腹膜透析患者血清脂联素与胰岛素抵抗的关系

Association of Serum Adiponectin with Insulin Resistance in Peritoneal Dialysis Patients

目的探讨持续不卧床腹膜透析(CAPD)患者血清脂联素与胰岛素抵抗的关系。方法选择80例CAPD患者,采用ELISA法测定血清脂联素,放射免疫分析法检测超敏C反应蛋白(hs-CRP)、血浆胰岛素水平,采用酶法测定空腹血糖、血尿酸、三酰甘油水平。分析血清脂联素水平与稳态模型胰岛素抵抗指数(HOMA-IR)、hs-CRP、BMI、三酰甘油、尿酸等的关系。结果三酰甘油、HOMA-IR、hs-CRP与血清脂联素水平有密切相关性(P<0.01或P<0.05)。HOMA-IR与BMI(r=0.58,P<0.01)、三酰甘油(r=0.31,P<0.01)、尿酸(r=0.26,P<0.05)、hs-CRP(r=0.31,P<0.01)呈正相关关系,而与脂联素(r=-0.49,P<0.01)呈负相关关系。脂联素、尿酸、hs-CRP是腹膜透析患者HO-MA-IR主要决定因素。结论腹膜透析患者血清脂联素水平与三酰甘油、hs-CRP和胰岛素抵抗密切相关,血清脂联素较高的患者HOMA-IR低,提示腹膜透析患者血清脂联素可能具有心血管保护作用。

Objective To investigate the relationship between serum adiponectin（ADPN） and insulin resistance in continuous ambulatory peritoneal dialysis（CAPD） patients.Methods Eighty CAPD patients were enrolled in this study.Serum adiponectin levels were measured by ELISA.Serum high-sensitivity C-reactive protein（hs-CRP） and plasma insulin levels were detected by radioimmunoassay.Fasting blood glucose,uric acid and triglyceride levels were determined by enzymatic method.Relationships of serum adiponectin to homeostasis model assessment of insulin resistance（HOMA-IR）,hs-CRP,body mass index（BMI）,triglyceride and uric acid were analyzed.Results Serum adiponectin levels were closely related to HOMA-IR,hs-CRP and triglyceride（P〈0.01 or P〈0.05）.HOMA-IR were positively correlated with BMI（r=0.58）,triglyceride（r=0.31）,uric acid（r=0.26） and hs-CRP（r=0.31）,but negatively correlated with adiponectin（r=-0.49）（all P〈0.01）.Adiponectin,uric acid and hs-CRP were the main variables associated with HOMA-IR in CAPD patients.Conclusion Serum adiponectin is closely correlated with triglyceride,hs-CRP and HOMA-IR in CAPD patients.Patients with high levels of adiponectin have low levels of HOMA-IR,suggesting that adiponectin exerts cardioprotective effects in CAPD patients.