curve（AUCPG）were calculated. The insulin dosages during ITT between two groups were compared and the main factors influencing the insulin dosage were analyzed.Results There was no difference in the insulin dosage during ITT between primary and secondary groups. The actual dosage of insulin in this cohort study revealed a significant difference from the initial insulin dosage recommended by the guideline. Multiple linear regression analysis found that AUCINS and body mass index were the independent factors affecting the insulin dosage. Then the optimized coefficient of ITT（γ）were found.Conclusion The insulin dosage used in our study was inconsistent with the guidelines-recommended ones. In order to make ITT more efficient and safer, a more optimized calculation method to improve the successful rate of insulin-induced hypoglycemia in ITT is proposed.

关 键 词：胰岛素低血糖-生长激素刺激试验 口服葡萄糖耐量-胰岛素释放试验 胰岛素释放曲线下面积 优化系数 

分 类 号：R58[医药卫生—内分泌]