由血清甘油三酯和血糖所得简易指数用于评估胰岛素抵抗的临床研究

A simple index derived from triglycerides and blood glucose for identifying insulin resistance

目的在不同体重指数和糖耐量状态受试者中，比较由血甘油三酯和血糖所得简易胰岛素抵抗指数与两种传统方法稳态模型和静脉葡萄糖耐量试验（FSIGT）所得胰岛素抵抗指数（HOMA-IR和FSIGT-ISI）用于评估胰岛素抵抗的敏感性和特异性。方法共收集1024名受试者。其中，正常对照组240名，单纯性肥胖组335例，糖调节受损组312例及初发2型糖尿病组137例，均进行口服75g葡萄糖耐量试验及胰岛素释放试验，检测空腹血脂谱和其他重要生化指标。所有受试者中540名进行FSlGT。甘油三酯与空腹血糖所得简易指数为TyG，甘油三酯与餐后2h血糖所得简易指数为Tyc2。结果Pearson相关分析结果显示，TyG与HOMA-IR（r=0．427，P〈0．01）和FSIGT-ISI（r=-0．100，P=0．024）均显著相关。TyG2与HOMA-IR（r=0．455，P〈0．01）和FSIGT-ISI（r=-0．162，P〈0．01）亦显著相关。与HOMA-IR相比，TyG用于诊断胰岛素抵抗的敏感性和特异性分别为68．5％和63．5％，TyG2分别为81．7％和51．5％。与FSlGT．ISI相比，TyG用于诊断胰岛素抵抗的敏感性和特异性分别为68．5％和49．5％，YyG2分别为75．7％和48．2％。结论在中国人群中，TyG和TyC2可以作为胰岛素抵抗的简易评价指数。但由于其存在敏感性高而特异性低的特点。限制了其在大规模流行病学筛查中的应用。

Objective To compare the sensitivity and specificity of a new index of insulin resistance （IR） derived from plasma triglyeeride and glucose with homeostasis model assessment for insulin resistance index （ HOMA- IR） and insulin sensitivity index from frequent sampling intravenous glucose tolerance test （FSIGT-ISI）. Methods A total of 1 024 subjects （240 normal control, 335 with obesity, 312 impaired glucose regulation, and 137 type 2 diabetes mellitus） were included in the present study. Standard oral glucose tolerance test, insulin release test, lipid profiles, and other biochemical markers were measured. Among them 540 subjects were selected to undertake FSIGT. TyG index is derived from plasma triglyceride and fasting glucose. TyG2 index is derived from plasma triglyeeride and postprandial 2 plasma glucose. Results Pearson correlation coefficient between TyG and HOMA-IR or FSIGT-ISI was 0. 427 （ P〈0.01 ） and -0. 100 （ P=0. 024） , respectively, and that between TyG2 and HOMA-IR or FSIGT-ISI was 0. 455 （ P〈0.01 ） and - 0. 162 （ P 〈 O. 01 ）, respectively. The sensitivity and specificity of TyG index for diagnosis of IR was 68.5% and 63.5% compared with HOMA-IR, and 68.5% and 49.5% compared with FSIGT-ISI. For TyG2 index, the slightly higher sensitivity （81.7% with HOMA-IR, 75.7% with FSIGT-ISI）, but lower specificity （5l. 5% with HOMA-IR, 48.2% with FSIGT-IS1） were found. Conclusions Both TyG and TyG2 indices could be used as a surrogate for assessing IR in Chinese subjects. However, considering its moderately high sensitivity but low specificity, these two indices are limited in the use of large-scale epidemiological screening.