肥胖儿童的胰岛素动力学可预测体重指数和对胰岛素抑制或增敏药物治疗反应的Z评分

作     者：Lustig R.H. Mietus-Snyder M.L. Bacchetti P. 贺莉 

作者机构：Division of Pediatric Endocrinology University of California San Francisco Box 0434 5 13 Parnassus Ave San Francisco CA 94143-0434 United States.Dr 

出 版 物：《世界核心医学期刊文摘（儿科学分册）》 (Dkgest of the World Latest Medical Information)

年 卷 期：2006年第2卷第5期

页      面：27-27页

学科分类：1007[医学-药学(可授医学、理学学位)] 1006[医学-中西医结合] 100706[医学-药理学] 1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 100602[医学-中西医结合临床] 10[医学] 

主　　题：胰岛素分泌过多 药物治疗反应 胰岛素增敏药 肥胖儿童 体重指数 口服葡萄糖耐量试验 预测 Z评分 动力学 胰岛素敏感指数 

摘      要：Objective: To assess the use of oral glucose tolerance testing (OGTT) to predi ct efficacy of insulin sensitization (metformin)-or suppression (octreotide) be cause insulin resistance and insulin hypersecretion may impact pharmacotherapeut ic efficacy in obese children. Study design: Forty-three and 24 obese children, with and without central nervous system (CNS) insult, underwent OGTT. Insulin s ensitivity was expressed as composite insulin sensitivity index (CISI), and secr etion as corrected insulin response (CIRgp). Those without CNS insult received metformin (weight-based dosing) for 6 to 16 months. Those with CNS insult receiv ed octreotide SQ 15 μg/kg/d for 6 months. Body mass index (BMI) and z-score responses were modeled using CIRgp and CISI. Results: Metformin: With CIRgp and CI SI = 1, BMI z-score in white children declined by 0.23 over the first 4 months (P .001), and by 0.14 over the next year (P= .33). Each 2-fold increase in CI Rgp or CISI attenuated BMI z-score reduction, but with wide uncertainty (P= .24 ). Black children exhibited little response. Octreotide: With CIRgp and CISI = 1 , BMI z-score decreased by 0.23 in the first 4 months (P= .052). Efficacy was d ependent on an interaction between CIRgp and CISI (P= .051). Conclusions: Effica cy of metformin was predicted by pretreatment insulin resistance. Efficacy of oc treotide was predicted by insulin hypersecretion and sensitivity.