老年慢性肾衰竭患者胰岛素抵抗情况及分析

Analysis of insulin resistance in elderly patients with chronic renal failure

目的了解老年慢性肾衰竭(CRF)时胰岛素抵抗的情况,及其与白蛋白(Alb)、血脂、肾功能、瘦素(Leptin)浓度的关系。方法测定首都医科大学宣武医院23例老年CRF患者及28例正常老年对照组的空腹血糖(Glu)、胰岛素、瘦素、血脂、白蛋白、体重指数(BMI)等指标。计算胰岛素敏感指数(ISI)-空腹血糖与空腹胰岛素浓度乘积的倒数。分析ISI与其它参数的关系。结果老年CRF组ISI显著低于正常老年对照组[(-4.24±0.78)对(-3.81±0.47),取自然对数值,P<0.05];老年CRF组Leptin水平显著高于对照组(P<0.01);直线相关分析显示老年CRF组ISI的自然对数值与血肌酐(Scr)、瘦素、脂肪容量和BMI呈显著负相关,与内生肌酐清除率(Ccr)呈正相关。结论老年CRF时存在明显的胰岛素抵抗,可能与肾功能减退、瘦素抵抗、肥胖和β细胞对胰岛素抵抗的代偿能力下降有关。

Objective To investigate insulin resistance （IR） in elderly patients with chronic renal failure （CRF） and the correlation of IR with plasma albumin, leptin, cholesterol, triglycerides and creatinine （Scr）, body mass index （BMI） and percentage of body fat. Methods We recruited 23 elderly patients with CRF and 28 healthy elderly people for this study. Plasma glucose, insulin, leptin, BUN, Scr, cholesterol and triglycerides were measured. The reciprocal value of fasting plasma glucose multiplied by insulin product was used as the insulin sensitivity index （ISI）. Results IS1 was significantly lower in elderly patients with CRF than in the elderly control subjects （-4.24±0.78 vs -3.81±0.47, taken from the values of natural logarithm, P〈0.05）. The mean plasma leptin was significantly higher in elderly CRF patients than in the elderly control subjects （P〈0.01）. There was a strong nega- tive correlation of ISI with Scr, plasma leptin, BMI and percentage of body fat. Conclusions IR presents in elderly patients with CRF. IR may be related to the decreased renal function, leptin resistance, obesity and the decreased compensation ability of β-cells to IR.