非糖尿病腹膜透析患者胰岛素抵抗改变及其影响因素

Insulin resistance in non- diabetic peritoneal dialysis patients and its influencing factors

目的观察非糖尿病腹膜透析患者的胰岛素抵抗（IR）指数改变，分析其相关影响因素。方法选择2012年8月北京大学人民医院的非糖尿病腹膜透析患者56例为研究对象。采用横断面研究方法，在相同条件下测定患者身高、体质量、体质量指数（BMI）、空腹血糖、空腹胰岛素及血脂等生化指标及透析充分性指标。按稳态模式评估公式计算胰岛素抵抗指数（HOMA—IR）。按照患者IR中位数水平分为高胰岛素抵抗（高IR）组和低胰岛素抵抗（低IR）组，比较两组患者生化及透析充分性等指标的差异，分析影响患者胰岛素抵抗的危险因素。结果与低IR（HOMA-IR〈1．79，n=27）组相比，高IR（HOMA-IR≥1.79，n=29）组患者年龄较大[（57．9±14．2）岁比（48．7±14．5）岁]；每日腹透液葡萄糖含量较高[（138．7±28．5）mmol／L比（114．0±21．5）mmol／L]；腰臀比较高[（0．91±0．08）比（0．86±0．07）]；BMI较高[（23．0±3．0）kg/m^2比（21．2±3．1）kg/m^2]；三酰甘油较高[（2．51±1．36）mmol/L比（1．42±0．48）mmoFL]；高密度脂蛋白胆固醇（HDL）较低[（1．00±0．27）mmoUL比（1．23±0．32）mmol／L]；尿素清除指数（Kt／V）较低[（1．74±0．37）比（2．08±0．56）]。多因素loggistie回归结果显示，年龄（β=0．122，P=0．033）、血三酰甘油（β=1．798，P=0．030）和每日腹透液葡萄糖含量（β=0．094，P=0．031）与胰岛素抵抗程度相关。结论过多腹透液葡萄糖暴露是非糖尿病腹膜透析患者发生胰岛素抵抗的危险因素。

Objective To observe insulin resistance （IR） in non-diabetic peritoneal dialysis （PD） patients, and analyze its related factors. Methods The non-diabetic PD patients who had been on stable PD at least three months were eligible to enroll. The patients were measured for their height, weight, waist to hip ratio, fasting glucose, fasting insulin, lipids and other biochemical indicators, dialysis adequacy indicators in August 2012, and divided into two groups depended on median HOMA-IR in August 2012. Results A total of 56 patients were enrolled and divided into two groups according to median HOMA-IR, including high IR group （HOMA-IR≥ 1.79, n=29） and low IR group （HOMA-IR 〈 1.79, n=27）. Compared to low IR group, high IR group were older [（57.9±14.2） years vs （48.7± 14.5） years], had higher daily dialysate glucose load [（138.7±28.5） mmol/L vs （114.0± 21.5） mmol/L], higher waist-to-hip ratio [（0.91±0.08） vs （0.86±0.07）], higher BMI [（23.0±3.0） kg/m^2 vs （21.2±3.1） kg/m^2], higher triglycerides [（2.51±1.36） mmol/L vs （1.42±0.48） mmol/L], lower high-density lipoprotein cholesterol [（1.00±0.27） mmol/L vs （1.23±0.32） mmol/L], and lower Kt/V [（1.74±0.37） vs （2.08 ±0.56）]. Multivariate logistic regression showed that age （β=0.122, P=0.033）, triglycerides （β=1.798, P=0.030） and daily dialysate glucose load （β=0.094, P=0.031） associated with the degree of insulin resistance. Conclusion More dialysate glucose exposure is a risk factor of the occurrence of insulin resistance in non-diabetic patients with peritoneal dialysis.