慢性肾脏病患者胰岛素抵抗的发生情况及其影响因素分析

Incidence of Insulin Resistance and Its Risk Factors in Patients with Chronic Kidney Disease

目的:探究慢性肾脏病(chronic kidney disease,CKD),尤其是非肥胖CKD患者,胰岛素抵抗(insulin resistance,IR)的发生情况,并分析其影响因素。方法:按照纳排标准,选择2016年1月至2017年11月在解放军总医院肾病科就诊的CKD患者共573例,其中非肥胖CKD患者510例,检测患者的身高、体重、空腹胰岛素、血肌酐、血尿素氮等临床指标,计算患者身高体重指数(body mass index,BMI),以BMI≥28 kg/m^2定义为肥胖,按照e GFR水平将CKD分期,建立HOMA指数(HOMA-IR)稳态模型评价IR情况,对CKD患者及非肥胖CKD患者各期IR的发生率进行比较,应用单因素相关性分析和多元逐步回归分析进行HOMA-IR指数相关因素的研究。结果:随着CKD患者肾脏功能的逐渐恶化,IR的发生率逐渐升高。各期CKD患者及非肥胖CKD患者IR的发生率比较差异均具有统计学意义(P=0.019,P=0.000)。在单因素相关性分析结果显示CKD患者的HOMA-IR指数与BMI、血尿素氮、甘油三酯、甲状旁腺激素、CKD分期呈正相关,与总蛋白、白蛋白、高密度脂蛋白、e GFR呈负相关。非肥胖CKD患者的HOMA-IR指数与年龄、尿素氮、甘油三酯、甲状旁腺激素、CKD分期呈正相关,与总蛋白、白蛋白、高密度脂蛋白、e GFR呈负相关。多元回归分析显示CKD患者的BMI、血尿素氮、甘油三酯、CKD分期进入最终回归方程,HOMA-IR与BMI、血尿素氮、甘油三酯、CKD分期呈正相关(P<0.05)。非肥胖CKD患者的尿素氮、甲状旁腺激素、CKD分期进入最终回归方程,HOMA-IR与尿素氮、甲状旁腺激素、CKD分期呈正相关(P<0.05)。结论:IR的发生率随CKD的进展逐渐升高,肥胖、血尿素氮升高、甘油三酯升高、肾功能降低是CKD患者发生IR的相关危险因素,血尿素氮升高、甲状旁腺激素升高、肾功能降低是非肥胖CKD患者IR发生的相关危险因素。

Objective： To explore the incidence of insulin resistance（IR） in chronic kidney disease（CKD）,especially in non-obese CKD patients,and to analyze its influencing factors.Methods： According to inclusion and exclusion criteria,A total of 573 cases of CKD patients from January 2016 to November 2017 in the Department of nephropathy of PLA general hospital were selected,including 510 cases of non-obese patients with CKD,the height and weight,fasting insulin,serum creatinine,blood urea nitrogen and other clinical parameters were detected,and the body mass index（BMI）,BMI≥28 kg/m^2 were defined as obesity,CKD was staged according to e GFR level,HOMA-IR steady state model was established to evaluate IR,the occurrence of IR were compared between CKD patients and non-obese CKD patients using single factor correlation analysis and multiple stepwise regression analysis of factors.Results： The incidence of IR gradually increased with the progressive deterioration of renal function.The difference of the incidence of IR between CKD patients and non-obese CKD patients at all stages was statistically significant（P=0.019,P=0.000）.In single factor correlation analysis,the HOMA-IR of CKD patients was positively correlated with BMI,blood urea nitrogen,triglycerides,parathyroid hormone,CKD grade,but negatively correlated with h total protein,albumin,high density lipoprotein,e GFR.The HOMA-IR of non-obese CKD patients was positively correlated with age,urea nitrogen,triglyceride,parathyroid hormone and CKD grade in non-obese CKD patient,but negatively correlated with total protein,albumin,high density lipoprotein and e GFR.In Multiple regression analysis showed that BMI,blood urea nitrogen,triglyceride and CKD grade in CKD patients entered the final regression equation.HOMA-IR was positively correlated with BMI,blood urea nitrogen,triglyceride and CKD stage（P〈0.05）.Blood urea nitrogen,parathyroid hormone and CKD grade in non-obese CKD patients entered the final regression equation,HOMA-IR was positively correlated with blood urea nitrogen,parathyroid hormone and CKD grade（P〈0.05）.Conclusions： The incidence of IR increased gradually with the progression of CKD,obesity,elevated blood urea nitrogen,elevated triglyceride levels,reduced renal function in CKD patients were related risk factors of IR,elevated blood urea nitrogen,elevated parathyroid hormone,reduced renal function in non-obese CKD patients are related risk factors of IR.