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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

世界核心医学期刊文摘（儿科学分册） 2006年第5期2卷 27-27页

作者： Lustig R.H. Mietus-Snyder M.L. bacchetti p. 贺莉 Division of p.diatric Endocrinology University of California San Francisco Box 0434 5 13 Parnassus Ave San Francisco CA 94143-0434 United States.Dr

Objective: To assess the use of oral glucose tolerance testing (OGTT) to p.edi ct efficacy of insulin sensitization (metformin)-or sup.ression (octreotide) be cause insulin resistance and insulin hyp.rsecretion may imp.ct p.armacotherap.ut 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 exp.essed as comp.site insulin sensitivity index (CISI), and secr etion as corrected insulin resp.nse (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 resp.nses 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.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 resp.nse. Octreotide: With CIRgp.and CISI = 1 , BMI z-score decreased by 0.23 in the first 4 months (p. .052). Efficacy was d ep.ndent on an interaction between CIRgp.and CISI (p. .051). Conclusions: Effica cy of metformin was p.edicted by p.etreatment insulin resistance. Efficacy of oc treotide was p.edicted by insulin hyp.rsecretion and sensitivity.

关键词：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

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肥胖儿童的胰岛素分泌过多与胰岛素抵抗的种族及疾病发生学上的差异

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世界核心医学期刊文摘（儿科学分册） 2005年第8期1卷 31-31页

作者： p.eeyasombat C. bacchetti p. Lazar A.A. Lustig R.H. 郭战宏 Division of p.diatric Endocrinology Box 0434 Univ. of California San Francisco 513 Parnassus Ave San Francisco CA 94143- 0434 United States Dr.

Objectives: To assess insulin dynamics to oral glucose tolerance testing in o bese children, denoting individual contributions of insulin hyp.rsecretion versu s resistance to racial and etiop.thogenetic sp.cificity. Study design: We p.rfor med 3- hour oral glucose tolerance testing in 113 nondiabetic obese children (a ge 13.6 ± 3.1 years; 41 male, 78 female; 37 black, 41 white; 35 with central n ervous system [CNS] insult). The corrected insulin resp.nse (CIRgp. measuring β - cell secretion) and the comp.site insulin sensitivity index (CISI) were comp.uted and log- transformed, and each was modeled in terms of the other, p.us rac e/etiology, age, sex, body mass index z score, glucose tolerance, p.bertal statu s, and geograp.ic location. Results: A scatterp.ot of logCIRgp.versus logCISI sh owed that racial and etiop.thogenetic group. p.otted in different areas. CISI (c ontrolled for CIRgp.and other variables) was only 13% lower in blacks than in whites (p.= .32). Conversely, CIRgp.(controlled for CISI and other variables) wa s 49% higher in blacks (p.= .028). CNS insult exhibited a 40% higher CIRgp.( p.= .054) and 11% higher CISI (p.= .42) than intact white subjects. Conclusion s: Insulin hyp.rsecretion and resistance are distinct p.enomena in childhood obe sity. Insulin hyp.rsecretion ap. p.ars to be the more relevant insulin abnormal ity both in obese blacks and in CNS insult.

关键词：疾病发生学分泌过多肥胖儿童胰岛素抵抗儿童期肥胖 β细胞口服糖耐量试验发病机制胰岛素敏感指数黑色人种

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