利用Botnia钳夹技术评估新简易胰岛素抵抗指数在2型糖尿病患者中与胰岛素抵抗的相关性

摘要

目的:通过Botnia钳夹试验验证简易胰岛素抵抗指数(TyG)在评估2型糖尿病患者胰岛素抵抗中的临床应用价值.方法:共收集43例2型糖尿病受试者,检测空腹血脂谱及其他重要生化指标.所有受试者均行Botnia钳夹试验,并计算葡萄糖代谢率、TyG指数以及HOMA指数、QUICK指数、ISI指数.比较各指数预测评估糖尿病患者胰岛素抵抗的能力.结果:Pearson 相关分析结果显示:TyG指数与Botnia钳夹试验所得葡萄糖代谢率(r=-0.536,P＜0.001)、HOMA 1-IR指数(r=0.464,P＜0.01)、HOMA2-IR指数(r=0.402,P＜ 0.01)、QUICK指数(r=-0.448,P＜ 0.01)、ISI指数(r=-0.464,P＜ 0.01)均显著相关.以葡萄糖代谢率为标准,绘制ROC曲线,不同指数曲线下面积为TyG(0.879)＞ HOMA1-IR(0.762)＞ HOMA2-IR(0.738).TyG指数诊断胰岛素抵抗的最佳值为4.76,此值在ROC曲线中对应了最高的敏感性(96.4％)和特异性(66.7％).结论:TyG指数是较好的评估胰岛素抵抗的简易指数,在2型糖尿病患者中与Botnia钳夹试验所得的葡萄糖代谢率以及HOMA指数、QUICK指数、ISI指数有较好的相关性,较高的敏感度及特异度,且价格低廉临床容易获得,值得推广.%Objective:To investigate the sensitivity and specificity of a new insulin resistance index derived from triglycerides and blood glucose through the Botnia clamp and other simple index in clinical application.Methods:A total of 43 subjects were included in the present study.All the patients underwent Botnia clamp.Lipid profiles and other biochemical markers were measured from the fasting blood sample.Correlation coefficient between insulin resistance index and glucose metabolic rate (M value) were studied.Results:The Pearsons' linear correlation coefficient between TyG and M value (r =-0.536,P ＜ 0.001),HOMA1-IR (r =0.464,P ＜0.01),HOMA2-IR (r =0.402,P ＜ 0.01),QUICK index(r =-0.448,P ＜ 0.01) and ISI index(r =-0.464,P ＜ 0.01) were statistically significant.The area under ROC curve are TyG(0.879)＞ HOMA1-IR(0.762)＞ HOMA2-IR(0.738).The best value of TyG index for the diagnosis of insulin resistance was 4.76,which showed the highest sensitivity (96.4％) and specificity (66.7％).Conclusion:The TyG index is a better index in evaluating the insulin sensitivity in type 2 diabetes.It is accessible and has higher sensitivity and specificity,suggesting that it could be widely used in epidemiological studies or some large-scale clinical trials.