中国内脏脂肪指数对中国成人生长激素缺乏患者胰岛素抵抗的评估作用

Significance of visceral adipose index on evaluating insulin resistance in Chinese adult patients with growth hormone deficiency

目的探讨中国内脏脂肪指数(CVAI)对中国成人生长激素缺乏(AGHD)患者胰岛素抵抗(IR)的评估作用。方法纳入2010年6月-2017年6月在重庆医科大学附属第一医院确诊的77例AGHD患者和同期77名健康人作为研究对象。以1994年全国糖尿病防治协作组调查库中10 147名25~74岁糖耐量正常人群的胰岛素抵抗指数(HOMA-IR)上1/4位点的2.69作为判断IR的切割点,将AGHD患者分为IR组和胰岛素敏感(IS)组。根据CVAI的四分位数将AGHD患者分为4组。测定人体测量学参数,糖脂生化指标,计算腰臀比(WHR)、体重指数(BMI),以稳态模型评价HOMAIR、脂质蓄积指数(LAP)、内脏脂肪指数(VAI)和CVAI。通过绘制受试者工作特征(ROC)曲线,计算BMI、WHR、腰围(WC)、LAP、VAI、CVAI曲线下面积,评估CVAI对IR的评估作用。结果 AGHD组BMI、WC、臀围(HC)、舒张压(DBP)、空腹胰岛素(FINS)、HOMA-IR、LAP、VAI、CVAI均明显高于对照组(P<0.05),而高密度脂蛋白(HDL-C)明显低于对照组(P<0.05)。IR组体重、BMI、WC、HC、空腹血糖(FPG)、FINS、HOMA-IR、三酰甘油(TG)、LAP、VAI、CVAI均明显高于IS组(P<0.05),而IGF-1、HDL-C明显低于IS组(P<0.05)。根据AGHD患者的CVAI四分位数分为4组进行比较,年龄、身高、体重、BMI、WC、HC、WHR、FINS、HOMA-IR、TG、LAP、VAI随CVAI递增而增高(P<0.05),而HDL-C、胰岛素样生长因子(IGF-1)随CVAI的递增而降低(P<0.05)。ROC曲线分析显示CVAI曲线下面积(0.899)最大,CVAI的最佳临界值为89.26,具有较高的灵敏度和特异度。结论与其他体脂指标相比,CVAI能更准确地筛查和评估中国AGHD患者IR。

Objective To investigate the significance of Chinese visceral adipose index(CVAI) on predicting insulin resistance(IR) in Chinese adult patients with growth hormone deficiency(AGHD). Methods Seventy-seven AGHD patients, admitted from Jun. 2016 to Jun. 2017 in the First Affiliated Hospital of Chongqing Medical University, and 77 healthy people matched with age and gender were enrolled as the subjects. The cut-off point for judging IR was 2.69 that was at the upper quartile of the homeostasis model assessment of insulin resistance(HAMA-IR) value of 10 147 subjects aged 25-74 with normal glucose tolerance in the National Diabetes Prevention and Treatment Cooperative Group Survey Bank in 1994. Based on the cut-off point, AGHD patients were divided into IR group and insulin sensitivity(IS) group. Based on CVAI quartile, the AGHD patients were divided into 4 groups. The general anthropometric parameters and glycolipid biochemical index were measured, and waist hip index(WHR), body mass index(BMI), HOMA-IR, lipid accumulation product(LAP), visceral adipose index(VAI) and CVAI were calculated. The calculated area under curve(AUC) of receiver operating characteristic(ROC) curve was used to evaluate the significance of BMI, WHR, waist circumference(WC), LAP, VAI and CVAI in the prediction of IR among AGHD patients. Results The levels of BMI, WC, hip circumference(HC), diastolic blood pressure(DBP), fasting insulin(FINS), HOMA-IR, LAP, VAI and CVAI were obviously higher(P<0.05), and of high density lipoprotein cholesterol(HDL-C) was markedly lower(P<0.05) in AGHD group than those in control group. The weight, DBP, fasting plasma glucose(FPG), FINS, HOMA-IR, triglyceride(TG), CVAI, LAP and VAI were significantly higher(P<0.05) and insulin-like growth factor 1(IGF-1), HDL-C were significantly lower(P<0.05) in IR group than those in IS group. The age, height, weight, BMI, WC, HC, WHR, FINS, HOMA-IR, TG, LAP and VAI were increased(P<0.05) and HDL-C and IGF-1 decreased(P<0.05) along with the CVAI increase. The ROC curve showed the largest area under the CVAI curve(0.899), the optimal critical value of CVAI was 89.26, which showed higher sensitivity and specificity. Conclusion Compared with the other body adipose index, CVAI may be more accurately able to screen and evaluate IR in Chinese patients with AGHD diseases.