血液透析滤过对维持性血液透析患者胰岛素抵抗的影响

THE EFFECTS OF HEMODIAFILTRATION ON INSULIN RESISTANCE IN NONDIABETIC PATIENTS WITH MAINTENANCE HEMODIALYSIS

目的观察不同透析方式对维持性血液透析(MHD)非糖尿病患者胰岛素抵抗(IR)的影响,探讨血液透析滤过(HDF)改善IR的机制。方法将50例MHD患者随机分为两组,常规血液透析组(HD组)和血液透析滤过组(HDF组)。HDF组在常规透析基础上,每隔2周加入血液透析滤过1次,每次4 h,治疗前及治疗6个月后各取血标本检测两组空腹血糖、空腹胰岛素、脂联素、尿酸及hs-CRP;采用IR的体内稳态模型评估方法(HOMA-IR)评估IR;以HOMA-IR作为因变量,体重指数、脂联素、尿酸、hs-CRP作为自变量,分析6个月后胰岛素抵抗指数与各变量间的数量依存关系。结果透析6个月后,HDF组HOMA-IR、尿酸、hs-CRP水平明显低于HD组(P<0.05),脂联素水平明显高于HD组(P<0.05)。多元线性回归显示HOMA-IR与BMI、脂联素无数量依存关系(P>0.05),与尿酸、hs-CRP存在数量依存关系(P<0.05)。结论 HDF可以很好地改善胰岛素抵抗,可能是通过降低hs-CRP水平,减轻患者的微炎症状态这一途径来实现的。

Objective To observe the influence of hemodiafiltration （HDF） on insulin resistance in maintenance hemodialysis nondiabetic patients and to investigate the pathogenic mechanism by which HDF improves the insulin resistance. Methods Fifty nondiabetic patients with MHD were recruited for this study, which were divided into two groups randomly, the HD （treated with HD） and the HDF（treated with HDF every two weekly in addition to HD）. The serum fasting blood-glucose and uric acid levels were measured by an oxidase method. Fasting insulin,adiponectin and hs-CRP levels were detected by radioimmunometric assay. Insulin resistance was assessed by using the homeostasis model assessment （HOMA-IR）. Results After 6 month observation, the levels of HOMA-IR,serum uric acid and hs-CRP in HDF groups were significantly decreased according to HD groups（ P 〈 0.05）, the levels of adiponectin were significantly increased according to HD groups（ P 〈 0.05）. Multiple linear regression analysis showed that changes in uric acid and hs-CRP were found to be significant predictive factors for a change in insulin HOMA-IR after HDF therapy（ P 〈0.05）. Conclusion HDF can more effectively reduce insulin resistance than HI） therapy, which may achieve it through decreasing the level of hs-CRP and relieving the chromic inflammation.