血浆葡萄糖、胰岛素比值是可靠的胰岛素敏感性指数吗?

Isplasmaglucose/insulinratioareliableinsulin┐sensitivityindexinpopulation┐basedstudy?

本文５０８例资料显示，国内、外文献中常用的空腹血糖（ＦＰＧ）与胰岛素（ＦＩＮＳ）比值——Ｇ／Ｉ不能对非糖尿病人群的胰岛素敏感性（ＩＳ）做出正确评估：（１）在ＩＳ逐渐降低表现为ＦＰＧ及ＦＩＮＳ水平都依次递增的各组中，Ｇ／Ｉ判定的ＩＳ在相应各组间差异无显著性；（２）在ＩＳ降低表现为ＦＩＮＳ水平相似而ＦＰＧ较高的各组中，Ｇ／Ｉ值对ＩＳ做出与实际完全相反的判断。表明在ＩＳ降低表现为ＦＰＧ、ＦＩＮＳ同步升高者，Ｇ／Ｉ完全丧失正确判定ＩＳ的能力。在ＩＳ降低仅表现为血糖水平升高而β细胞不能代偿性增加ＦＩＮＳ者，Ｇ／Ｉ也不是评价ＩＳ的可靠指数。

Thepresentstudyaimedatevaluatingthereliabilityoftheplasmsglucose/insulinra-tioasaninsulin-sensitivity-indexin508casesofnon-diabeticsincluding201subjectswithnormalglu-cosetolerance(male101,female100)and307subjectswithimpairedglucosetolerance(male159,female148)aged25to74yearsold.Althesubjectswereautomaticalystratifiedtoseveralgroupsbyelectroniccomputoracordingtotheirfastingplasmaglucoseandinsulinlevels.Theresultsshowedthatthecommonlyusedfastingplasmaglucose/insulinratio(FPG/FINS,G/I)inliteraturecannotevaluatetheinsulin-sensitivity(IS)correctlyinnon-diabetics:(1)BothFINSandFPGwereraisinggradulyamongsubgroups1to3ingroupA,B,C,D,EandFrespectively,whichdemon-stratedtheISleveldeclinedgradulyineachthreesubgroups.HowevertheG/IindicatedISinthesecorrespondingsubgroupshadnosignificantdiference.(2)GroupK2comparedwithH2,groupM1comparedwithJ1andgroupM3comparedwithI3hadhigherFPGlevel(5.76vs4.65,6.59vs5.27and6.78vs5.02mmol/L)atthepresenceofsimilarFINSlevel(16.9vs16.9,10.1vs10.2and35.8vs35.5μU/ml),whichdemonstratedthattheISlevelingroupK2,M1andM3werepoorthanthatingroupH2,J1andI3respectively.HowevertheG/IgavetheinversejudgmenttotheISbe-tweeneachcorrespondingsubgroups:K2>H2(0.35>0.28,P<0.001),M1>J1(0.67>0.53,P<0.001)andM3>I3(0.20>0.15,P<0.001).Incontrastwiththe′ratio′,thereverseoffastingplasmglucose-insulinproductefectivelyevaluatedtheISintheabovementionedcondition.Thuswecon-cludethattheglucose/insulinratiowasnotareliableindexfortheestimatingofinsulinsensitivityinthepopulation-basedstudy.