Gu Weijun, Liu Yixin, Liu Hongyan, Yang Guoqing, Guo Qinghua, Du Jin, Jin Nan, Zang Li, Lv Zhaohui, Ba Jianming, Mu Yiming, Dou Jingtao
Department of Endocrinology, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853 People's Republic of China.
Department of Internal Medicine, The Affiliated Hospital of Institute of Aviation Medicine, Beijing, 100089 People's Republic of China.
Diabetol Metab Syndr. 2017 Mar 14;9:17. doi: 10.1186/s13098-017-0215-3. eCollection 2017.
Analyze the clinical applicability of glucose metabolism indexes and continuous glucose monitoring data on the qualitative diagnosis of insulinoma.
Involve 22 patients with insulinoma (insulinoma group), 11 patients with hypoglycemia (hypoglycemia group) and 31 people with normal glucose tolerance (control group). HbA1c, fasting blood glucose (FBG), insulin (FINS) and C-peptide (FCP) was tested. Using CGMS to monitor the blood glucose for three consecutive days and selecting the monitoring data of 24 h thereof, figuring out, with the aid of EasyGV Version 9.0, the mean glucose (MG), the standard deviation (SD) of blood glucose, CONGA (continuous overall net glycemic action), J-Index, LI (Lability Index), LBGI (Low Blood Glucose Index), HBGI (High Blood Glucose Index), GRADE (glycaemic risk assessment diabetes equation), MAGE (mean aplitude of glycaemic excursions), M value, MAG (mean absolute glucose).
(1) FBG and LBG of insulinoma group are lower than those of control group and those of hypoglycemia group while FINS and FCP of insulinoma group are markedly higher than those of the other two groups; (2) the MG and CONGA of insulinoma group are lower than those of control group and its indexes like ST, LI, LBGI, GRADE, MAGE, M value and MAG are higher than those of control group; there are differences between the indexes of insulinoma group and those of hypoglycemia group in CONGA (lower than that of hypoglycemia group), LBGI (higher than that of hypoglycemia group), and M value (higher than that of hypoglycemia group). By drawing the ROC curve and calculating Youden index, the cut-off values of LBGI, M value, CONGA are respectively as 4.06, 7.79, 4.38, and the best index of differential diagnosis is LBGI.
Continuous glucose monitoring data can be used to diagnose insulinoma and blood glucose fluctuation indicators such as LBGI, M value, CONGA might be useful to identify insulinoma.
分析糖代谢指标及动态血糖监测数据在胰岛素瘤定性诊断中的临床适用性。
纳入22例胰岛素瘤患者（胰岛素瘤组）、11例低血糖患者（低血糖组）及31例糖耐量正常者（对照组）。检测糖化血红蛋白（HbA1c）、空腹血糖（FBG）、胰岛素（FINS）及C肽（FCP）。采用动态血糖监测系统（CGMS）连续3天监测血糖，选取其中24小时监测数据，借助EasyGV Version 9.0软件计算平均血糖（MG）、血糖标准差（SD）、连续总体净血糖作用（CONGA）、J指数、血糖波动指数（LI）、低血糖指数（LBGI）、高血糖指数（HBGI）、血糖风险评估糖尿病方程（GRADE）、血糖波动幅度平均值（MAGE）、M值、平均绝对血糖（MAG）。
（1）胰岛素瘤组FBG及LBG低于对照组及低血糖组，而胰岛素瘤组FINS及FCP显著高于其他两组；（2）胰岛素瘤组MG及CONGA低于对照组，其ST、LI、LBGI、GRADE、MAGE、M值及MAG等指标高于对照组；胰岛素瘤组与低血糖组在CONGA（低于低血糖组）、LBGI（高于低血糖组）及M值（高于低血糖组）指标上存在差异。绘制ROC曲线并计算约登指数，LBGI、M值、CONGA的截断值分别为4.06、7.79、4.38，鉴别诊断的最佳指标为LBGI。
动态血糖监测数据可用于胰岛素瘤的诊断，LBGI、M值、CONGA等血糖波动指标可能有助于胰岛素瘤的鉴别。
