超重及肥胖人群中不同胰岛素抵抗计算指数准确性评价

摘要

Objective To observe the accuracy of several indices in assessing insulin resistance ( IR ) in the over-weight/obesity population and to find more desirable cut-off point of IR .Methods This study involved 406 overweight/o-besity participants without overt diabetes .Homeostasis model assessment of insulin resistance (HOMA-IR) index, Quanti-tative insulin sensitivity check index (QUICKI) and McAuley index (McA index) were calculated and compared with fast-ing insulin levels ( FINS) (≥12 mIU/L, which was the reference criteria for determined IR ) .Results Of the 406 partic-ipants, 114 cases of IR and 292 cases of non-IR were found.When using HOMA-IR≥2.6 as the cut-off point of IR, there were 138 cases of IR and 268 cases of non-IR.The sensitivity was 94.74%and the specificity was 89.73%.Youden index was 0.84.When using HOMA-IR≥2.68 as the cut-off point, the sensitivity and specificity was 93.3%and 92.9%, re-spectively.Youden index was elevated to 0.86.When using QUICKI≤0.339 as the cut-off point of IR, there were 210 ca-ses of IR and 196 cases of non-IR.The sensitivity was 100%and the specificity was 67.12%.Youden index was 0.67. When using QUICKI≤0.335 as the cut-off point, the sensitivity and specificity was 79.8% and 99.0%, respectively. Youden index was increased to 0.79.When using McA≤5.8 as the cut-off point of IR, there were 403 cases of IR and 3 cases of non-IR.The sensitivity was 98.25%and the specificity was only 0.34%.Youden index was -1.41.When using McA≤4.29 as the cut-off point, the sensitivity and specificity was 78.0% and 82.9%, respectively.Youden index was increased to 0.61.Conclusions HOMA-IR is more accurate in detecting IR in overweight/obese population.The thresh-olds of these three indices in overweight/obese population should be adjusted appropriately considering the influence of obe -sity and lipid metabolism on insulin levels to increase the accuracy in evaluating IR .%目的：观察不同胰岛素抵抗（ IR）计算指数评价超重及肥胖人群中IR的准确性，寻找超重及肥胖人群更为理想的判定临界值。方法研究对象为406例超重及肥胖的非糖尿病患者，计算纳入者的稳态模型胰岛素抵抗指数（HOMA-IR）、定量胰岛素敏感性检测指数（QUICKI）、McAuley指数（McA），以空腹胰岛素≥12 mIU／L为IR金标准，评价各指数判定IR的准确性。结果406例超重及肥胖者中，IR114例、非IR292例。以HOMA-IR≥2．6判定IR时，IR 138例、非IR 268例，其灵敏度为94．74％、特异度为89．73％，约登指数为0．84；以HOMA-IR≥2．68作为判定切点时，其灵敏度为93．3％、特异度为92．9％，约登指数为0．86。以QUICKI≤0．339判定IR时，IR 210例、非IR196例，其灵敏度为100％、特异度为67．12％，约登指数为0．67；以QUICKI≤0．335作为判定切点时，其灵敏度为79．8％、特异度为99．0％，约登指数为0．79。以McA≤5．8判定IR时，IR 403例、非 IR3例，其灵敏度为98．25％、特异度为0．34％，约登指数为－1．41；以McA≤4．29作为判定切点时，其灵敏度为78．0％、特异度为82．9％，约登指数为0．61。结论在超重及肥胖人群中HOMA-IR能更准确地评估IR；在这部分人群中判定IR时应考虑肥胖及脂代谢对胰岛素水平的影响作用，适当调整判定临界值，以便能提高评价IR的准确性。