Ⅱ型糖尿病患者的胰岛素抵抗指数分析

Analysis of homeostasis model assessment of insulin resistance in type Ⅱ diabetes mellitus patients

目的探讨胰岛素抵抗与Ⅱ型糖尿病发病的关系，并分析其可能的影响因素。方法随机收集Ⅱ型糖尿病患者117例、正常对照组109例，测定其身高、体重、腰围、臀围及空腹血糖和空腹胰岛素水平，估算胰岛素抵抗指数（HOMA—IR），比较上述指标在糖尿病患者和正常对照人群之间的差异；分析胰岛素抵抗指数与Ⅱ型糖尿病发病的关系。结果Ⅱ型糖尿病患者的BMI、腰臀围比（WHR）、空腹血糖、空腹胰岛素及胰岛素抵抗指数均显著高于正常对照组（P〈0．01）；胰岛素抵抗指数高于正常人的平均数者，其发生Ⅱ型糖尿病的危险度显著增加，OR=3．08，95％可限区间=1．72—5．51。经多元线性回归分析，发现Ⅱ型糖尿病患者腰／臀围比（WHR）与胰岛素抵抗指数有一定的关联（P=0．046）。结论Ⅱ型糖尿病的发生可能与胰岛素抵抗指数增高有关；检测腰／臀围比（WHR）是评价胰岛素抵抗程度的一种生理指标。

Objective To investigate the association between insulin resistance and type Ⅱ diabetes, and to search the factors that have effect on insulin resistance. Methods 117 cases with type Ⅱ diabetes mellitus and 109 sex-age matched normal controls were randomly selected from hospitalized patients and visitors. The height, weight, waist and hip circumference were measured. The blood-fasting glucose and insulin were assayed, and used to calculate the homeostasis model assessment of insulin resistance （HOMA-IR）. The differences of these biomarkers between diabetes and controls, and the association between the insulin resistence and type Ⅱ diabetes mellitus were analyzed. Results The levels of Body-mass index（BMI）, waist to hip ratio （WHR）,fasting-blood glucose, insulin and the insulin resistance in type Ⅱ diabetes mellitus group are significantly higher than those in control group （P〈0.01）.When using the mean of HOMA-IR in control as a cut off, the elevated level of insulin resistance was associated with a increased risk of type Ⅱ diabetes mellitus, Odds ratio （0R）=3.08, 95% C.I=1.72-5.51. The level of HOMA-IR was associated with the scale of WHR in a linear multiple variable regression, P=0.046. Conclusion The insulin resistance was associated with a increased risk of type Ⅱ diabetes. WHR is a useful measurement to evaluate the insulin resistance in adults.