利用Botnia钳夹试验评估新HOMA稳态模型

Assessing new homeostasis model assessment by Botnia clamp

目的研究新HOMA稳态模型（HOMA2）的胰岛素敏感性指数（HOMA2-％S）和分泌功能指数（HOMA2-％B）在临床中的应用价值。方法利用80例重庆地区多囊卵巢综合征妇女[正常糖耐量（NGT）组50人，糖调节受损（IGR）组30人]的口服葡萄糖耐量试验和Botnia钳夹试验资料，应用传统HOMA稳态模型（HOMA1）计算胰岛素敏感性指数HOMA1-ISI、分泌功能指数HOMA1-β和葡萄糖处置指数DI—HOMA1，借助新HOMA稳态模型计算胰岛素敏感性指数HOMA2-镯、分泌功能指数HOMA2-％B和葡萄糖处置指数DI—HOMA2，分别研究两种敏感性指数（HOMA1-ISI和HOMA2-％S）与Botnia钳夹试验稳态葡萄糖输注速率（GIR）的相关性，以及两种分泌功能指数（HOMA1-β和HOMA2-％B）与第-时相胰岛素分泌（AIR）的相关性。结果HOMA2-％S与GIR的Pearson线性相关系数为0．503（P〈0．01），HOMA1-ISI与HOMA2-％S的Pearson线性相关系数为0．990（P〈0．01）。HOMA2-％B与AIR的Pearson线性相关系数为0．382（P〈0．01），HOMA1-B与HOMA2-％B的Pearson线性相关系数为0．976（P〈0．01）。IGR组的葡萄糖处置指数DI—HOMA2和DI—HOMA1均明显小于NGT组（t=2．825，P〈0．01；t=2．222，P〈0．05）。结论与传统HOMA稳态模型（HOMAI）相比较，利用新HOMA稳态模型（HOMA2）计算的HOMA2-％S和HOMA2-％B是一对相对较好的胰岛素敏感性指数和分泌功能指数，可以广泛地应用于临床工作。

Objective To investigate the ability of insulin sensitivity index HOMA2-%S and secretion function index HOMA2-%B calculated by HOMA2, the new homeostasis model assessment, in clinical application. Methods Eighty female volunteers with polycystic ovary syndrome in Chongqing area [ 50 subjects with normal glucose tolerance （NGT group）and 30 subjects with impaired glucose regulation （IGR group）] were involved in this study. They underwent a 75 g oral glucose tolerance test （OGTT） and the Botnia clamp test. From the data of fasting blood samples in OGTT, insulin sensitivity index HOMAI-ISI, secretion function index HOMA1-β and disposal index DI-HOMA1 were calculated by the old homeostasis model assessment （ HOMA1 ）, meanwhile insulin sensitivity index HOMA2-%S, secretion function index HOMA2-%B and disposal index （DI-HOMA2） were calculated by the new homeostasis model assessment （HOMA2）. Correlation coefficients between insulin sensitivity index and GIR （ the glucose infusion rate at steady state of Botnia clamp test）, and between insulin secretion function index and AIR （the acute insulin response in Botnia clamp test） , were studied. Results The Pearson＇s linear correlation coefficient between HOMA2-%S and GIR （ r = 0. 503 ） , HOMAI-ISI and HOMA2-%S （ r = 0.990） ,HOMA2-%B and AIR （r = 0. 382）, HOMA1-β and HOMA2-%B （r = 0. 976） were all statistically significant（all P〈0.01 ）. The glucose disposal indexes calculated from the HOMA2 and HOMA1 of IGR group were significantly lower than those from the NGT group （t = 2. 825, P〈0. 01; t =2. 222, P〈0. 05）. Conclusion The HOMA2 is a better model in evaluating the insulin sensitivity and secretion function and is recommended to be widely used in clinical evaluation.