非糖尿病慢性肾功能不全血液透析患者胰岛素抵抗与左心室质量指数相关性研究

The correlation research between insulin resistance and left ventricular mass index in non-diabetic dialysis patients

目的探讨非糖尿病慢性肾功能不全血液透析患者胰岛素抵抗与左心室质量指数之间的相关性。方法选取78例非糖尿病慢性肾功能不全患者作为研究对象,计算胰岛素抵抗指数(HOMA-IR)。根据HOMA-IR将患者分为两组,胰岛素抵抗组(IR)和非胰岛素抵抗组(NIR)。采用心脏彩超连续测量3个心搏舒张末左室内径(LVDd)、舒张末室间隔厚度(IVST)、左室后壁厚度(PWT),得出平均值,然后采用Deiereux的心室重量(LVM)校正公式计算左心室质量指数。同时检测患者血压、体质量指数、三酰甘油、总胆固醇、C反应蛋白等,比较IR组与NIR组各个指标的差异。通过多元回归分析计算LVMI与各指标的相关性。结果 IR组与NIR组比较,收缩压[(136.6±20.8)vs(128.0±16.4)mm Hg]、体质量指数[(26.7±4.8)vs(25.2±2.4)kg·m^(-2)]、空腹胰岛素[(18.2±11.3)vs(12.3±10.2)IU·L^(-1)]、HOMA-IR[(14.4±1.8)vs(2.1±0.8)]、三酰甘油[(2.52±1.12)vs(1.84±1.45)mmol·L^(-1)]、C反应蛋白[(6.89±3.43)vs(3.87±1.54)mg·L^(-1)]、LVMI[(153.7±26.3)vs(142.4±22.4)g·m^(-2)]等指标均差异有统计学意义(P<0.05)。多元回归分析显示:LVMI与收缩压和HOMA-IR呈正相关(β=0.24,P=0.02;β=0.27,P=0.01)。结论胰岛素抵抗和收缩压是影响非糖尿病慢性肾功能不全血液透析患者左心室质量指数的危险因素。

Objective To explore the correlation between insulin resistance and left ventricular mass index in non-diabetic dialysis patients.Methods Seventy-eight non-diabetic chronic renal failure patients were included in the study and homeostatic model assessment of insulin resistance(HOMA-IR)was calculated.The patients were assigned into two groups according to HOMA-IR,IR group and NIR group.Left ventricular diastolic diameter(LVDd),interventricular septum thickness(IVST)and posterior wall thickness(PWT)were measured in succession for three times by colour Doppler echocardiography and the mean was calculated.And then left ventricular mass index(LVMI)was calculated by Deiereux formula.Meanwhile,patients′blood pressure,body mass index,triacylglycerol,total cholesterol,and C-reative protein were detected and compared between IR group and NIR group.Multivariate regression analysis was adopted for evaluating the correlation between LVMI and all the indexes.Results There were significant differences in systolic blood pressure[(136.6±20.8)vs(128.0±16.4)mmHg],body mass index[(26.7±4.8)vs(25.2±2.4)kg·m-2],fasting insulin[(18.2±11.3)vs(12.3±10.2)IU·L-1],HOMA-IR[(14.4±1.8)vs(2.1±0.8)],triacylglycerol[(2.52±1.12)vs(1.84±1.45)mmol·L-1],C reative protein[(6.89±3.43)vs(3.87±1.54)mg·L-1]and LVMI[(153.7±26.3)vs(142.4±22.4)g·m-2]between IR group and NIR group(P<0.05).Multi-Variate regression analysis showed that there was positive correlation between LVMI,systolic blood pressure and HOMA-IR(β=0.24,P=0.02;β=0.27,P=0.01).Conclusions Systolic blood pressure and HOMA-IR were the risk factors of LVMI in the non-diabetic dialysis patients.