IgA肾病胰岛素抵抗相关因素研究

Factors Related to Insulin Resistance in IgA Nephropathy

背景胰岛素抵抗(IR)是代谢综合征发病的中心环节及致病基础,也是发生肾损害、最终导致肾衰竭的独立危险因素。目的探讨Ig A肾病(Ig AN)患者IR的发生情况以及IR和Ig AN基础临床指标、肾素-血管紧张素-醛固酮系统(RAAS)活性及病理严重程度之间的关系。方法回顾性选择2013年6月—2014年12月就诊于中国医科大学附属盛京医院第一肾内科且符合纳入标准的患者94例为研究对象。根据最终诊断结果将其分为Ig AN组(44例)、膜性肾病(MN)组(26例)、微小病变肾病(MCD)组(24例)。收集患者一般资料,包括性别、年龄、体质指数(BMI)、收缩压、舒张压、24 h尿蛋白定量、清蛋白、血红蛋白、肌酐、肾小球滤过率(e GFR)、尿酸、空腹血糖(FBG)、空腹胰岛素(FINS)、肾素、血管紧张素Ⅱ(AngⅡ)、醛固酮、三酰甘油、胆固醇、低密度脂蛋白、C反应蛋白(CRP);计算稳态膜型的胰岛素抵抗指数(HOMA-IR),记录IR发生率;评估Ig AN病理严重程度,包括MEST评分、肾小球硬化率、新月体率。结果 MN组BMI、24 h尿蛋白定量、e GFR、三酰甘油、胆固醇、低密度脂蛋白水平高于Ig AN组,清蛋白、肌酐、AngⅡ水平低于Ig AN组(P<0.05);MCD组24 h尿蛋白定量、e GFR、三酰甘油、胆固醇、低密度脂蛋白水平高于Ig AN组,清蛋白、肌酐、AngⅡ水平低于Ig AN组(P<0.05)。MN组、MCD组HOMA-IR、IR发生率低于Ig AN组(P<0.05)。HOMA-IR与年龄、24 h尿蛋白定量、清蛋白、血红蛋白、e GFR、肾素、醛固酮、胆固醇、低密度脂蛋白、MEST评分、肾小球硬化率、新月体率无直线相关关系(P>0.05);HOMA-IR与BMI、收缩压、舒张压、肌酐、尿酸、AngⅡ、三酰甘油、CRP呈正相关(P<0.05)。线性回归分析结果显示,HOMA-IR与BMI、收缩压、舒张压、肌酐、尿酸、AngⅡ、三酰甘油、CRP存在回归关系(P<0.05)。结论大部分Ig AN患者存在IR,且与基础临床指标(BMI、收缩压、舒张压、肌酐、尿酸、三酰甘油、CRP)、RAAS活性呈正相关,但与病理严重程度无关。

Background Insulin resistance（ IR） is the central link and the pathogenic basis of metabolic syndrome as well as the independent risk factor leading to kidney damage and eventually renal failure. Objective To discuss the occurrence of IR and the relationship between IR and basic clinical indexes of Ig AN, activity of renin- angiotensin- aldosterone system（ RAAS） and pathological severity. Methods 94 patients who met inclusion criteria and visited the First Nephrology Department of Shengjing Hospital of China Medical University from June 2013 to December 2014 were retrospectively selected as objects of study. According to the results of final diagnosis, they were divided into Ig AN group（ 44 cases）, membranous nephropathy（ MN） group（ 26 cases） and minimal change disease（ MCD） group（ 24 cases）. General data of patients were collected,including gender, age, body mass index（ BMI）, systolic pressure, diastolic pressure,24 h urinary protein quantitative,albumin,hemoglobin,creatinine,glomerular filtration rate（ e GFR）,uric acid,fasting blood glucose（ FBG）,fasting insulin（ FINS）,rennin,AngⅡ,aldosterone,triglycerides,cholesterol,low density lipoprotein,c- reactive protein（ CRP）. The HOMA- IR was calculated and the incidence of IR was recorded. The pathological severity of Ig AN was evaluated,including MEST score,glomerular sclerosis rate and crescent rate. Results MN group was significantly higher in the levels of BMI,24 h urinary protein quantitative,e GFR,triglycerides,cholesterol and low density lipoprotein and lower in the levels of albumin,creatinine and AngⅡ than those of Ig AN group（ P〈0. 05）. MCD group was significantly higher in the levels of 24 h urinary protein quantitative,e GFR,triglycerides,cholesterol and low density lipoprotein and lower in the levels of albumin,creatinine and AngⅡthan those of Ig AN group（ P〈0. 05）. The HOMA- IR and incidence rate of IR in MN group and MCD group were lower than those of Ig AN group（ P〈0. 05）. There was no linear correlation between HOMA- IR and age,24 h urinary protein quantitative, albumin, hemoglobin, e GFR, renin, aldosterone, cholesterol, low density lipoprotein, MEST score,glomerular sclerosis rate and crescent rate（ P〈0. 05）. HOMA- IR was positively correlated with BMI, systolic pressure,diastolic pressure,creatinine,uric acid,AngⅡ,triglycerides and CRP（ P〈0. 05）. The results of linear regression analysis showed that there was a linear regression relationship between HOMA- IR and BMI, systolic pressure, diastolic pressure,creatinine,uric acid, Ang Ⅱ, triglycerides and CRP（ P〈0. 05）. Conclusion Most Ig AN patients have IR, which is positively correlated with basic clinical indexes（ BMI, systolic pressure, diastolic pressure, creatinine, uric acid,triglycerides,CRP） and the activity of RAAS,but has nothing to do with pathological severity.