vs , P < 0. 01) ( 2B)

Transcription

1 ( ) J Cent South Univ(Med Sci) 2004,29 (4) 419 C Homa, 3,,, (, ) [ ] : C Homa : 21 (O GTT), 30,60,120 min C C C / ( ), Homa ( Homa2IR) ( Homa2islet), Homa (CP) : C : Homa2IR (CP) = C / 2800( F = , P = ) ; Homa2islet (CP2Normal) = C / ( ) + 50 ; Homa2islet (CP2DM) = C / ( ) ( F = , P = ) Homa2IR (CP) Homa2IR, Homa2islet (CP) Homa2islet ( , P = ) : C Homa [ ] Homa ; C ; ; ; [ ] R [ ] A [ ] (2004) Replacement of insulin by fasting C2peptide in modif ied homeostasis model assessment to evaluate insulin resistance and islet cell f unction L I Xia, ZHOU Zhi2guang 3, Q I Hai2ying, CHEN Xiao2yan, HUAN G Gan ( Depart ment of Endocrinology, Second Xiangya Hospital, Central South U niversity, Changsha , China) Abstract : Objective To investigate the possibility of using C2peptide to replace insulin in home2 ostasis model assessment ( Homa) to evaluate insulin resistance and islet cell function. Methods Oral glucose tolerance test (O GT T) was performed in 21 normal subject s, whose venous blood was drawn before taking glucose and 30, 60, 120 minutes after taking glucose. Insulin and C2peptide were deter2 mined with radioimmune assay. Homa indices of insulin resistance and islet cell function were calculat2 ed. Multiple stepwise linear regression model of insulin resistance was measured using C2peptide blood glucose as independent variables and Homa2IR was used as the dependent variable, while the model of islet cell function was determined using C2peptide/ (fasting blood glucose ) as the independent variable and Homa2islet as the dependent variable. Results The modified Homa formula were : Homa2IR (CP) = fasting blood glucose fasting C2peptide / 2800 ( F = , P = ), Homa2islet (CP2 Normal) = fasting C2peptide / (fasting blood glucose ) + 50,and Homa2islet (CP2DM) = fasting C2Peptide/ (fasting blood glucose ) ( F = , P = ),respectively. The modified Homa2IR ( CP) and Homa2IR, Homa2islet ( CP) and Homa2islet were highly correlated ( r = and r = ; all P = ). Using Homa and modified Homa formula to evaluate the insulin resistance and islet cell function both in the normal and diabetic subjects was similar. Conclusion Fasting C2peptide can substitute insulin in Homa model to assess insulin resistance and islet cell function. The modified homeostasis model assessment may be applied in the diabetics using exogenous insulin. : : (19772),,,, 3,E2mail : com

2 420 ( ),2004,29 (4) Key words : Homa formula ; C2peptide ; islet cell function ; insulin resistance ; diabetes [J Cent South Univ(Med Sci),2004,29 (4) : ], (minimal model),, Homa [1 ],, 1 2 C, C, : 2 h, 21 10, 11, (19 69) : < 5, 1999 WHO,,, 16 11, 5, (33 72) (O GTT) 10 h 8 9 O GTT 30 min, 60 min 120 min C 4. 4 % 9. 8 % ( n = 3) % 5. 4 %( n = 3) ( Homa) [ Homa2 islet = 20 / ( ) ] [ Homa2IR = / ] ( U/ ml ; mmol/ L ) 1. 3 gx s t ; Pearson, SPSS P < O GTT C O GTT, ( P < 0. 01) ( 1 A) ; 30 min ( P < 0. 01), ( 1B) ; C 30 min, min, ( 1C) 2. 2 Homa (4. 1 vs 2. 9, P < 0. 01) ( 2 A) ; (66. 7 vs , P < 0. 01) ( 2B) 1 O GTT (A) (B) C (C) Fig. 1 Changes of blood glucose (A), serum insulin (B) and C2peptide during O GTT in healthy controls and diabetic patients

3 C Homa, (A) (B), Fig. 2 Scattered plot of index for insulin resistance and islet cell function in healthy controls and diabetic patients,broken line represents the average value 2. 3 C bs0 cp0, bs30 cp30, bs60 cp60, bs120 cp120, Homa Homa2IR C (bs0 cp0), F = , P = , : Homa2IR (CP) = C / , Homa2IR (CP) = C / 2800 C ( ) cp0/ (fbs ),cp30/ (fbs ),cp60/ (fbs ),cp120/ (fbs ), Homa2islet C ( ) cp0/ (bs0-3. 5), F = , P = , : Homa2islet ( CP) = C / ( ) , Homa2 islet (CP) = C / ( ) Homa2IR (CP) Homa2IR, Homa2islet (CP) Homa2islet Homa2IR (CP) Homa2IR, ( P = , P = ) Homa2islet ( CP) Homa2islet, ( P = ), Homa2islet (CP) Homa2islet ( P = ) Homa2islet (CP) Homa2islet (CP2DM) = cp0/ (fbs ), Homa2islet (CP2Normal) = cp0/ (fbs ) + 50 Homa2islet (CP2DM) Homa2islet ( P = ) ( 1) 1 Homa Homa n Homa2IR Homa2IR(CP) Homa2islet Homa2islet (CP) ( ) ( ) ( ) ( ) Homa2IR (CP) Homa2IR, Homa2islet (CP) Homa2islet :Homa2IR (CP) Homa2IR ( P = ) ( 3) ; Homa2islet (CP2DM) Homa2 islet (CP2Normal) Homa2islet ( P = ) ( 4),, 0 ( 5, 6) Homa (CP) T1DM LADA Homa (CP) T1DM LADA, T1DM LADA, ; LADA,LADA21 LADA22 ( 2)

4 422 ( ),2004,29 (4) 3 Homa2IR Homa2IR(CP) Fig. 3 Correlation of Homa2IR with Homa2IR(CP) 4 Homa2islet Homa2islet (CP) Homa2islet ( CP2DM) ; Homa2islet (CP2Normal) Fig. 4 Correlation of Homa2islet with Homa2islet (CP) Islet function of diabetes was calculated with Homa2islet (CP2DM) ;islet function of controls was calculated with Homa2islet (CP2Normal) 5 Homa2IR Homa2IR(CP) Fig. 5 Difference between Homa2IR and Homa2IR(CP) 6 Homa2islet Homa2islet (CP) Homa2islet ( CP2DM) ; Homa2islet (CP2Normal) Fig. 6 Difference between Homa2islet and Homa2islet ( CP) Islet func2 tion of diabetes was calculated with Homa2islet ( CP2DM) ; islet function of controls was calculated with Homa2islet (CP2Normal) 2 Homa (CP) T1DM LADA T1DM LADA LADA21 LADA22 Homa2IR(CP) Homa2islet (CP) ( ) ( ) ( ) # ( ) # T1DM, 3 3 P < ; LADA21, # P < ,,, [2 ],, ;, Homa Homa [1 ],, Homa : [3 ],,

5 C Homa, 423 C, C,, C [4 ] O GTT, C, 1 [5 ], 24 % LADA [6 ], O GTT, 30 min, C 60 min, C C? 21 O GTT C C ( ), C Homa Homa (CP) C,? ; ; Homa2islet ( CP2Normal) Homa, Homa2islet (CP2Normal) Homa2 islet (CP2DM), 18 % 28 %, Homa, [7 ] C, C,, Homa Homa (CP), 0,, Homa Homa (CP),, Homa Homa (CP) 1, 1 LADA, C Homa (CP), T1DM LADA, ; LADA,LADA21 LADA - 2 ( P < 0. 05) T1DM LADA [8 ], T1DM LADA,, Homa (CP), Homa 30 % [1 ], Homa ( CP), : [1 ] Matthews DR, Hosker J P, Rudenski AS, et al. Homeostasis model assessment : insulin resistance and cell function from fast2 ing plasma glucose and insulin concentrations in man [ J ]. Dia2 betologia, 1985, 28 (7) : [2 ]., [J ].,2003,19 (1) :527. [ 3 ] Matthews DR,Lang DA,Burnett MA,et al. Control of pulsatile in2 sulin secretion in man[j ]. Diabetologia,1983,24 (4) : [ 4 ] Torn C, Landin2Olsson M, Lernmark A, et al. Prognostic factors for the course of cell function in autoimmune diabetes[j ]. J Clin Endocrinol Metab, 2000, 85 (12) : [5 ] Greenbaum CJ. Insulin resistance in type 1 diabetes[j ]. Diabetes Metab Res Rev,2002,18 (3) : [6 ],,,. [J ].,2003,25 ( 6) : [7 ],,,. ( FINS FPG) / ( PG2h + PG1h2 2FPG) [J ].,2000,39 (4) : [ 8 ] Li X, Yang L, Zhou Z, et al. Glutamic acid decarboxylase 65 au2 toantibody levels discriminate two subtypes of latent autoimmune diabetes in adults[j ]. Chin Med J, 2003,116 (11) : ( )