不同指标在评价肥胖儿童胰岛素抵抗中的价值

Value of Different Indexes in Evaluating Insulin Resistance in Obese Children

目的探讨单纯性肥胖儿童胰岛素抵抗临床评估的指标。方法对单纯性肥胖和正常对照儿童进行葡萄糖耐量试验和胰岛素释放试验,在试验前及试验后30、60、120、180 min分别测血糖和胰岛素,并计算稳态模型胰岛素抵抗指数(HOMA-IR)、敏感指数(HOMA-IAI)、胰岛素分泌功能(HOMA-IS)、血糖曲线下面积与胰岛素曲线下面积比及空腹血糖和空腹胰岛紊的比值(FBG/FINS)等胰岛素抵抗评价指标。结果肥胖组FINS明显高于对照组,FBG、HOMA-IS与对照组无显著差异。HOMA-IR和HOMA-IAI之间具有显著相关性,r为-1,与FINS的r分别为0.913和-0.913,与FBG/FINS的r分别为-0.889和0.889,与曲线下面积比的r分别为-0.523和-0.523,P均<0.01。结论FINS、HOMA-IR、HOMA-IAI、血糖与胰岛素曲线下面积比、FBG/FINS均适用于肥胖儿童胰岛素抵抗的评估,尤以FINS、HOMA-IR、HOMA-IAI更可取。

Objective To explore the effect of different indexes on evaluating insulin resistance in obese children. Methods Oral glucose tolerance test （OGTT） was performed in obese children （ n ： 61 ） and age - matched normal volunteers（ n = 23 ）. Serum glucose and insulin levels were determined at 0,30,60,120,180 rnin after OGTT, insulin resistance was estimated by homeostasis model assessment of irLsulin resistance （HOMA- IR）. Indexes such as the ratk） of area under the curve of glucce, e（AUCG）/area under the curve of insulin（AUCI ）, the ratio of fasting blood sugar（FBG） and fasting blood insulin （FINS） were meanwhile calculated. Results The level of serum FINS was significantly higher in obese children（ P〈 0.01 ） compared with age - matched normal volunteers. There were no difference in FBG and HOMA- IS between the two groups. In obese children, the correlation between HOMA - IR and HOMA - IAI was found;the correlation- efficient was - 1 ; the correlation of HOMA - IR and HOMA - IA with FINS, FBG/FINS and AUCS/ AUCI were 0. 913 and - 0. 913, - 0. 889 and 0. 889 , - 0. 523 and - 0. 523, P 〈 0.01 respectively. Conclusions FINS, HOMA- IR,HOMA- IAI ,AUCS/AUCI and FBG/FINS might be used as the indexes of evaluating insulin resistance in obese children. However,FINS, HOMA - IR AND HOMA - IAI are more suitable aniong these indexes. Further investigation is needed to determine whether these indexes can be efficient in other children,particularly in type 1 diabetic patients.