非糖尿病慢性肾病患者游离脂肪酸水平与细胞因子及胰岛素抵抗的关系

Relationship Between Serum Free Fatty Acid and Cytokines and Insulin Resistance in Non-Diabetic Chronic Kidney Disease Patients

目的:观察非糖尿病慢性肾脏病(CKD)患者血清游离脂肪酸(FFA)水平及其与高敏C-反应蛋白(hs-CRP)、肿瘤坏死因子(TNF-α)、胰岛素抵抗的关系。方法:测定118例非糖尿病CKD患者(非透析治疗80例,血液透析38例)及50名健康人FFA、空腹胰岛素(FINS)、空腹血糖(FPS),同时检测hs-CRP、TNF-α、血脂等指标,并计算胰岛素敏感指数(ISI)、稳态模型胰岛素抵抗指数(Homa-IR),分析FFA与胰岛素抵抗的关系。结果:非糖尿病非透析和透析CKD患者血清FFA、hs-CRP、TNF-α、Homa-IR、TG和LP(α)水平均较健康对照组显著升高(P<0.05或P<0.01),且透析CKD组FFA、hs-CRP、TNF-α、FINS、Homa-IR、TG和LP(α)水平较非透析CKD组明显升高(P<0.05或P<0.01);血FFA水平与hs-CRP、TNF-α、FINS、Homa-IR、TG和LP(α)呈正相关(P<0.01),与ISI负相关(P<0.01)。结论:非糖尿病CKD患者FFA水平明显升高,且与hs-CRP、TNF-α及胰岛素抵抗密切相关。

Objective： To investigate the relationship between serum free fatty acid （FFA） and high sensitive C reactive protein （hs-CRP）, tumor necrosis factor α （TNF-α）, and insulin resistance in patients with non-diabetic chronic kidney disease （CKD）. Methods： Serum FFA, fasting insulin （FINS）, fasting plasma glucose （FPS）, hs-CRP, TNF-α, and the lipid profile were measured and compared between 118 patients with non-diabetic CKD （non-dialytic 80 patients and dialytic 38 patients）and 50 normal controls. Insulin resistance was evaluated by using insulin sensitivity index and homeostasis model assessment-insulin resistance index（Homa-IR）. Results： Serum FFA, hs-CRP, TNF-α, Homa-IR, triglyceride and lipoprotein（α） were significantly higher in non-diabetic CKD patients compared to those in normal controls （P〈0.05 or P〈0.01）. The increase of serum FFA,hs-CRP, TNF-α, FINS, Homa-IR,triglyceride and lipoprotein（α） were higher in dialytic patients than those in non-dialytic patients （P〈0.05 or P〈0.01）. In all patients,FFA was positively correlated with hs-CRP, TNF-α, FINS, Homa-IR, triglyceride and lipoprotein（α） but was negatively related to insulin sensitivity index （P〈0.01）. Conclusion： Serum FFA significantly increased in non-diabetic CKD patients and was closely correlated with insulin resistance. Key words non-diabetic chronic kidney disease free fatty acid high sensitive C-reactive protein tumor necrosis factor-or insulin resistance