胰岛素抵抗指数在不同糖耐量人群中诊断代谢综合征的作用

The diagnostic significance of homeostasis model assessment of insulin resistance in metabolic syndrome among subjects with different glucose tolerance

目的 探讨胰岛素抵抗指数 (HOMA IR)在不同糖耐量人群中诊断代谢综合征 (MS)的作用。 方法 15 5 6 8名≥ 2 5岁的经口服 75 g葡萄糖耐量试验的人群被分为糖耐量正常 (NGT)组、糖调节受损 (IGR)组、新诊断糖尿病 (DM )组。MS诊断根据 1999年WHO定义 ,其中胰岛素抵抗(IR)采用胰岛素抵抗指数 (HOMA IR)判断。 结果 ( 1) 10 14 7名 2 5～ 74岁NGT人群的HOMA IR值上 1/4位点为 2 6 9。MS、IGR、DM、IR患病率 ( 2 0 0 0年中国人口年龄标化后 )分别为 5 9 0 %、19 5 8%、2 5 2 8%和 2 9 2 2 %。在IGR +DM组中MS人群伴发IR的频率为 4 5 30 %。 ( 2 )Logistic回归分析显示 :HOMA IR在NGT组与MS发生有关 ,在IGR +DM和总组中与MS发生无关。与MS发生相关性最强的是腰 /臀围比和血压。各方程预测MS发生的一致性高达 90 %以上 (P均 =0 0 0 0 1)。 结论 HOMA IR诊断MS的作用并不适宜于所有人群 ,在高血糖人群中不是一个灵敏的指标。在NGT人群中诊断MS ,HOMA IR判定IR可以作为一个简易、准确的指标。但在高血糖人群中诊断MS ,IR的评估应该综合判断。

Objective To explore the diagnostic significance of homeostasis model assessment of insulin resistance (HOMA IR)in metabolic syndrome among subjects with different glucose tolerance Methods Given 75g oral glucose tolerance test, 15,568 Chinese were divided into normal glucose tolerance(NGT) group, impaired glucose regulation(IGR) group, diabetes mellitus group Metabolic syndrome (MS) was diagnosed according to the definition proposed by WHO in 1999 Results (1) The cutoff point(2 69) of insulin resistance was defined as a HOMA IR exceeding the 75th percentile of the distribution in 10 147 NGT subjects aged 25～74 years The prevalence of the MS, IGR, DM and insulin resistance were 59 0%,19 58%, 25 28% and 29 22%(standardized to the 2000 Chinese population), respectively The distribution frequency of insulin resistance was 45 30% in MS subgroup of IGR+DM group (3) Logistic regression analysis demonstrated that waist hip ratio and blood pressure were significantly positively correlated with development of MS in NGT group, IGR+DM group, and general group But, HOMA IR was significantly positively correlated with development of MS in NGT group The predictable concordance on development of MS was 0 90 in every analysis model ( P =0 0001) Conclusions HOMA IR as a diagnostic index of MS is not suitable for all persons It is not sensitive in patients with hyperglycemia It is, however, a simple, accurate parameter for the diagnosis of MS in subjects with NGT In those patients with hyperglycemia, the diagnosis of insulin resistance depends on a variety of parameters