Holzinger U, Kitzberger R, Fuhrmann V, Funk G-C, Madl C, Ratheiser K
Medical University of Vienna, Intensive Care Unit, Department of Internal Medicine IV, Waehringer Guertel, Vienna, Austria.
Eur J Anaesthesiol. 2007 Nov;24(11):966-70. doi: 10.1017/S0265021507001111. Epub 2007 Jul 27.
Insulin resistance is frequently observed in critical illness. It can be quantified by the expensive and time-consuming euglycaemic hyperinsulinaemic clamp technique (M-value) and calculated indices of insulin resistance (Quantitative Insulin Sensitivity Check Index; QUICKI and Homeostasis Model Assessment; HOMA) with lower costs and efforts. We performed an observational study to assess the reliability of QUICKI and HOMA to evaluate insulin resistance in critically ill patients compared with the current gold standard method, the euglycaemic hyperinsulinaemic clamp technique.
Insulin resistance was measured in 30 critically ill medical patients by the euglycaemic hyperinsulinaemic clamp technique (M-value) as well as calculated using QUICKI and HOMA. Correlations between the M-values as well as QUICKI and HOMA were assessed by means of the Pearson's correlation coefficient.
M-value, QUICKI and HOMA indicated insulin resistance in all 30 patients. However, both indices QUICKI and HOMA did not correlate with the M-values in our patients (r2 = 0.008 and 0.0005, respectively). A significant negative correlation was found between the M-value and the severity of illness assessed by the APACHE (Acute Physiology and Chronic Health Evaluation) III score (r2 = 0.16; P < 0.05). In contrast, neither HOMA nor QUICKI correlated with the APACHE III score (r2 = 0.034 and 0.033, respectively).
Although QUICKI and HOMA indicated insulin resistance in the critically ill medical patients, both indices did not correlate with the M-value. Therefore, the euglycaemic hyperinsulinaemic clamp technique remains the gold standard for estimating insulin resistance in critically ill patients.
胰岛素抵抗在危重病中较为常见。其可通过昂贵且耗时的正常血糖高胰岛素钳夹技术（M值）进行量化，也可采用成本和工作量较低的胰岛素抵抗计算指数（定量胰岛素敏感性检查指数；QUICKI和稳态模型评估；HOMA）。我们进行了一项观察性研究，以评估与当前金标准方法即正常血糖高胰岛素钳夹技术相比，QUICKI和HOMA评估危重病患者胰岛素抵抗的可靠性。
采用正常血糖高胰岛素钳夹技术（M值）对30例危重病内科患者的胰岛素抵抗进行测量，并使用QUICKI和HOMA进行计算。通过Pearson相关系数评估M值与QUICKI和HOMA之间的相关性。
M值、QUICKI和HOMA均表明所有30例患者存在胰岛素抵抗。然而，在我们的患者中，QUICKI和HOMA这两个指数均与M值不相关（r²分别为0.008和0.0005）。M值与通过急性生理与慢性健康评估（APACHE）III评分评估的疾病严重程度之间存在显著负相关（r² = 0.16；P < 0.05）。相比之下，HOMA和QUICKI与APACHE III评分均无相关性（r²分别为0.034和0.033）。
尽管QUICKI和HOMA表明危重病内科患者存在胰岛素抵抗，但这两个指数均与M值不相关。因此，正常血糖高胰岛素钳夹技术仍然是评估危重病患者胰岛素抵抗的金标准。
