非糖尿病腹膜透析患者胰岛素抵抗与颈动脉粥样硬化的相关性

Relationship Between Insulin Resistance and Carotid Atherosclerosis in Non-diabetic Peritoneal Dialysis Patients

目的探讨非糖尿病腹膜透析患者胰岛素抵抗与动脉粥样硬化的关系。方法选择非糖尿病腹膜透析的成年患者64例,对其临床资料包括胰岛素抵抗指数(HOMA-IR)进行分析。采用高分辨二维超声对双侧颈总动脉内膜中膜厚度(IMT)及颈动脉粥样斑块进行测量。按IMT厚度及有无斑块分为两组:无颈动脉硬化组(IMT<1.0 mm)和颈动脉硬化组(IMT≥1.0 mm和/或已发现有颈动脉斑块)。结果颈动脉硬化组餐后2 h血糖(2h PBG)、低密度脂蛋白胆固醇(LDLC)、高敏C反应蛋白(hs-CRP)、甘油三酯(TG)和HOMA-IR高于无颈动脉硬化组(P<0.05),而血浆白蛋白则低于无颈动脉硬化组(P<0.01);颈动脉硬化组胰岛素抵抗患者占53.49%,而无颈动脉硬化组胰岛素抵抗患者仅占4.76%(P<0.01)。相关分析显示非糖尿病腹膜透析患者动脉硬化与年龄、2h PBG、LDLC、hs-CRP、TG和HOMA-IR呈正相关(r=0.375、0.373、0.420、0.345、0.351、0.458,P<0.05);Logistic回归分析发现,年龄、HOMA-IR、2h PBG、hs-CRP是非糖尿病腹膜透析患者发生动脉粥样硬化的危险因素。结论在非糖尿病腹膜透析患者中HOMA-IR水平与颈动脉粥样硬化正相关,HOMA-IR可能促进了动脉粥样硬化的发生。

Aim To investigate the correlation between insulin resistance and atherosclerosis in non-diabetic continuous ambulatory peritoneal dialysis（ CAPD） patients.Methods Sixty-four non-diabetic CAPD adult patients were enrolled in this study.The clinical data including insulin resistance index（ HOMA-IR） of 63 patients on CAPD was analyzed.The bilateral common carotid artery intima-media thickness（ IMT） and carotid artery atheromatous plaque were measured by high resolution two-dimensional ultrasonic diagnostic apparatus.Patients were divided into two groups：nonatherosclerosis group（ IMT 1.0 mm） and atherosclerosis group（ IMT≥1.0 mm or atheromatous plaque）.Results Compared with the patients in non-atherosclerosis group,the level of plasma albumin in the patients in atherosclerosis group was lower（ P〈0.01）,but the levels of 2h PBG,HOMA-IR,hs-CRP,TG and LDLC were significantly higher（ P〈0.05）.The prevalence of insulin resistance was 53.49% in atherosclerosis group,but only 4.76% in non-atherosclerosis group（ P〈0.01）.Linear correlation analysis showed that atherosclerosis was correlated with age,2h PBG,HOMA-IR,hs-CRP,LDLC and TG in non-diabetic CAPD patients（ r=0.375,0.373,0.420,0.345,0.351 and 0.458,all P〈0.05）.Binary Logistic regression showed that age,2h PBG,HOMA-IR,hs-CRP were independent risk factors of atherosclerosis.Conclusions HOMA-IR is positively correlated with atherosclerosis and may be a predictor of carotid atherosclerosis in non-diabetic peritoneal dialysis patients.