妊娠期糖尿病胰岛素抵抗（HOMA-IR）和胰岛素敏感性（QUICKI）标志物的诊断准确性。

Diagnostic Accuracy of Markers of Insulin Resistance (HOMA-IR) and Insulin Sensitivity (QUICKI) in Gestational Diabetes.

机构信息

Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, Pakistan.

出版信息

J Coll Physicians Surg Pak. 2021 Sep;31(9):1015-1019. doi: 10.29271/jcpsp.2021.09.1015.

DOI:10.29271/jcpsp.2021.09.1015

PMID:34500513

Abstract

OBJECTIVES

To determine the diagnostic accuracy of HOMA-IR, and QUICKI in diagnosing gestational diabetes mellitus (GDM) considering oral glucose tolerance test (OGTT) as gold standard.

STUDY DESIGN

Cross-sectional analytical study.

PLACE AND DURATION OF STUDY

Department of Chemical Pathology, Armed Forces Institute of Pathology, Rawalpindi from September 2020 to February 2021.

METHODOLOGY

Pregnant women with gestational age between 24 to 28 weeks, who reported to Endocrine Clinic of AFIP for OGTT, were included in the study. OGTT was performed by following ADA guidelines. Sample for fasting insulin was collected along with first fasting sample of OGTT. HOMA-IR and QUICKI were calculated simultaneously. Percentage was used for qualitative variable while median (IQR 25th-75th) was applied for quantitative variables. OGTT was used as gold standard for calculation of diagnostic accuracy of HOMA-IR and QUICKI.

RESULTS

Out of 182 patients, 74 (40.6%) were found to have GDM on OGTT while 108 (59.4%) had normal OGTT. Women with GDM (n=74) had median values of fasting insulin 15.9 (IQR 11.2-17.77), HOMA-IR 3.5 (IQR 2.6-4.1) and QUICKI 0.31 (IQR 0.30-0.33) as compared to median values of fasting insulin 8.0 (IQR 5.9-10.3), HOMA-IR 1.60 (IQR 1.12-2.03) and QUICKI 0.35 (IQR 0.34-0.37) in patients (n=108) with normal response to OGTT, (p <0.001). On logistic regression analysis, there was a strong association of HOMA-IR and QUICKI with gestational diabetes mellitus (p <0.001, accuracy 84.6%). HOMA-IR at cutoff of ≤2 had 94.5% sensitivity, 72.2% specificity, 70% PPV, 95.1% NPV, and 81.31% overall diagnostic accuracy with 0.913 AUC. QUICKI at cutoff of 0.34 had 86.4% sensitivity, 83.3% specificity, 78.0% PPV, 90.0% NPV, and 84.61% overall diagnostic accuracy with 0.905 AUC.

CONCLUSION

Fasting insulin and HOMA-IR were significantly higher while QUICKI was lower in patients of GDM as compared to non-GDM pregnant patients at 24 to 28 weeks of gestation. Being more convenient for patients, it has the potential to be used as screening tool for gestational diabetes. Key Words: HOMA IR, QUICKI, Gestational diabetes mellitus, Insulin.

摘要

目的

以口服葡萄糖耐量试验（OGTT）为金标准，评估稳态模型评估的胰岛素抵抗指数（HOMA-IR）和简化 QI 指数（QUICKI）在诊断妊娠期糖尿病（GDM）中的诊断准确性。

研究设计

横断面分析研究。

地点和研究时间

2020 年 9 月至 2021 年 2 月，武装部队病理研究所化学病理学系。

方法

纳入在 AFIP 内分泌诊所进行 OGTT 的 24 至 28 周妊娠的孕妇。OGTT 按照 ADA 指南进行。同时采集空腹胰岛素样本和 OGTT 的第一份空腹样本。同时计算 HOMA-IR 和 QUICKI。定性变量采用百分比表示，定量变量采用中位数（IQR 25 至 75）表示。OGTT 用于计算 HOMA-IR 和 QUICKI 的诊断准确性。

结果

182 例患者中，74 例（40.6%）OGTT 结果为 GDM，108 例（59.4%）OGTT 结果正常。GDM 患者（n=74）的空腹胰岛素中位数为 15.9（IQR 11.2-17.77），HOMA-IR 中位数为 3.5（IQR 2.6-4.1），QUICKI 中位数为 0.31（IQR 0.30-0.33），而非 GDM 患者（n=108）的空腹胰岛素中位数为 8.0（IQR 5.9-10.3），HOMA-IR 中位数为 1.60（IQR 1.12-2.03），QUICKI 中位数为 0.35（IQR 0.34-0.37）（p<0.001）。logistic 回归分析显示，HOMA-IR 和 QUICKI 与妊娠期糖尿病有很强的关联（p<0.001，准确性为 84.6%）。HOMA-IR 截断值为≤2 时，其敏感性为 94.5%，特异性为 72.2%，阳性预测值为 70%，阴性预测值为 95.1%，总诊断准确性为 81.31%，曲线下面积为 0.913。QUICKI 截断值为 0.34 时，其敏感性为 86.4%，特异性为 83.3%，阳性预测值为 78.0%，阴性预测值为 90.0%，总诊断准确性为 84.61%，曲线下面积为 0.905。