223例慢性肾脏病患者胰岛素抵抗及其相关因素的研究

Insulin resistance and its correlated factors in 223 patients with chronic kidney disease

目的研究慢性肾脏病(chronic kidney disease,CKD)患者胰岛素抵抗(insulin resistance,IR)与肾脏病临床指标的相关性。方法选择近6个月在我院住院的CKD患者465例,测定身高、体重、血压;检测血生化、IR相关指标和24h尿蛋白定量,计算身高体重指数(body mass index,BMI)和估算的肾小球滤过率(estimated glomerular filtration rate,eGFR),建立数据库。排除6个月内使用过糖皮质激素、有糖尿病及糖尿病家族史的患者,最终入选223例。通过稳态模型HOMA-IR指数评价患者IR,比较CKD各期IR发生率,应用多元回归分析研究CKD患者HOMA-IR指数升高的相关因素。结果 CKD4～5期患者IR发生率分别为44.44%和42.41%,显著高于CKD1期患者(5.48%),P值均为0.000。在Pearson相关分析中,年龄(r=0.232,P=0.001)、BMI(r=0.227,P=0.002)、收缩压(r=0.343,P=0.000)、舒张压(r=0.293,P=0.000)、血尿酸(r=0.286,P=0.000)和甘油三酯(r=0.400,P=0.000)与HOMA-IR指数正相关,eGFR(r=-0.425,P=0.000)与该指数负相关,白蛋白(r=0.078,P=0.143)、总胆固醇(r=-0.006,P=0.937)和24h尿蛋白定量(r=0.002,P=0.177)与该指数无明显相关性。CKD4～5期(B=0.512,P=0.000)、甘油三酯(B=0.089,P=0.006)、BMI(B=0.027,P=0.007)和高血压3级(B=0.444,P=0.030)最终进入多元回归方程。结论与CKD1期相比,CKD4～5期患者IR发生率显著升高。对于CKD患者,eGFR<30ml.min-1.(1.73m2)-1,血清甘油三酯升高、肥胖和高血压3级是IR的相关因素。

Objective To investigate the potential correlation between clinical, laboratory parameters and insulin resistance（IR） in patients with chronic kidney disease（ CKD）, and to explore the possible correlated factors contributing to IR with these patients. Methods Data regarding height, weight, body mass index （BMI）, blood pressure, blood chemistry, estimated glomerular filtration rate （eGFR） and glucose metabolism were collected from 465 patients diagnosed with CKD. 223 non-diabetic patients who had not received glucocorticoid therapy for at least six months were assessed for IR using the homeostasis model of insulin resistance （HOMA-IR）. Those patients were selected for the comparisons of IR incidence between different stages of CKD. To analyze the risk factors of IR in CKD,we used multiple regression analysis to test for correlated factors of HOMA-IR index with 223 CKD patients. Results The incidence of IR with patients in the stage of CKD 1 was 5.48%, it was significantly higher in the patients of stage 4 and 5 of CKD（44. 44% and 42.41% respectively）. Age（r =0. 232 ,P =0. 001 ） ,BMI（r =0. 227, P = 0. 002 ）, systolic pressure （ r = 0. 343, P = 0. 000 ）, diastolic pressure （ r = 0. 293, P = 0. 000 ）, serum uric acid （ r = 0. 286, P = 0. 000） and triglyceride （ r = 0. 400, P = 0. 00） were correlated with HOMA-IR index positively, eGFR （r = - 0. 425, P = 0. 000） was correlated with HOMA-IR index negatively, albumin （ r = 0. 078, P = 0. 143 ）, total cholesterol（ r = - 0. 006, P = 0. 937 ） and total urinary protein within 24 hours （ r = 0. 002, P = 0. 177 ） were not correlated with the index in pearson correlations. Stage of CKD 4-5（ b = 0. 512, P = 0. 000）, triglyceride （ b = 0. 089, P = 0. 006）, BMI （ b = 0. 027, P = 0. 007） and grade 3 of hypertension （ b = 0. 444, P = 0. 030） were correlated factors of HOMA-IR index in the multiple regression analysis. Conclusions Patients in the stage of CKD 4-5 have higher HOMA-IR index compared with patients in the stages of CKD 1. For CKD patients, stage of CKD 4-5 （ b = 0. 512, P = 0. 000）, triglyceride （ b = 0. 089, P = 0. 006 ）, BMI （ b = 0. 027, P = 0. 007 ） and grade 3 of hypertension （ b = 0. 444, P = 0. 030） are correlated with IR.