上海地区慢性肾功能衰竭患者胰岛素代谢异常的调查

The epidemiology survey of insulin abnormal metabolism in chronic renal failure is Shanghai

目的 了解慢性肾功能衰竭（ＣＲＦ）时胰岛素抵抗（ＩＲ）的情况，及其与血压、血脂、肾功能、瘦素（ｌｅｐｔｉｎ）浓度的关系。方法 测定１４７例ＣＲＦ患者及１３例正常对照者的空腹血糖、空腹胰岛素、瘦素、血压、血脂等指标。血清瘦素测定采用ＥＬＩＳＡ法，胰岛素采用放射免疫法。计算胰岛素敏感指数（ＩＳＩ）——空腹血糖与空腹胰岛素浓度乘积的倒数。分析ＩＳＩ与其它参数的关系。结果ＣＲＦ组ＩＳＩ显著低于正常对照组（－３．９８±０．８１对－３ ４８±０．３７，取自然对数值，Ｐ＜０．０５）。ＣＲＦ组瘦素、总胆固醇、低密度脂蛋白浓度、收缩压、舒张压均比对照组显著升高，但与ＩＳＩ均不相关。多因素回归分析显示ＣＲＦ时体重、身体质量指数、血尿素氮、血肌酐、内生肌酐清除率及透析治疗均与ＩＳＩ显著相关。结论ＣＲＦ时存在明显ＩＲ，而透析治疗可能会改善机体对胰岛素的敏感性；ＣＲＦ时ＩＲ可能与肥胖、肾功能减退有关。

Objective To investigate the relationship between insulin resistance(IR) and chronic renal failure ( CRF) . Methods Plasma glucose, insulin, leptin levels were measured in 147 patients with CRF as well as in 13 healthy controls. The reverse of fasting plasma glucose and insulin product were used as an index of insulin resistance. Various biochemical parameters, which might be associated with change in insulin sensitivity , were also determined by carrying out multiple logistic regression analysis. Results Insulin sensitivity index(ISI)was singnificantly lower in CRF patients than that in normal controls( -3. 98 ±0. 81 vs - 3. 48 ± 0. 37, natural logarithm, P <0. 05) . Multiple logistic regression analysis showed that weight, body mass index, BUN, serum creatinine and endogenous creatinine clearance ( Ccr) were significant predictive factors for the change in insulin sensitivity. Clonclusions There is the presence of IR in patients with CRF. IR is related to obesity, renal function and can be ameliorated by dialysis therapy.