Assessment of insulin sensitivity from measurements in the fasting state and during an oral glucose tolerance test in polycystic ovary syndrome and menopausal patients
Assessment of insulin sensitivity from measurements in the fasting state and during an oral glucose tolerance test in polycystic ovary syndrome and menopausal patients
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DOI：
10.1210/jc.2004-0410
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发表时间：
2005-03-01
影响因子：
5.8
通讯作者：
Lanzone, A
中科院分区：
文献类型：
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作者：
Ciampelli, M;Leoni, F;Lanzone, A
背景：多囊卵巢综合征（PCOS）和绝经受试者的特点是心血管和2型糖尿病的风险增加，至少部分与胰岛素紊乱有关。评估这些患者的胰岛素抵抗可作为一级预防。本研究的目的是通过将这些指标与正糖-高胰岛素钳夹研究的数据进行比较，验证PCOS和绝经受试者胰岛素敏感性的几个指标的有效性。方法：对100例PCOS患者和110例绝经期患者进行分析；所有受试者都进行了口服葡萄糖耐量试验（75 g）和正糖-高胰岛素钳夹研究。7名多囊卵巢综合征患者和13名绝经期受试者有糖耐量受损或2型糖尿病，被排除在研究之外。在分析评价指标与钳夹研究的相关系数后，采用受试者工作特征（ROC）曲线分析各参数不同截止值的敏感性和特异性。结果：PCOS患者的Avignon胰岛素敏感性指数（SiM） （R(s) = 0.7812）和绝经期患者的Matsuda和De Fronzo指数（R(s) = 0.6178）与夹持研究的相关系数最好。PCOS患者胰岛素抵抗的最佳预测指标是Avignon胰岛素敏感性基础指数（SibB）值≤62（78%敏感性，95%特异性）和胰岛素曲线下面积(AUC)≥7000 μ IU/ml （>= 50,225 pmol/ l） × 120 min（83%敏感性，90%特异性）。在绝经期人群中，胰岛素AUC≥10,000 mu IU/ml （>= 71,750 pmol/ l） × 240 min（70%敏感性，88%特异性）可获得最佳预测效果。结论：高相关系数的存在并不一定意味着胰岛素抵抗指标具有最佳的预测性能；这可能是由于存在许多边缘值。在常规临床实践中，胰岛素AUC的简单评估似乎有效地取代了正血糖-高胰岛素钳，使结果可以与最小模型分析得到的结果重叠。
Background: Polycystic ovary syndrome ( PCOS) and menopausal subjects are characterized by an increased cardiovascular and type 2 diabetes mellitus risk, at least partially related to insulin disturbances. The evaluation of insulin resistance in these patients could be useful as primary prevention. The aim of the study was to verify the validity of several indexes of insulin sensitivity in PCOS and menopausal subjects by comparing the data obtained by these indexes to those of euglycemic-hyperinsulinemic clamp studies.Methods: One hundred PCOS and 110 menopausal subjects were analyzed; all subjects underwent an oral glucose tolerance test ( 75 g) and euglycemic-hyperinsulinemic clamp study. Seven PCOS patients and 13 menopausal subjects had impaired glucose tolerance or type 2 diabetes mellitus and were excluded from the study. After analysis of correlation coefficients between the evaluated indexes and the clamp studies, the sensitivity and specificity of different cut-off values for each parameter were analyzed by receiver operating characteristic (ROC) curves.Results: The best correlation coefficients with clamp studies were obtained with the Avignon insulin sensitivity index (SiM) (R(s) = 0.7812) in PCOS patients and the Matsuda and De Fronzo index (R(s) = 0.6178) in menopausal patients.The best predictive index of insulin resistance in PCOS was a Avignon insulin sensitivity basal index (SibB) value of 62 or less (78% sensitivity, 95% specificity) and an insulin area under the curve (AUC) of 7,000 mu IU/ml or more (>= 50,225 pmol/ liter) x 120 min (83% sensitivity, 90% specificity). In the menopausal population, the best predictive performance was obtained by an insulin AUC of 10,000 mu IU/ml or more (>= 71,750 pmol/ liter) x 240 min (70% sensitivity, 88% specificity).Conclusions: The presence of high correlation coefficients does not necessarily mean that the indexes of insulin resistance have an optimal predictive performance; this is probably due to the presence of many borderline values. The simple evaluation of insulin AUC seems to effectively replace the euglycemic-hyperinsulinemic clamp in routine clinical practice, allowing results superimposable to those obtained by minimal model analysis.