Conwell Louise S, Trost Stewart G, Brown Wendy J, Batch Jennifer A
Department of Endocrinology and Diabetes, Royal Children's Hospital, Herston, Brisbane, Queensland, Australia.
Diabetes Care. 2004 Feb;27(2):314-9. doi: 10.2337/diacare.27.2.314.
To assess the concurrent validity of fasting indexes of insulin sensitivity and secretion in obese prepubertal (Tanner stage 1) children and pubertal (Tanner stages 2-5) adolescents using estimates from the modified minimal model frequently sampled intravenous glucose tolerance test (FSIVGTT) as a criterion measure.
Eighteen obese children and adolescents (11 girls and 7 boys, mean age 12.2 +/- 2.4 years, mean BMI 35.4 +/- 6.2 kg/m(2), mean BMI-SDS 3.5 +/- 0.5, 7 prepubertal and 11 pubertal) participated in the study. All participants underwent an insulin-modified FSIVGTT on two occasions, and 15 repeated this test a third time (mean 12.9 and 12.0 weeks apart). S(i) measured by the FSIVGTT was compared with homeostasis model assessment (HOMA) of insulin resistance (HOMA-IR), quantitative insulin-sensitivity check index (QUICKI), fasting glucose-to-insulin ratio (FGIR), and fasting insulin (estimates of insulin sensitivity derived from fasting samples). The acute insulin response (AIR) measured by the FSIVGTT was compared with HOMA of percent beta-cell function (HOMA-beta%), FGIR, and fasting insulin (estimates of insulin secretion derived from fasting samples).
There was a significant negative correlation between HOMA-IR and S(i) (r = -0.89, r = -0.90, and r = -0.81, P < 0.01) and a significant positive correlation between QUICKI and S(i) (r = 0.89, r = 0.90, and r = 0.81, P < 0.01) at each time point. There was a significant positive correlation between FGIR and S(i) (r = 0.91, r = 0.91, and r = 0.82, P < 0.01) and a significant negative correlation between fasting insulin and S(i) (r = -90, r = -0.90, and r = -0.88, P < 0.01). HOMA-beta% was not as strongly correlated with AIR (r = 0.60, r = 0.54, and r = 0.61, P < 0.05).
HOMA-IR, QUICKI, FGIR, and fasting insulin correlate strongly with S(i) assessed by the FSIVGTT in obese children and adolescents. Correlations between HOMA-beta%, FGIR and fasting insulin, and AIR were not as strong. Indexes derived from fasting samples are a valid tool for assessing insulin sensitivity in prepubertal and pubertal obese children.
采用改良最小模型频繁采样静脉葡萄糖耐量试验（FSIVGTT）的评估结果作为标准测量值，评估肥胖青春期前（坦纳1期）儿童和青春期（坦纳2 - 5期）青少年胰岛素敏感性和分泌的空腹指标的同时效度。
18名肥胖儿童和青少年（11名女孩和7名男孩，平均年龄12.2±2.4岁，平均BMI 35.4±6.2 kg/m²，平均BMI-SDS 3.5±0.5，7名青春期前和11名青春期）参与了本研究。所有参与者均接受了两次胰岛素改良的FSIVGTT，其中15人第三次重复该试验（平均间隔12.9周和12.0周）。将FSIVGTT测量的S(i)与胰岛素抵抗的稳态模型评估（HOMA-IR）、定量胰岛素敏感性检查指数（QUICKI）、空腹血糖与胰岛素比值（FGIR）以及空腹胰岛素（从空腹样本得出的胰岛素敏感性估计值）进行比较。将FSIVGTT测量的急性胰岛素反应（AIR）与β细胞功能百分比的HOMA（HOMA-β%）、FGIR以及空腹胰岛素（从空腹样本得出的胰岛素分泌估计值）进行比较。
在每个时间点，HOMA-IR与S(i)之间存在显著负相关（r = -0.89、r = -0.90和r = -0.81，P < 0.01），QUICKI与S(i)之间存在显著正相关（r = 0.89、r = 0.90和r = 0.81，P < 0.01）。FGIR与S(i)之间存在显著正相关（r = 0.91、r = 0.91和r = 0.82，P < 0.01），空腹胰岛素与S(i)之间存在显著负相关（r = -90、r = -0.90和r = -0.88，P < 0.01）。HOMA-β%与AIR的相关性不那么强（r = 0.60、r = 0.54和r = 0.61，P < 0.05）。
在肥胖儿童和青少年中，HOMA-IR、QUICKI以及空腹胰岛素与FSIVGTT评估的S(i)密切相关。HOMA-β%、FGIR以及空腹胰岛素与AIR之间的相关性没那么强。从空腹样本得出的指标是评估青春期前和青春期肥胖儿童胰岛素敏感性的有效工具。
