肥胖儿童和青少年的胰岛素抵抗与分泌指标：一项验证研究。

Indexes of insulin resistance and secretion in obese children and adolescents: a validation study.

作者信息

Conwell Louise S, Trost Stewart G, Brown Wendy J, Batch Jennifer A

机构信息

Department of Endocrinology and Diabetes, Royal Children's Hospital, Herston, Brisbane, Queensland, Australia.

出版信息

Diabetes Care. 2004 Feb;27(2):314-9. doi: 10.2337/diacare.27.2.314.

DOI:10.2337/diacare.27.2.314

PMID:14747206

Abstract

OBJECTIVE

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.

RESEARCH DESIGN AND METHODS

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).

RESULTS

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).

CONCLUSIONS

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.

摘要

目的

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。

研究设计与方法

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。

结果

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）。