合并微量白蛋白尿的非肥胖、非高血压的非胰岛素依赖型糖尿病患者的胰岛素抵抗

Insulin resistance in non obese, non hypertension, noninsulin dependent diabetes mellitus with microalbuminuria

目的:研究在非胰岛素依赖型糖尿病(noninsulindependentdiabetesmellitus,NIDDM)患者胰岛素敏感性与微量白蛋白尿是否存在相关性,以及胰岛素抵抗在糖尿病肾病(diabeticnephropathy,DN)发生中的作用。方法:观察381例非肥胖、非高血压的NIDDM患者的胰岛素敏感性指数,所有病人按是否合并微量白蛋白尿(microalbuminuria,mUAE)分组,胰岛素敏感指数(insulinsensitivityindex,ISI)用空腹血糖与空腹胰岛素乘积倒数的自然对数计算,并以Homamodel公式进行对照。结果:糖尿病合并mUAE患者胰岛素敏感指数低于不合并mUAE患者[(-4.460±0.790)与(-4.208±0.729),P=0.0059)]。Logistic多元回归分析显示ISI与发生微量白蛋白尿显著负相关(OR0.6996,95%CI0.5292～0.9251,P=0.0197),且独立于年龄、性别、体重指数、血压、血脂和糖化血红蛋白,Homamodel公式计算结果与ISI的结果一致。结论:在NIDDM患者出现白蛋白尿时存在胰岛素敏感性减低,胰岛素抵抗有可能是DN发病的独立危险因素。

Objective: To investigate the association between insulin sensitivity and microalbuminuria in patients with noninsulin dependent diabetes mellitus(NIDDM), and the role of insulin resistance in the development of diabetic nephropathy. Methods: To determine insulin sensitivity index in 381 non obese, non hypertension, non insulin dependent diabetic subjects, the patients with or without microalbuminuria were divided into two groups. The insulin sensitivity index(ISI) was evaluated by both ISI(ISI was determined by natural logarithm of the reverse of fasting plasma glucose and fasting insulin product.) and Homa model. Results: The insulin sensitivity index was significantly lower in the patients with microalbuminuria than in those without microalbuminuria [(-4.460±0.790) vs (-4.208±0.729), P =0.005 9]. Using logistic regression analysis, we found insulin sensitivity indexes were significantly negatively associated with microalbuminuria and were independent of age, sex, body mass index, hypertension, hyperlipemia and Hb A1c (OR 0.699 6, 95%CI 0.529 2～ 0.925 1 , P =0.019 7). The ISI evaluated by Homa model was in agreement with ISI. Conclusion: These results indicate that the presence of microalbuminuria is associated with impaired insulin sensitivity in patients with NIDDM. Insulin resistance is an independent risk factor for development and progression of diabetic nephropathy.