血液透析患者促红素敏感性与胰岛素抵抗相关性研究

Relationship between insulin resistance and erythropoietin sensitivity in patients with maintenance hemodialysis

目的探讨维持血液透析(MHD)患者促红素敏感性与胰岛素抵抗的相关性。方法检测12例糖尿病肾病MHD患者、66例非糖尿病肾病MHD患者及12例健康对照者临床及生化指标,以rHuEPO用量/Hb比值(rHuEPO/Hb)作为促红素反应性指标、计算胰岛素抵抗指数(HOMA-IR)。结果糖尿病肾病组及非糖尿肾病组均存在促红素低反应,分别为56.6%和32.4%,糖尿病肾病组维持血液透析患者甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)、甲状旁腺激素(iPTH)、脂蛋白a(Lpa)、超敏C-反应蛋白(hs-CRP)、HOMA-IR均较非糖尿病肾病组及正常组增高(P<0.05),糖尿病肾病组增高更为明显,此外糖尿病肾病组血清白蛋白下降更为明显(P<0.05);相关分析提示rHuEPO/Hb比值与Alb(r=-0.166,P<0.05)、HDL(r=-0.233,P<0.05)呈负相关,与iPTH(r=0.382,P<0.05)、TG(r=0.258,P<0.05)、hs-CRP(r=0.399,P<0.05)和HOMA-IR(r=0.416,P<0.05)呈正相关,进一步行偏相关分析,结果示rHuEPO/Hb与HOMA-IR呈正相关(r=0.461,P<0.05)。结论维持血液透析患者促红素反应性与胰岛素抵抗密切相关。

Objective To investigate the relevance between erythropoietin sensitivity and insulin resistance in patients with maintenance hemodialysis.Methods The clinical and laboratory data were measured in 12 patients with diabetic nephropathy（group A） and 66 patients without diabetic nephropathy（group B） as well as 12 healthy individuals（the control group）.The insulin resistance index（HOMA-IR） was calculated by erthropoietin response index,which regarded as the ratio of the dosage of rHuEPO and Hb.Results Erythropoietin hyporesponsiveness occurred both in group A and group B,and the erthropoietin response indexes were 56.6% and 32.4%,respectively.Patients in group A and group B had significantly higher serum triglyceride（TG）,total cholesterol（TC）,low density lipoprotein（LDL）,parathyroid hormone（PTH）,lipoprotein a（Lpa）,high-sensitivity C-reactive protein（hs-CRP）,and HOMA-IR（P0.05） but significantly lower serum albumin（P0.05） than the control group.The changes in group A were more profound.There was a significant negative correlation between（rHuEPO/Hb） ratio and serum albumin（r=-0.166,P0.05）,high-density lipoprotein（r=-0.233,P0.05）,and a significant positive correlation between（rHuEPO/Hb） ratio and parathyroid hormone（r=0.382,P0.05）,high-sensitivity C-reactive protein（r= 0.258,P0.05）,and HOMA-IR（r=0.416,P0.05） in the two groups.There was a significant independent positive correlation between（rHuEPO/Hb） ratio and HOMA-IR（r=0.461,P0.05）.Conclusion Insulin resistance is associated with erythropoietin responsiveness in patients with maintenance hemodialysis.