新HOMA稳态模型在临床中的应用

目的研究利用新HOMA稳态模型HOMA2计算的胰岛素敏感性指数（ISI）和分泌功能指数在临床的应用价值。方法选取80名志愿者，其中正常糖耐量（NGT）31人、糖调节异常（IGR）26人，2型糖尿病（T2DM）23人；抽取空腹血测定血糖、胰岛素（Ins）、真胰岛素（TI）和C肽水平，利用HOMA2计算器分别计算三种ISI（HOMA2-％S-Ins、HOMA2-％S-TI和HOMA2-％S-C）和三种胰岛素分泌功能指数（HOMA2-％B-Ins、HOMA2-％B-TI和HOMA2-％B-C），比较上述指数区分不同糖耐量组的胰岛素敏感性和分泌功能变化的能力。结果在三种ISI中，利用空腹TI计算的HOMA2-％S-TI区分三组的胰岛素敏感性的能力相对最强（F=4．888，P〈0．01），利用空腹Ins计算的HOMA2-％S-Ins次之（F=3．397，P〈0．05），利用空腹C肽计算的HOMA2-％S-C不能区分三组的胰岛素敏感性（F=1．042，P〉0．05）。利用HOMA2-％S-TI调整后，三种胰岛素分泌功能指数区分三组胰岛素分泌功能的能力非常接近（F值分别为60．323、58．203和58．179，P〈0．01），且均可很好区分IGR组和DM组的胰岛素分泌功能，其中只有HOMA2-％B-C可较好区分NGT组和IGR组的胰岛素分泌功能（t=2．2709，P〈0．05）。结论利用新HOMA稳态模型计算的HOMA2-％S-TI是一个相对较好的计算ISI的公式，HOMA2-％B-C是一个相对较好的计算胰岛素分泌功能指数的公式。

Application of the new homeostasis model in clinic

Objective To investigate the application of insulin sensitivity index and insulin secretion function index calculated by the new homeostasis model in clinic. Methods Eighty Chinese volunteers in Tianjin area （31 subjects for NGT group, 26 subjects for IGR group and 23 subjects ＂for DM group） were involved in this study. Fasting blood samples were collected to measure the values of plasma glucose, insulin, true insulin and C peptide. Three insulin sensitivity indices （HOMA2-%S-Ins, HOMA2-%S-TI and HOMA2-%S-C） and three insulin secretion function indices （HOMA2-%B-Ins, HOMA2-% B-TI and HOMA2-%B-C） were calculated by the HOMA2 calculator. Results Among the three insulin sensitivity indices, the HOMA2-%S-TI calculated from plasma glucose and true insulin was relatively best （P〈 0.01） in distinguishing the insulin sensitivity of three groups, the HOMA2-%S-Ins calculated from plasma glucose and insulin was relatively better （0.05〉P〉0.01） and the HOMA2-%S-C calculated from plasma glucose and C peptide was relatively worse （P〉0.05）. After adjusted by HOMA2-%S-TI, the abilities of three insulin secretion function indices in distinguishing the insulin secretion function among three groups were very similar （F=60.3, 58.2 and 58.2 respectively, P〈0.01）, the abilities of them in distinguishing the insulin secretion function between IGR group and DM group were similar, meanwhile HOMA2-%B-C could distinguish the insulin secretion function between NGT group and IGR group （P〈 0.05）. Conclusion The HOMA2-%S-TI calculated from the new homeostasis model is a better index in assessingthe insulin sensitivity, and HOMA2-%B-C is a better index in evaluating the insulin secretion function.