对于评估肥胖儿童和青少年的胰岛素抵抗，稳态模型评估比空腹血糖/胰岛素比值和定量胰岛素敏感性检查指数更可靠。
Homeostasis model assessment is more reliable than the fasting glucose/insulin ratio and quantitative insulin sensitivity check index for assessing insulin resistance among obese children and adolescents.
作者信息
Keskin Mehmet, Kurtoglu Selim, Kendirci Mustafa, Atabek M Emre, Yazici Cevat
机构信息
Department of Pediatrics, School of Medicine, Erciyes University, 38039, Kayseri, Turkey.
出版信息
Pediatrics. 2005 Apr;115(4):e500-3. doi: 10.1542/peds.2004-1921. Epub 2005 Mar 1.
OBJECTIVE
Simple fasting methods to measure insulin resistance, such as the homeostasis model assessment (HOMA), fasting glucose/insulin ratio (FGIR), and quantitative insulin sensitivity check index (QUICKI) methods, have been widely promoted for adult studies but have not been evaluated formally among children and adolescents. The aim of this study was to compare the HOMA, FGIR, and QUICKI methods for measuring insulin resistance, expressed by oral glucose tolerance test (OGTT) results, among obese children and adolescents.
METHODS
Fifty-seven pubertal obese children and adolescents (30 girls and 27 boys; mean age, 12.04 +/- 2.90 years; mean BMI: 29.57 +/- 5.53) participated in the study. All participants underwent an OGTT. Blood samples were obtained 0, 30, 60, 90, and 120 minutes after oral glucose administration for glucose and insulin measurements, and 2 separate groups were studied, according to the presence or absence of insulin resistance. HOMA, FGIR, and QUICKI methods were studied for validation of insulin resistance determined with the OGTT for these groups.
RESULTS
The groups consisted of 25 obese children and adolescents with insulin resistance (14 girls and 11 boys; mean age: 12.88 +/- 2.88 years; mean BMI: 31.29 +/- 5.86) and 32 subjects without insulin resistance (16 girls and 16 boys; mean age: 11.38 +/- 2.79 years; mean BMI: 28.23 +/- 4.94). There were significant differences in the mean HOMA (6.06 +/- 4.98 and 3.42 +/- 3.14, respectively) and QUICKI (0.313 +/- 0.004 and 0.339 +/- 0.004, respectively) values between the 2 groups. Sensitivity and specificity calculations based on insulin resistance with receiver operating characteristic curve analysis indicated that HOMA had high sensitivity and specificity for measuring insulin resistance.
CONCLUSIONS
As a measure of insulin resistance among children and adolescents, HOMA is more reliable than FGIR and QUICKI. The present HOMA cutoff point for diagnosis of insulin resistance is 3.16. The HOMA cutoff point of >2.5 is valid for adults but not for adolescents.
目的
简单的空腹测量胰岛素抵抗的方法，如稳态模型评估（HOMA）、空腹血糖/胰岛素比值（FGIR）和定量胰岛素敏感性检查指数（QUICKI）方法，已在成人研究中得到广泛推广，但尚未在儿童和青少年中进行正式评估。本研究的目的是比较HOMA、FGIR和QUICKI方法在肥胖儿童和青少年中测量胰岛素抵抗的情况，胰岛素抵抗通过口服葡萄糖耐量试验（OGTT）结果来表示。
方法
57名青春期肥胖儿童和青少年（30名女孩和27名男孩；平均年龄12.04±2.90岁；平均BMI：29.57±5.53）参与了本研究。所有参与者均接受了OGTT。在口服葡萄糖后0、30、60、90和120分钟采集血样用于测量血糖和胰岛素，并根据是否存在胰岛素抵抗将研究对象分为2组。对HOMA、FGIR和QUICKI方法进行研究，以验证这些组通过OGTT确定的胰岛素抵抗情况。
结果
研究对象分为25名有胰岛素抵抗的肥胖儿童和青少年（14名女孩和11名男孩；平均年龄：12.88±2.88岁；平均BMI：31.29±5.86）和32名无胰岛素抵抗的受试者（16名女孩和16名男孩；平均年龄：11.38±2.79岁；平均BMI：28.23±4.94）。两组的平均HOMA值（分别为6.06±4.98和3.42±3.14）和QUICKI值（分别为0.313±0.004和0.339±0.004）存在显著差异。基于胰岛素抵抗通过受试者工作特征曲线分析进行的敏感性和特异性计算表明，HOMA在测量胰岛素抵抗方面具有较高的敏感性和特异性。
结论
作为儿童和青少年胰岛素抵抗的一种测量方法，HOMA比FGIR和QUICKI更可靠。目前诊断胰岛素抵抗的HOMA切点为3.16。HOMA切点>2.5对成年人有效，但对青少年无效。
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