相对胰岛素敏感性指数在肥胖症和糖尿病中的临床应用

目的探讨肥胖儿童和糖尿病儿童外周组织的胰岛素敏感性及其与血浆胰岛素浓度的相关性。方法随机选择单纯性肥胖儿童３２例分为糖耐量正常组（ＮＧＴ组）和糖耐量低减组（ＩＧＴ组）各１６例。Ⅰ型糖尿病组（ＩＤＤＭ组）１６例。健康儿童１６例（对照组）。用放射免疫法测定血浆胰岛素，葡萄糖氧化酶法测定血浆葡萄糖。以相对胰岛素敏感性指数（ＲＩＳＩ）来判断组织的胰岛素敏感性。结果肥胖组、糖尿病组ＲＩＳＩ值均明显低于对照组（Ｐ＜０．０１）。以对照组ＲＩＳＩ均值减去一个标准差值衡量不同机体组织的胰岛素敏感性表明，对照组、ＨＧＴ组、ＩＧＴ组、ＩＤＤＭ组在此值以上者分别占８１．２％、５６．２％、１２．５％、０。后两组与对照组比较均有极显著差异（Ｐ＜０．０１）。肥胖组ＲＩＳＩ与ＦＰＩ间呈显著负相关（ｒ＝０．４６，Ｐ＜０．０１），而糖尿病组相关不显著（ｒ＝０．２８９，Ｐ＞０．０５）。结论肥胖组（尤其ＩＧＴ组）与糖尿病组普遍存在组织的胰岛素敏感性下降，是导致肥胖儿童血浆胰岛素升高的一个原因。ＲＩＳＩ判断组织的胰岛素敏感程度有实用价值。

Clinical application of relative insulin sensitivity index in children with obesity and diabetes mellitus

To search for the tissue insulin sensitivity and its relationship to plasma insulin concentration in children with obesity and diabetes mellitus.Methods The plasma glucose and insun concentration (by radioimmunoassay) were determined respectively by glucose oxidase method and radioimmunoassay in 32 children with obesity (16 NGT and 16 IGT),16 children with IDDM, and 16 health children.The relative insulin sensitivity index (RISI) was considered as a index to judge the tissue insulin sensitivity in subjects.Results The values of RISI in obesity group and in IDDM group were significantly lower than that in coutrol group (all p<0.01) .The percentage over 0.890 in IGT group and in IDDM group were significantly fewer than that in contrul. group (all P<0.01).There was a negative relationship (r=-0.46, p<0.01) in obesity group but not in IDDM group between RISI and FPI (r=0.239, P>0.05).Conclusions The results reveal that there are the decreased tissue insulin sensitivity,it is a cause of hyperinsulinemia in obesity group.The RISI has practical value on assessment of the tissue sensitivity in IDDM group.