University Hospital Birmingham, Edgbaston, Birmingham, United Kingdom.
Transplantation. 2010 Feb 15;89(3):327-33. doi: 10.1097/TP.0b013e3181bbf2c4.
Insulin resistance is common posttransplantation and contributes to both new onset diabetes after transplantation and the metabolic syndrome. Insulin resistance indexes have never been validated in transplant recipients on tacrolimus compared with cyclosporine, although it is more diabetogenic. We aimed to assess these indexes in renal transplant recipients on tacrolimus as primary immunosuppressant.
Retrospective analysis of 76 frequently sampled, intravenous glucose tolerance tests (for insulin sensitivity) in 38 nondiabetic renal transplant recipients on tacrolimus-centered immunosuppression. Indexes tested were fasting glucose/insulin ratio, homeostasis model assessment (HOMA) index, 1/HOMA, log (HOMA), quantitative insulin sensitivity check index, and the McAuley's index. Indexes were also compared against waist/hip ratio and C-reactive protein (CRP). Multivariate linear regression analysis was performed to determine independent variables predictive for insulin resistance.
Insulin sensitivity successfully correlated with all indexes: fasting glucose/insulin ratio (r=0.246, P=0.033), HOMA index (r=-0.240, P=0.038), 1/HOMA (r=0.282, P=0.014), log (HOMA) (r=-0.316, P=0.006), quantitative insulin sensitivity check index (r=0.320, P=0.005), and McAuley's index (r=0.323, P=0.005). McAuley's index also correlated strongest with waist/hip ratio (r=-0.425, P<0.001). All indexes failed to correlate with CRP. Variables independently associated with insulin sensitivity were HbA1c (r=0.189, P=0.019), pulse pressure (r=0.146, P=0.021), and CRP (r=0.210, P=0.010).
Insulin resistance indexes are valid in transplant recipients taking tacrolimus, with McAuley's index the strongest surrogate.
胰岛素抵抗在移植后很常见，它既导致移植后新发糖尿病，也导致代谢综合征。虽然他克莫司比环孢素更具致糖尿病性，但尚未在接受他克莫司治疗的移植受者中对胰岛素抵抗指数进行验证，而这些指数是在环孢素治疗的移植受者中进行验证的。我们旨在评估这些在接受他克莫司为主要免疫抑制剂的肾移植受者中的指标。
对 38 例接受他克莫司为中心免疫抑制治疗的非糖尿病肾移植受者的 76 次频繁采样静脉葡萄糖耐量试验（用于评估胰岛素敏感性）进行回顾性分析。检测的指标包括空腹血糖/胰岛素比值、稳态模型评估（HOMA）指数、1/HOMA、log（HOMA）、定量胰岛素敏感性检查指数和 McAuley 指数。还将这些指标与腰围/臀围比和 C 反应蛋白（CRP）进行了比较。进行多元线性回归分析，以确定预测胰岛素抵抗的独立变量。
胰岛素敏感性与所有指标均成功相关：空腹血糖/胰岛素比值（r=0.246，P=0.033）、HOMA 指数（r=-0.240，P=0.038）、1/HOMA（r=0.282，P=0.014）、log（HOMA）（r=-0.316，P=0.006）、定量胰岛素敏感性检查指数（r=0.320，P=0.005）和 McAuley 指数（r=0.323，P=0.005）。McAuley 指数与腰围/臀围比相关性最强（r=-0.425，P<0.001）。所有指标均与 CRP 无相关性。与胰岛素敏感性独立相关的变量是 HbA1c（r=0.189，P=0.019）、脉压（r=0.146，P=0.021）和 CRP（r=0.210，P=0.010）。
在接受他克莫司治疗的移植受者中，胰岛素抵抗指数是有效的，其中 McAuley 指数的相关性最强。
