Graci S, Baratta R, Degano C, Luppa A, Vigneri R, Frittitta L, Trischitta V
Institute of Internal Medicine, Endocrine and Metabolic Disease, University of Catania, Italy.
J Endocrinol Invest. 1999 Jun;22(6):472-5. doi: 10.1007/BF03343592.
To verify whether the short intravenous insulin tolerance test (ITT) (a safe, reproducible, inexpensive, rapid and easy to perform measurement of insulin sensitivity) is a suitable test for insulin resistance screening in a general population, we measured in 60 non diabetic subjects, either non-obese (no.=40) or obese (BMI>28, no.=20) the K of glucose disappearance from plasma after ITT (K(ITT)), plasma glucose (PG) and insulin (IRI) both fasting (FPG, FIRI) and at 120 min of OGTT (PG- 120, IRI- 120), and also triglycerides (Tg), cholesterol (Chol) and blood pressure (BP). Subjects were subdivided into quartiles according to K(ITT) values. Average FPG, PG-120, FIRI, IRI-120, Tg and Chol values were progressively increased, and average HDL/Chol was progressively decreased from quartile 1 (the most insulin sensitive) to 4 (the most insulin resistant) (p<0.05, by 1-way ANOVA test). Also BP was increased in the insulin resistant patients, but statistical significance was not reached. Three or more of the studied parameters (FPG and/or PG-120, FIRI and/or IRI-120, Tg, HDL/Chol, mean BP) were altered (below the worst 25 degree percentile) in 64% of subjects from quartile 4; none of the subjects in quartile 1 was affected by such a cluster of alterations. K(ITT) values < or =4.8 identified the cluster of insulin resistance related alterations with an accuracy of 82% (sensitivity=83.3%, specificity=80.5%). In healthy subjects with a wide range of BMI the ITT is a reliable procedure for screening for the cluster of metabolic alterations related to insulin resistance.
为验证短程静脉胰岛素耐量试验(ITT)(一种安全、可重复、廉价、快速且易于实施的胰岛素敏感性测量方法)是否适用于普通人群的胰岛素抵抗筛查,我们对60名非糖尿病受试者进行了测量,其中非肥胖者(n = 40),肥胖者(BMI>28,n = 20),测量了ITT后血浆葡萄糖消失率(K(ITT))、空腹血浆葡萄糖(PG)和胰岛素(IRI)即空腹血糖(FPG,FIRI)以及口服葡萄糖耐量试验(OGTT)120分钟时的情况(PG - 120,IRI - 120),还测量了甘油三酯(Tg)、胆固醇(Chol)和血压(BP)。根据K(ITT)值将受试者分为四分位数。从第1四分位数(胰岛素最敏感)到第4四分位数(胰岛素抵抗最强),平均FPG、PG - 120、FIRI、IRI - 120、Tg和Chol值逐渐升高,平均高密度脂蛋白胆固醇比值(HDL/Chol)逐渐降低(通过单因素方差分析,p<0.05)。胰岛素抵抗患者的血压也升高,但未达到统计学显著性。在第4四分位数的受试者中,64%的受试者有三个或更多研究参数(FPG和/或PG - 120、FIRI和/或IRI - 120、Tg、HDL/Chol、平均血压)发生改变(低于最差的25百分位数);第1四分位数的受试者均未受此类改变群的影响。K(ITT)值≤4.8识别胰岛素抵抗相关改变群的准确率为82%(敏感性 = 83.3%,特异性 = 80.5%)。在BMI范围广泛的健康受试者中,ITT是筛查与胰岛素抵抗相关的代谢改变群的可靠方法。