368例非糖尿病性慢性肾脏病患者胰岛素抵抗的相关因素分析

Factor( s) that Result in Insulin Resistance in Patients of Non-Diabetic Chronic Kidney Disease: an Analysis Based on 368 Cases

目的分析368例非糖尿病性慢性肾脏病(chronic kidney disease,CKD)患者胰岛素抵抗(insulin resistance,IR)与其各项临床指标的相关性,为对其干预提供依据。方法收集368例住院确诊为非糖尿病慢性肾脏病患者的临床资料,通过稳态模型胰岛素抵抗(homeostasis model of insulin resistance.HOMA-IR)指数评价患者IR,比较CKD各期IR发生率,应用Logistic回归分析HOMA-IR指数的相关因素。结果 CKD4、5期患者IR发生率(25.5%、29%)较CKD1、2、3期患者(3.4、5.6%、8.4%)有所升高,差异有统计学意义(P<0.05);肾小球滤过率(e GFR)、血红蛋白、白蛋白与HOMA-IR指数负相关(P<0.05),甲状腺旁腺激素、超敏C反应蛋白、血尿酸、身体指数(BMI)、甘油三酯、高血压2级、高血压3级和年龄与该指数呈正相关(P<0.05),而高血压1级、总胆固醇和24小时尿蛋白定量与该指数无明显相关性(P>0.05)。CKD4、5期、甘油三脂、BMI、甲状腺旁腺激素、超敏C反应蛋白(CRP)和血红蛋白最终进入HOMA-IR指数的多元回归方程。结论 CKD患者在CKD 4、5期时,IR发生率明显升高;可能与肾小球滤过率、甘油三脂、BMI、甲状腺旁激素、血红蛋白、CRP等因素有关。

Objective To determine the correlation between relevant clinical indicators and insulin resistance（ IR） in patients of non diabetic chronic renal disease（ CKD） so as to provide a basis for its intervention. Methods The clinical data of 368 hospitalized patients with non-diabetic CKD were collected. IR was evaluated by homeostasis model of insulin resistance（ HOMA-IR）. The incidence of IR was compared in various stages of CKD. Logistic regression was used to analyze possible factors of HOMA-IR. Results The incidence of IR in CKD4（ 25. 5%） and CKD5（ 29%） patients were higher than those in CKD1（ 3. 4%）,CKD2（ 5. 6%）,CKD3（ 8. 4%） patients（ P 〈0. 05）. The glomerular filtration rate（ e GFR）,hemoglobin,albumin and HOMA-IR were negatively correlated（ P〈0.05）. Parathyroid hormone,hypersensitive c-reactive protein,serum uric acid,body mass index（ BMI）,triglyceride,hypertension level 2,hypertension level 3 and age were positively correlated with the index（ P〈0.05）. There was no significant correlation between hypertension level 1,total cholesterol and 24 hours of urine protein（ P〉 0. 05）. CKD4,CKD5,triglycerides,BMI,parathyroid hormone,hypersensitive c-reactive protein（ CRP） and hemoglobin finally entered the multivariate regression equation of HOMA-IR.Conclusions For CKD patients,the incidence of IR was significantly increased during CKD4 and CKD5. It may be related to glomerular filtration rate,triglyceride,BMI,parathyroid hormone,hemoglobin,CRP,etc.