Schwartz Betsy, Jacobs David R, Moran Antoinette, Steinberger Julia, Hong Ching-Ping, Sinaiko Alan R
Department of Pediatrics, School of Medicine, University of Minnesota, Minneapolis, Minnesota 55455, USA.
Diabetes Care. 2008 Apr;31(4):783-8. doi: 10.2337/dc07-1376. Epub 2008 Jan 3.
In this study we compared fasting insulin and measures of insulin sensitivity (M) based on fasting insulin and glucose (i.e., homeostasis model assessment [HOMA], quantitative insulin sensitivity check index [QUICKI], and fasting glucose-to-insulin ratio [FGIR]) or triglycerides to the insulin clamp in a cohort of children/adolescents.
The subjects were Minneapolis fifth- to eighth-grade students. Euglycemic-hyperinsulinemic clamps were performed on 323 adolescents at mean age 13 and were repeated on 300 of these subjects at mean age 15. Insulin sensitivity was determined by glucose uptake (milligrams per kilogram per minute) adjusted for lean body mass (M(LBM)) and steady-state insulin (M(LBM)/ln SSI). Comparisons were made for the whole cohort and by body size (BMI < 85th percentile vs. BMI > or = 85th percentile). Receiver operating characteristic (ROC) curves were used to test whether specific fasting insulin cut points separated true-positive from false-positive approximations of insulin resistance.
Fasting insulin was significantly correlated with HOMA (r = 0.99), QUICKI (r = 0.79), FGIR (r = -0.62), and (ln fasting insulin + ln triglycerides) (r = 0.88). Correlations of the surrogates with M(LBM) were significantly lower than those with M for the total cohort and > or = 85th percentile group. In general, correlations in the > or = 85th percentile group were higher than those in the < 85th percentile group. Correlations with M(LBM) and M(LBM)/ln SSI decreased in the total cohort and > or = 85th percentile group from age 13 to 15. ROC curves showed only a modest capability to separate true- from false-positive values.
Surrogate measures are only modestly correlated with the clamp measures of insulin sensitivity and do not offer any advantage over fasting insulin. In general, lower correlations are seen with M(LBM) than with M and with thinner than with heavier individuals.
在本研究中，我们在一组儿童/青少年中，比较了空腹胰岛素以及基于空腹胰岛素和血糖（即稳态模型评估[HOMA]、定量胰岛素敏感性检查指数[QUICKI]和空腹血糖与胰岛素比值[FGIR]）或甘油三酯的胰岛素敏感性指标（M）与胰岛素钳夹试验的结果。
研究对象为明尼阿波利斯市五至八年级的学生。对323名平均年龄为13岁的青少年进行了正常血糖-高胰岛素钳夹试验，并在其中300名平均年龄为15岁的受试者中重复进行。胰岛素敏感性通过根据瘦体重调整的葡萄糖摄取量（毫克/千克/分钟）（M[LBM]）和稳态胰岛素（M[LBM]/ln SSI）来确定。对整个队列以及按体型（BMI＜第85百分位数与BMI≥第85百分位数）进行了比较。采用受试者工作特征（ROC）曲线来检验特定的空腹胰岛素切点是否能区分胰岛素抵抗的真阳性与假阳性近似值。
空腹胰岛素与HOMA（r = 0.99）、QUICKI（r = 0.79）、FGIR（r = -0.62）以及（ln空腹胰岛素+ln甘油三酯）（r = 0.88）显著相关。对于整个队列以及≥第85百分位数组，替代指标与M[LBM]的相关性显著低于与M的相关性。一般而言，≥第85百分位数组的相关性高于＜第85百分位数组。从13岁到15岁，整个队列以及≥第85百分位数组中，与M[LBM]和M[LBM]/ln SSI的相关性均降低。ROC曲线显示区分真阳性与假阳性值的能力有限。
替代指标与胰岛素敏感性的钳夹试验指标仅具有中等程度的相关性，相较于空腹胰岛素并无优势。一般而言，与M[LBM]的相关性低于与M的相关性，且较瘦个体低于较胖个体。
