不同公式评估1型糖尿病胰岛素敏感性价值的研究  

Evaluation of insulin sensitivity with different formulas in type 1 diabetes mellitus

作　　者：吴胜兰 石梅 谢雨婷[2] 范黎 刘芳[2] 李霞[2] Wu Shenglan;Shi Mei;Xie Yuting;Fan Li;Liu Fang;Li Xia(Department of Endocrinology,Changsha Traditional Chinese Medicine Hospital,Eighth Hospital of Changsha,Changsha 410199,China;Department of Metabolism and Endocrinology,Second Xiangya Hospital,Central South University,National Clinical Research Center for Metabolic Diseases,Changsha 410011,China)

机构地区：[1]长沙市中医医院长沙市第八医院内分泌科,长沙410199 [2]中南大学湘雅二医院代谢内分泌科国家代谢性疾病临床医学研究中心,长沙410011

出　　处：《中华糖尿病杂志》2022年第8期771-777,共7页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：湖南省科技创新计划(2020RC4044)。

摘　　要：目的:探讨匹兹堡公式、SEARCH公式、1型糖尿病(T1DM)冠状动脉钙化(CACT1)公式和广东公式4个替代公式评估T1DM患者胰岛素敏感性的可行性和价值。方法:本研究为回顾性研究。收集2015年11月至2016年12月就诊于中南大学湘雅二医院T1DM综合管理门诊的患者。记录患者的腰围和臀围并计算腰臀比,收集其血压、空腹血糖(FPG)、糖化血红蛋白(HbA 1c)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)等资料。依据4个替代公式分别计算患者的胰岛素敏感指数(ISI),将ISI的上、下四分之一位数分别定义为低、高度胰岛素抵抗,上、下四分之一位数之间定义为中度胰岛素抵抗。根据年龄,将患者分为未成年组(≤18岁)和成年组(>18岁)。两组间比较采用t检验或Mann‐Whitney U检验,4个替代公式的一致性分析采用Kappa分析,采用Pearson或Spearman相关分析法分析不同公式计算的ISI与患者临床特征的相关性。结果:共纳入T1DM患者84例。其中,成年组40例,未成年组44例;高、中、低度胰岛素抵抗组分别为21、42、21例。广东公式和匹兹堡公式的一致性最好,一致性为78.6%,Kappa系数为0.657(P<0.01)。4个替代公式计算的ISI均与患者腰围(r值分别为-0.300、-0.697、-0.422和-0.349)、腰臀比(r值分别为-0.733、-0.514、-0.231和-0.678)、收缩压(r值分别为-0.241、-0.263、-0.356和-0.384)、FPG(r值分别为-0.355、-0.321、-0.359和-0.300)、TG(r值分别为-0.358、-0.700、-0.686和-0.423)、LDL-C(r值分别为-0.385、-0.369、-0.329和-0.428)呈负相关(均P<0.05)。匹兹堡公式、SEARCH公式、广东公式评估的ISI在未成年和成年组均与腰臀比(在未成年组r值分别为-0.651、-0.472、-0.631,在成年组r值分别为-0.755、-0.651、-0.730)、HbA 1c(在未成年组r值分别为-0.936、-0.843、-0.895,在成年组r值分别为-0.799、-0.752、-0.826)、TG(在未成年组r值分别为-0.449、-0.696、-0.499,在成年组r值分别为-0.353、Objective To explore the feasibility and the value of Pittsburgh formula,SEARCH formula,coronary artery calcification in type 1 diabetes mellitus(CACT1)formula and Guangdong formula in evaluating insulin sensitivity in patients with type 1 diabetes mellitus(T1DM).Methods This study was a retrospective study.The patients who were admitted into T1DM comprehensive management clinic of the Second Xiangya Hospital of Central South University from November 2015 to December 2016 were collected.Waist circumference and hip circumference were recorded,and waist-hip ratio was calculated.Their blood pressure,fasting plasma glucose(FPG),glycated hemoglobin A1c(HbA1c),triglyceride(TG)and low-density lipoprotein-cholesterol(LDL-C)were collected.According to the 4 alternative formulas,the insulin sensitivity index of patients was calculated,respectively.The upper and lower quartile of insulin sensitivity indexes were defined as low and high insulin resistance respectively,and between the upper and lower quartile of insulin sensitivity indexes were defined as moderate insulin resistance.According to age,the patients were divided into minor group(≤18 years old)and adult group(>18 years old).T test or Mann-Whitney U test was used for comparison between the two groups.Kappa analysis was used for consistency analysis of 4 alternative formulas.Pearson or Spearman correlation analysis was used to analyze the correlation between insulin sensitivity index calculated by different formulas and clinical features of patients.Results Eighty-four patients with T1DM were included.Among them,there were 40 cases in adult group and 44 cases in minor group.There were 21 cases in high insulin resistance group,42 cases in moderate insulin resistance group and 21 cases in low insulin resistance group.The consistency between Guangdong formula and Pittsburgh formula was the best,with the consistency rate of 78.6%and the Kappa coefficient of 0.657(P<0.01).The insulin sensitivity indices calculated by the 4 alternative formulas were negatively correlate

关 键 词：糖尿病 1型 胰岛素抵抗 胰岛素敏感性 

分 类 号：R587.1[医药卫生—内分泌]