How to measure hepatic insulin resistance?
How to measure hepatic insulin resistance?
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DOI：
10.1016/s1262-3636(08)74602-0
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发表时间：
2008-12-01
影响因子：
7.2
通讯作者：
Gautier, J. -F
中科院分区：
文献类型：
--
作者：
Choukem, S. -P.;Gautier, J. -F
肝脏在能量代谢中起着举足轻重的作用。在荷尔蒙的控制下。特别是胰岛素，肝脏根据身体系统的需要储存或释放葡萄糖。它还负责非酯化脂肪酸和氨基酸代谢的所有重要部分。评估肝脏胰岛素抵抗几乎总是与测量肝脏葡萄糖产生（HGP）和计算肝脏胰岛素抵抗指数同义。为此目的最常用的方法是使用示踪剂的同位素稀释技术。在追踪器里。稳定的同位素标记的葡萄糖分子比放射性同位素标记的葡萄糖特别有利。因此，示踪剂的选择。在禁食过夜后单独输注示踪剂以评估空腹HGR，或者与一些常用的胰岛素敏感性测试一起输注示踪剂以评估胰岛素和/或葡萄糖对HGP的抑制作用。处于禁食状态。HGP很容易计算，而在胰岛素或葡萄糖输注期间，需要一些公式来校正非稳态条件。肝胰岛素抵抗指数是HGP与相应血浆胰岛素浓度的乘积。尽管会有误差。然而，同位素稀释法仍然是临床研究中评估肝脏胰岛素抵抗的不可替代的工具。从实际的角度来看。一些容易获得的指标和临床或生化指标在临床上可作为肝胰岛素抵抗的替代物或标志物。最后，二甲双胍或格列酮等药物可以改善肝脏胰岛素抵抗。因此它们在肝脏胰岛素抵抗状态如2型糖尿病和非酒精性脂肪肝病中的用途。(C)2008年，Elsevier Masson SAS。All rights reserved.
The liver plays a pivotal role in energy metabolism. Under the control of hormones. especially insulin, the liver stores or releases glucose as needed by the body's systems. It is also responsible for all important part of non-esterified fatty-acid and aminoacid metabolism. Assessing hepatic insulin resistance is almost always synonymous with measuring hepatic glucose production (HGP) and calculating indices of hepatic insulin resistance. The most frequently used method to this end is the isotope dilution technique using a tracer. Among tracers. stable isotope-labelled glucose molecules are particularly advantageous over radioactive isotope-labelled glucose and are. therefore, the tracers of choice. The tracer is infused either on its own after an overnight fast to evaluate fasting HGR or with some among the usual insulin-sensitivity tests to assess HGP suppression by insulin and/or glucose. In a fasting state. HGP is easily calculated whereas, during insulin or glucose infusion, some formula are needed to correct for the non-steady-state condition. The hepatic insulin-resistance index is the product of HGP and the corresponding plasma insulin Concentration. Although subject to error. the isotope dilution method nevertheless remains an irreplaceable tool for assessing hepatic insulin resistance in clinical research. From a practical point of view. some easily obtainable indices and clinical or biochemical parameters call serve as Surrogates or markers of hepatic insulin resistance in clinical practice. Finally, drugs Such as metformin or glitazones call improve hepatic insulin resistance. hence their use in hepatic insulin-resistant states such as type 2 diabetes and non-alcoholic fatty liver disease. (C) 2008 Elsevier Masson SAS. All rights reserved.