Preeclampsia in lean normotensive normotolerant pregnant women can be predicted by simple insulin sensitivity indexes
Preeclampsia in lean normotensive normotolerant pregnant women can be predicted by simple insulin sensitivity indexes
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DOI：
10.1161/01.hyp.0000205122.47333.7f
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发表时间：
2006-03-01
期刊：
影响因子：
8.3
通讯作者：
Mello, G
中科院分区：
文献类型：
--
作者：
Parretti, E;Lapolla, A;Mello, G
先兆子痫和胰岛素抵抗综合征之间的某些相似之处表明这两种疾病之间可能存在联系。本研究的目的是评估3个胰岛素敏感性（IS）指标（空腹稳态模型评估IS [ISHOMA]、定量胰岛素敏感性检查指数[ISQUICKI]和口服葡萄糖IS [OGIS]）在大量糖耐量正常的血压正常孕妇中的妊娠早期和晚期，并测试这些指标预测随后先兆子痫风险的能力。总共有829名孕妇在怀孕早期（16至20周）和晚期（26至30周）接受了75 g，2小时口服葡萄糖负荷的测试。在妊娠早期和晚期，ISHOMA分别为1.23 ± 0.05和1.44 ± 0.05（P < 0.01），ISQUICKI为0.40 ± 0.002和0.38 ± 0.002 OGIS分别为457 +/- 2.4 mL min（-1）m（-2）和445 +/- 2.2（P < 0.001），均证实妊娠期间胰岛素敏感性降低。先兆子痫发生率为6.4%，与ISHOMA第75百分位数呈正相关（P = 0.001），早期敏感性为79%，晚期为83%，特异性均为97%。ISQUICKI <第25百分位数也与先兆子痫相关（P = 0.001），早期敏感性为85%，晚期为88%，特异性均为97%。从我们的研究结果来看，ISHOMA和ISQUICKI是简单的测试，可以在怀孕早期查明胰岛素敏感性受损。鉴于其高灵敏度和特异性，这些指标可能有助于在疾病变得临床明显之前预测妊娠早期先兆子痫的发展。
Certain similarities between preeclampsia and insulin resistance syndrome suggest a possible link between the 2 diseases. The aim of our study was to evaluate 3 insulin sensitivity ( IS) indexes ( fasting homeostasis model assessment IS [ISHOMA], quantitative insulin sensitivity check index [ISQUICKI], and oral glucose IS [OGIS]) early and late in pregnancy in a large number of normotensive pregnant women with a normal glucose tolerance and to test the ability of these indexes to predict the risk of subsequent preeclampsia. In all, 829 pregnant women were tested with a 75-g, 2-hour oral glucose load in 2 periods of pregnancy: early ( 16 to 20 weeks) and late ( 26 to 30 weeks). In early and late pregnancy, respectively, ISHOMA was 1.23 +/- 0.05 and 1.44 +/- 0.05 ( P < 0.01), ISQUICKI was 0.40 +/- 0.002 and 0.38 +/- 0.002 ( P < 0.01), and OGIS was 457 +/- 2.4 mL min(-1) m(-2) and 445 +/- 2.2 ( P < 0.001), all confirming the reduction in insulin sensitivity during pregnancy. Preeclampsia developed in 6.4% of the pregnant women and correlated positively with the 75th centile of ISHOMA ( P = 0.001), with a sensitivity of 79% in the early and 83% in the late period and a specificity of 97% in both. ISQUICKI < 25th centile was also related with preeclampsia ( P = 0.001), with a sensitivity of 85% in the early ;and 88% in the late period and a specificity of 97% in both. Judging from our findings, ISHOMA and ISQUICKI are simple tests that can pinpoint impaired insulin sensitivity early in the pregnancy. Given their high sensitivity and specificity, these indexes could be useful in predicting the development of preeclampsia in early pregnancy, before the disease become clinically evident.