Davis S N, Piatti P M, Monti L, Möller N, Ng L L, Coppack S, Antsiferov M, Brown M D, Alberti K G
Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232-2230.
Diabetes Res. 1992 Mar;19(3):107-17.
Several methods of varying complexity are available for the measurement of in vivo insulin secretion in man. No study has previously compared these in the same subjects to establish which is the most appropriate for routine use. We have, therefore, compared four methods for measuring insulin secretion in man: Hyperglycaemic clamp (Hy), Minimal model (MIN), shortened intravenous glucose tolerance test (IVGTT) and continuous infusion of glucose with model assessment (C.I.G.M.A.). Seventeen subjects with varying degrees of insulin sensitivity were studied. Seven normal (BMI 22.5 +/- 1.5 kg/m2), five obese (BMI 38 +/- 5 kg/m2) and five NIDDM subjects (BMI 27 +/- 3 kg/m2) were investigated, in a randomised fashion, on separate days. First (PSI) and second phase (PSII) rate constants (MIN); incremental insulin secretion 0-10 mins (Hy delta I) and steady state insulin levels from the last 30 minutes (Hy120-150) from the hyperglycaemic clamp; 3 minute insulin concentration and incremental area under insulin secretion curve 0-10 min (IVGTT) and beta-cell function (%) from C.I.G.M.A. were used as indicators of insulin secretion. Each index of insulin secretion could detect an overall difference between the groups. Insulin secretion in normals and obese was similar but significantly increased compared to NIDDM. In normals PSI correlated with C.I.G.M.A. (Rs = 0.92, p < 0.02) and Hy120-150 (Rs = 0.82, p < 0.05). IVGTT0-10 correlated with PSII (Rs = 0.83, p < 0.05), HY delta I (Rs = 0.84, p < 0.05) and IVGTT3 min (Rs = 1.0, p < 0.001). In obese PSII correlated with C.I.G.M.A. (Rs = 0.91, p < 0.05), Hy delta I (Rs = 1.0, p < 0.02) Hy120-150 (Rs = 0.92, p < 0.05) and IVGTT3 min Rs = 1.0, p < 0.02). In addition Hy delta I also correlated with C.I.G.M.A. (Rs = 0.92, p < 0.05) and IVGTT3 min (Rs = 1.0, p < 0.02). In NIDDM Hy delta I correlated with C.I.G.M.A. (Rs = 0.91, p < 0.005). When all subjects from the three groups were combined, significant positive correlations were obtained between each index of insulin secretion. In conclusion we have demonstrated that: (a) C.I.G.M.A., IVGTT, Minimal model and hyperglycaemic clamp can provide similar overall results for, in vivo, beta-cell function in man. (b) Significant positive correlations were obtained between each index of insulin secretion when all subjects were combined. (c) Using the above methodologies insulin secretion in normal and obese appears similar but significantly increased compared to NIDDM subjects.(ABSTRACT TRUNCATED AT 400 WORDS)
有几种复杂度各异的方法可用于测量人体体内胰岛素分泌。此前尚无研究在同一受试者中对这些方法进行比较，以确定哪种方法最适合常规使用。因此，我们比较了四种测量人体胰岛素分泌的方法：高血糖钳夹法（Hy）、最小模型法（MIN）、缩短的静脉葡萄糖耐量试验（IVGTT）以及葡萄糖持续输注联合模型评估法（C.I.G.M.A.）。研究了17名胰岛素敏感性程度不同的受试者。随机选取7名正常受试者（体重指数BMI 22.5±1.5kg/m²）、5名肥胖受试者（BMI 38±5kg/m²）和5名非胰岛素依赖型糖尿病（NIDDM）受试者（BMI 27±3kg/m²），在不同日期进行研究。最小模型法的第一相（PSI）和第二相（PSII）速率常数；高血糖钳夹法中0至10分钟的胰岛素分泌增量（Hy delta I）以及最后30分钟的稳态胰岛素水平（Hy120 - 150）；静脉葡萄糖耐量试验中3分钟时的胰岛素浓度以及0至10分钟胰岛素分泌曲线下的增量面积（IVGTT），以及C.I.G.M.A.法中的β细胞功能（%），均用作胰岛素分泌的指标。每种胰岛素分泌指标都能检测出各组之间的总体差异。正常人和肥胖者的胰岛素分泌相似，但与非胰岛素依赖型糖尿病患者相比显著增加。在正常受试者中，PSI与C.I.G.M.A.（Rs = 0.92，p < 0.02）以及Hy120 - 150（Rs = 0.82，p < 0.05）相关。IVGTT0 - 10与PSII（Rs = 0.83，p < 0.05）、HY delta I（Rs = 0.84，p < 0.05）以及IVGTT3分钟时的值（Rs = 1.0，p < 0.001）相关。在肥胖受试者中，PSII与C.I.G.M.A.（Rs = 0.91，p < 0.05）、Hy delta I（Rs = 1.0，p < 0.02）、Hy120 - 150（Rs = 0.92，p < 0.05）以及IVGTT3分钟时的值（Rs = 1.0，p < 0.02）相关。此外，Hy delta I还与C.I.G.M.A.（Rs = 0.92，p < 0.05）以及IVGTT3分钟时的值（Rs = 1.0，p < 0.02）相关。在非胰岛素依赖型糖尿病患者中，Hy delta I与C.I.G.M.A.（Rs = 0.91，p < 0.005）相关。当将三组的所有受试者合并时，各胰岛素分泌指标之间均存在显著的正相关。总之，我们证明了：（a）C.I.G.M.A.法、静脉葡萄糖耐量试验、最小模型法和高血糖钳夹法在评估人体体内β细胞功能方面可提供相似的总体结果。（b）当将所有受试者合并时，各胰岛素分泌指标之间存在显著的正相关。（c）使用上述方法，正常人和肥胖者的胰岛素分泌似乎相似，但与非胰岛素依赖型糖尿病患者相比显著增加。（摘要截取自400字）
