改良式簡易型靜脈葡萄糖耐受性試驗及胰島素敏感性試驗(HOMA)臨床應用之評估

Clinical applications of modified simplified intravenous glucose tolerance test (MSIVGTT) and homeostasis model assessment (HOMA) in client-owned healthy obese and lean cats

陳依妲(Yi Ta Chen)

指導教授 ： 蘇璧伶

國立臺灣大學/獸醫專業學院/臨床動物醫學研究所/碩士(2010年)

https://doi.org/10.6342/NTU.2010.02399

摘要

現今貓隻血糖恆定之評估主要仍需依賴靜脈葡萄糖耐受性試驗之結果(Intravenous glucose tolerance test, IVGTT)，由於此試驗需要麻醉及住院，因此在臨床上的實用性非常低。本研究目的在於建立臨床可行之修正簡化型靜脈葡萄糖耐受性試驗 (modified simplified intravenous glucose tolerance test, MSIVGTT)及簡化胰島素敏感指數(Homeostasis model assessment, HOMA)，進而篩選出葡萄糖耐受性異常( Impaired glucose intolerance)之貓隻。38隻家貓參與本研究，修正簡化型靜脈葡萄糖耐受性試驗過程包括畜主陪同、以延長之蝴蝶針重複採血以及提供軟墊及毛巾供緊張貓隻遮蔽，試驗時間共計三個小時。所有貓隻依據貓身體質量指數 (Feline body mass index)分為肥胖及體態正常兩組。38隻貓中，32隻貓隻(84%)完成修正簡化型靜脈葡萄糖耐受試驗，試驗結果在肥胖貓組顯示其葡萄糖排除率(Glucose disposal rate)較體態正常貓組緩慢及在第二時期胰島素分泌過量，兩組結果的不同皆達統計上顯著差異。在32隻貓中，篩選出3隻貓葡萄糖耐受性異常。此外，全部38隻貓所進行HOMA試驗結果顯示在肥胖貓有較高之數值，且達統計上顯著之差異，同時與貓隻肥胖程度呈現正相關結果。總結，本研究成功的建立臨床上可應用的修正簡化型靜脈葡萄糖耐受性試驗及HOMA試驗，並且藉此之試驗篩選出葡萄糖耐受性異常之貓隻。

關鍵字

改良式 ； 簡易型 ； 靜脈 ； 葡萄糖 ； 耐受性 ； 試驗

並列摘要

Intravenous glucose tolerance test is a suggested method to evaluate the glucose homeostasis in cats. However, anesthesia and hospitalization required in performing the test hamper its clinical application. In order to establish a clinical applicable test, 34 client-owned cats were enrolled in this study. A modified simplified intravenous glucose tolerance test (MSIVGTT), a simple indice of insulin sensitivity homeostasis model assessment (HOMA) were evaluated for their applicability in the detection of glucose intolerant patients. The modifications include accompany of the pet owner, application of winged infusion set connected with the catheter for repeatable blood sampling, lay of the examined cats upon a soft pet bed and covered with a towel, as well as shorten the examined procedure to 3 hours. All cats were divided into obese and lean groups based on the feline body mass index (FBMI). Complete evaluation was achieved from 32 out of 38 cats (84%) using MSIVGTT and the results showed statistical differences between obese and lean cats with slower glucose disposal rate in glucose response and exaggerated insulin secretion in the 2nd phase of insulin response in the obese cats. Moreover, the test also screens out 3 impaired glucose tolerant cats from the 32 cats. The HOMA showed significant difference between two groups and had a positive correlation with the obese condition of the 38 cats. In conclusion, MSIVGTT and HOMA were established for clinical usage evaluation of glucose homeostasis. Application of these 2 assays can be used to screen out impaired glucose tolerant cats in clinical practice.

並列關鍵字

modified ； simplified ； intravenous ； glucose ； tolerance ； test

參考文獻

1. Abdul-Ghani M.A.,Williams K, DeFronzo R., Stern M., 2006. Risk of progression to type 2 diabetes based on relationship between postload plasma glucose and fasting plasma glucose. Diabetes Care., 29,1613-1618.

2. Abdul-Ghani M.A.,Williams K, DeFronzo R., Stern M., 2007.What is the best predictors of future type 2 diabetes? Diabetes Care., 30,1544-1548.

3. Akinmokun A., Shelby P.L., Ramaiya K. et al., 1992. The short insulin tolerance test for determination of insulin sensitivity: a comparison with the euglucemic clamp. Diabet Med, 9, 432-437.

5. Appleton D.J., Rand J.S., Sunvold G.D., 2000. Plasma leptin concentrations in cats: reference range, effect of weight gain and relationship with adiposity as measured by dual energy x-ray absorptionmetry. J Feline Med Surg., 2, 191-199.

6. Appleton D.J., Rand J.S., Sunvold G.D.,2001a. Insulin sensitivity decreases with obesty, and lean cats with low insulin sensitivity are at greatest risk of glucose intolerance with weight gain. J Feline Med Surg., 3, 211-228.