利用高胰岛素-正葡萄糖钳夹技术评估肥胖患者血清白蛋白水平与胰岛素敏感性的相关性研究

Assessing the relationship between serum albumin and insulin sensitivity in patients with obesity by hyperinsulinemic-euglycemic clamp

目的:利用高胰岛素-正葡萄糖钳夹技术评估肥胖患者血清白蛋白(ALB)水平与胰岛素敏感性的相关性。方法:回顾性分析2015年1月至2018年12月南京医科大学第一附属医院内分泌科行高胰岛素-正葡萄糖钳夹试验的患者144例,将患者分为3组,包括正常体重指数糖调节正常组(NNGR)37例,肥胖糖调节正常组(ONGR)34例及肥胖糖调节受损组(OIGR)73例,其中OIGR组包括糖尿病前期15例(空腹血糖受损1例及糖耐量异常14例)及糖尿病58例。记录患者的一般资料、ALB及其他实验室检查结果。胰岛素敏感性以葡萄糖输注速率(GIR)表示。采用二元logistic回归分析评价血清ALB与胰岛素抵抗的相关性,采用受试者工作特征(ROC)曲线分析ALB及胰岛素抵抗指数(HOMA-IR)评估胰岛素抵抗的效能。结果:从OIGR组、ONGR组到NNGR组,ALB值和GIR值增高,ALB值分别为(42.28±3.48)、(44.04±3.12)和(46.33±3.52)g/L,GIR值分别为(3.55±1.46)、(4.77±1.60)和(10.38±2.97)mg·kg^(-1)·min^(-1),差异有统计学意义(P<0.05)。107例肥胖患者的ALB和GIR呈正相关(r=0.352,P<0.01)。肥胖受试者中ALB水平是改善胰岛素抵抗的独立因素(比值比为0.744,P=0.002)。以GIR为标准,肥胖患者HOMA-IR联合1/ALB、1/ALB和HOMA-IR预测胰岛素抵抗的ROC曲线下面积分别为0.834、0.757和0.710。HOMA-IR联合1/ALB评估胰岛素抵抗的灵敏度和特异度分别为64.0%和92.5%。结论:在肥胖人群中ALB水平低与胰岛素抵抗独立相关。与HOMA-IR相比,HOMA-IR联合1/ALB可更好地评估肥胖患者胰岛素抵抗程度,具备更好的敏感度及特异度。

Objective To investigate the relationship between serum albumin(ALB)and insulin sensitivity in patients with obesity by hyperinsulinemic-euglycemic clamp.Methods One hundred and forty-four patients who underwent the hyperinsulinemic-euglycemic clamp in the Department of Endocrinology and Metabolism,the First Affiliated Hospital of Nanjing Medical University from January 2015 to December 2018 were included retrospectively.All participants were divided into 3 groups including 37 subjects with normal body mass index and normal glucose regulation(NNGR),34 obese individuals with normal glucose regulation(ONGR)and 73 obese patients with impaired glucose regulation(OIGR).The OIGR group included 15 patients with prediabetes(1 patient with impaired fasting glucose and 14 patients with impaired glucose tolerance)as well as 58 patients with diabetes.Basic characteristics,serum albumin and other laboratory test results were recorded.Glucose infusion rate(GIR)was calculated to evaluate insulin sensitivity.Binary logistic regression analysis was used to analyze the correlation between serum albumin and insulin resistance.Receiver operating characteristic(ROC)curve was used to access the efficacy of homeostasis model assessment of insulin resistance(HOMA-IR)and 1/ALB for the evaluation of insulin resistance.Results The ALB level[(42.28±3.48),(44.04±3.12)vs.(46.33±3.52)g/L,P<0.05]and the GIR level[(3.55±1.46),(4.77±1.60)vs.(10.38±2.97)mg·kg^(-1)·min^(-1),P<0.05]gradually increased from OIGR group to ONGR group and NNGR group.ALB in 107 obese participants were positively correlated with GIR(r=0.352,P<0.01).ALB level was an independent factor to improve insulin resistance in obese subjects(OR=0.744,P=0.002).GIR was the standard for the ROC curve.The areas under different exponential curves were HOMA-IR+1/ALB(0.834),1/ALB(0.757)and HOMA-IR(0.710),respectively.HOMA-IR combined with 1/ALB for the evaluation of insulin resistance corresponded to sensitivity at 64.0%and specificity at 92.5%.Conclusions Low ALB levels in obese individuals are independently correlated with insulin resistance.HOMA-IR combined with 1/ALB can better evaluate insulin resistance compared with HOMA-IR in obese subjects,with higher sensitivity and specificity.