上海地区40岁以上自然人群中胰岛素抵抗现况及特征分析

Study of insulin resistance among Chinese population over 40 in Shanghai area

目的 评价胰岛素抵抗指数 (稳态模式评估法HOMA IR)的可靠性 ,并应用HOMA IR估测自然人群中胰岛素抵抗伴发情况。方法 联合应用高胰岛素 正葡萄糖钳夹及 3 3 H葡萄糖示踪技术对 2 9例上海地区中国人进行机体胰岛素敏感性测定 ,同时评价HOMA IR的敏感性、特异性及准确度。应用HOMA IR估测上海华阳社区基线调查人群 (1873人 )胰岛素抵抗伴发情况。结果 1.HOMA IR估测机体胰岛素抵抗的敏感性为 86 .4% ,特异性为 71.4% ,诊断符合率为 82 .8%。 2 .本基线调查人群中糖尿病、糖耐量减退 /空腹血糖减损、高三酰甘油 /低 高密度脂蛋白血症 (高TG/低HDL血症 )、高血压者伴胰岛素抵抗的频率分别为 6 2 .5 %、41.7%、30 .8%及 32 .0 %。 3.胰岛素抵抗发生频率随体块指数 (BMI)及代谢异常成分的增加而升高 (趋势分析P <0 .0 0 1)。 4.Logistic分析表明 ,胰岛素抵抗对高血糖的影响最大 ,其次为高TG/低HDL血症。 结论 以HOMA IR估测机体胰岛素抵抗有较高的准确度。胰岛素抵抗在人群中 ,尤其是成人常见病中普遍存在 ,但对不同代谢紊乱成分的影响及参与程度并不一致。

Objective To evaluate the reliability of homeostasis model assessment (HOMA) for estimating insulin sensitivity, as well as to investigate the insulin resistance of base line survey people by HOMA IR. Methods The hyperinsulinemic euglycemic clamp combined with 3 3H glucose infusion were performed in 29 Chinese individuals to determine the glucose disposal rate and assess the sensitivity, specificity and accuracy of HOMA IR (HOMA insulin resistance index). The current status of insulin sensitivity in Shanghai Huayang community survey(n=1873)was estimated by HOMA IR. Results 1.In comparison with the glucose disposal rate by glucose clamp, the sensitivity、specificity、accuracy of HOMA IR was 86.4%、71.4% and 82.8%, respectively. 2. In diabetes、impaired glucose tolerance and/or impaired fasting glucose、hypertriglyceridemia and/or low high density lipoprotein cholesterol(H TG/L HDL) and hypertensives, about 62.5%、41.7%、30.8% and 32.0% suffered from insulin resistance respectively. 3.With the rise of BMI or metabolic disorders, the frequency of insulin insensitivity was also increased (P for trend, P <0.001). 4. Results of logistic regression analysis revealed that insulin resistance had a major effect on hyperglycemia, and that on H TG/L HDL being the next. Conclusion HOMA IR in the estimation of insulin resistance has a higher accuracy,while insulin resistance is common among the adults, especially in those with metabolic disorders.