Botnia葡萄糖钳夹技术的建立和临床评价

The Establishment and Clinic Evaluation of Botnia Clamp in Healthy People and Obese Patients

目的通过对糖耐量正常者建立Botnia葡萄糖钳夹技术(Botnia钳夹术),评价在一次试验中同时测定胰岛β细胞功能和胰岛素抵抗方法的临床价值。方法选择60例糖耐量正常者,分为正常体质量组(30例)和肥胖组(30例),每组又按照钳夹术的不同分为正常Botnia钳夹组、正常正糖钳夹组、肥胖Botnia钳夹组和肥胖正糖钳夹组,各15例。正常Botnia钳夹组和肥胖Botnia钳夹组进行Botnia钳夹术,即将静脉注射葡萄糖耐量试验(IVGTT)与高胰岛素-正葡萄糖钳夹(正糖钳夹)试验联合,先进行IVGTT(0～60min),随后进行正糖钳夹术(60～180min);正常正糖钳夹组和肥胖正糖钳夹组进行正糖钳夹试验;对两种试验进行比较,评价Botnia钳夹术的价值。以正糖钳夹稳态期胰岛素介导的葡萄糖利用率(Rd)来判定周围组织胰岛素敏感性,以IVGTT测定的第一时相胰岛素分泌量(FPIR)与Rd值的乘积,即处置指数(DI)来判定β细胞功能。结果正常Botnia钳夹组和正常正糖钳夹组受试者的Rd值间差异无统计学意义(P=0.475);肥胖Botnia钳夹组和肥胖正糖钳夹组受检者的Rd值间差异亦无统计学意义(P=0.388);肥胖Botnia钳夹组受试者的Rd值显著低于正常Botnia钳夹组,差异有统计学意义(P=0.009)。两组受试者的FPIR值间差异无统计学意义(P=0.126),但对其用Rd校正之后,肥胖Botnia钳夹组受试者的DI值显著低于正常Botnia钳夹组,差异有统计学意义(P=0.005)。结论Botnia钳夹术中首先进行的IVGTT并不影响随后进行的正糖钳夹术,Botnia钳夹术能够实现在一次试验中同时测定胰岛β细胞功能和胰岛素抵抗。

Objective To validate and apply a method for independent assessment of insulin secretion and insulin sensitivity during the same test.Methods The Botnia clamp,that is an intravenous glucose tolerance test followed by a euglycemic-hyperinsulinemic clamp,was performed in 15 normal subjects and 15 cases of obesity with normal glucose tolerance.The rate of insulin-mediated glucose disposal（Rd）during the steady state of glucose clamp was used to assess the peripheral tissue insulin sensitivity.The disposition index （DI） is a measure of insulin secretion adjusted for insulin sensitivity and was calculated from the product of the FPIR and the Rd.Results It had no significant statistical difference when compared the Rd obtained during the Botnia clamp with the Rd from a euglycemic clamp without prior glucose bolus （P0.05）.Obese patients showed decreased Rd（6.27±2.59 mg·kg^-1·min^-1 vs 9.03±2.78 mg·kg^-1·min^-1,P=0.009）,but similar FPIR,compared with Healthy people.However,insulin secretion adjusted for the degree of insulin resistance was significantly impaired （P=0.005）.Conclusion The Botnia clamp provides reliable and independent measures of insulin sensitivity and β-cell function during the same test.