不同方法评估不同糖代谢人群胰岛素抵抗结果的分析

Analysis of result with different methods to assess insulin resistance in different status of glucose metabolism

目的探讨临床工作中不同糖代谢状态下不同胰岛素抵抗评估方法的可靠性.方法对25～73岁的正常糖耐量(NGT)者448例;空腹血糖受损(IFG)者56例;糖耐量受损(IGT)者197例;IFG合并IGT(IFG+IGT)者63例;糖尿病(DM)患者225例,采用以下6种方法评估不同糖代谢状态下胰岛素抵抗程度:(1)OGTT计算胰岛素敏感指数;(2)HOMA-IR;(3)李光伟胰岛素敏感指数[1/(FINS×FPG)];(4)胰岛素曲线下面积(AUCinsulin);(5)葡萄糖曲线下面积/胰岛素曲线下面积比值(AUCglucose/AUCinsulin);(6)空腹血糖/空腹胰岛素比值(FPG/FINS).结果OGTT计算胰岛素敏感指数、HOMA-IR以及1/(FINS ×FPG)显示,IFG、IFG+IGT、IGT、DM组胰岛素抵抗显著高于NGT(P＜0.05),而DM组显著高于NGT、IFG、IFG+IGT、IGT组(P＜0.05);AUCinsulin显示,IGT组胰岛素抵抗显著高于NGT、IFG、IFG+IGT、DM组(P＜0.05),而DM组显著低于NGT、IFG、IFG+IGT、IGT组(P＜0.085);AUCglucose/AUCinsulin、FPG/FINS显示,NGT、IFG、IFG+IGT、IGT四组患者之间胰岛素抵抗差异无显著性(P＞0.05),而DM组显著高于NGT、IFG、IFG+IGT、IGT组(P＜0.05).结论OGTT计算胰岛素敏感指数、1/(FINS×FPG)与HOMA-IR得出结果基本一致,并且OGTT计算胰岛素敏感指数可以分辨不同糖调节异常状态下胰岛素抵抗程度;AUCinsulin、AUCglucose/AUCinsulin、FPG/FINS不能准确分辨不同糖代谢人群胰岛素抵抗程度.

Objective To investigate the reliability of different methods to assesse insulin resistance in different status of glucose metabolism in clinical work. Methods Normal glucose tolerance（ NGT, n = 448） , isolated impaired fasting glucose （IFG, n = 56 ） , isolated impaired glucose tolerance （IGT, n = 197） , combined IFG and IGT （ IFG ＋ IGT, n = 63 ） , diabetes （ DM, n=225 ） aged 25 - 73 years were studied. Insulin sensitivity index from OGTI＇, HOMA-IR, 1/（ FINS × FPG）, AUCinsulin, AUCglucose/AUCinsulin, FPG/FINS were applied to assess the status of insulin resistance respectively. Results Insulin sensitivity index from OGTI＇, HOMA-IR and 1/（ FINS × FPG） demonstrated that insulin resistance was higher in subjects with IFG, IFG ＋ IGT and IGT and DM than that with NGT （ P 〈 0.05 ）, and lower in subjects with NGT and IFG,IFG ＋ IGT and IGT than that with DM （P 〈 0.05 ）. Insulin resistance index of AUCinsulin, demonstrated that subjects in IGT was higher than in subjects with NGT, IFG and IFG ＋ IGT, while there was lower in DM than in other four groups subjects （P 〈 0.05 ）. Compared with subjects in NGT, IFG, IFG ＋ IGT and IGT, subjects with DM had lower AUCglucose/AUCinsulin, FPG/FINS （P 〈 0.05 ）, but had no difference among NGT,IFG,IFG ＋ IGT and IGT （ P 〉 0.05）. Conclusion Insulin sensitivity index from OGTI＇, HOMA-IR, 1/（ FINS x FPG） in assessment of insulin resistance had no difference. Moreover insulin sensitivity index from OGTI＂ could identify insulin resistance among subjects with IFG, IFG ＋ IGT and IGT. The insulin resistance of the different status of glucose metabolism couldn＇ t be identified exactly by AUCinsulin, AUCglucose/AUCinsulin, FPG/FINS.