Olsen M H, Andersen U B, Wachtell K, Ibsen H, Dige-Petersen H
Department of Clinical Physiology and Nuclear Medicine, Glostrup Hospital, University of Copenhagen, Denmark.
Blood Press. 1999;8(4):207-13. doi: 10.1080/080370599439580.
We wanted to investigate whether time to steady state was reached within 2 h of insulin infusion during isoglycemic hyperinsulinemic clamp, comparing the glucose uptake index (M/IG) with Bergman's insulin sensitivity index (Sip). We performed a 2-h oral glucose tolerance test and a 3-h isoglycemic hyperinsulinemic clamp in 26 young, healthy subjects and 43 elderly patients with unmedicated essential hypertension and left ventricular hypertrophy. The 3-h Sip correlated strongly with the 2-h M/IG in the patients (r = 0.88, p < 0.001) as well as in the healthy subjects (r = 0.96, p < 0.001) with relatively narrow limits of agreement in the patients. However, during the third hour of insulin infusion, M/IG (10.0 vs 12.21(2) x kg(-1) x min(-1) x mmol(-1), p < 0.001) as well as Sip (7.1 vs 9.41(2) x kg(-1) x min(-1) x mmol(-1), p < 0.001) increased significantly in the patients, but not in the healthy subjects. Because the 2-h M/IG correlated strongly with the 3-h Sip with relatively narrow limits of agreement, it is a good measure of insulin sensitivity. However, a 2-h clamp results in lower insulin sensitivity values in elderly, hypertensive patients due to the fact that steady state is not reached, demonstrating a higher prevalence of insulin resistance in such a population.
我们想要研究在等血糖高胰岛素钳夹试验期间，胰岛素输注2小时内是否达到稳态，同时比较葡萄糖摄取指数（M/IG）和伯格曼胰岛素敏感性指数（Sip）。我们对26名年轻健康受试者以及43名未接受药物治疗的老年原发性高血压合并左心室肥厚患者进行了2小时口服葡萄糖耐量试验和3小时等血糖高胰岛素钳夹试验。在患者组中，3小时的Sip与2小时的M/IG显著相关（r = 0.88，p < 0.001），在健康受试者组中也是如此（r = 0.96，p < 0.001），且患者组的一致性界限相对较窄。然而，在胰岛素输注的第三个小时，患者组的M/IG（10.0对12.21(2) x kg(-1) x min(-1) x mmol(-1)，p < 0.001）以及Sip（7.1对9.41(2) x kg(-1) x min(-1) x mmol(-1)，p < 0.001）显著升高，而健康受试者组未出现这种情况。由于2小时的M/IG与3小时的Sip显著相关且一致性界限相对较窄，所以它是衡量胰岛素敏感性的一个良好指标。然而，由于未达到稳态，2小时钳夹试验在老年高血压患者中得出的胰岛素敏感性值较低，这表明该人群中胰岛素抵抗的患病率较高。
