非糖尿病慢性肾脏病患者胰岛素抵抗和胰岛β细胞功能及血糖变化研究

Changes in Insulin Resistance,Islet β-cell Function and Blood Glucose in Non-diabetic Patients with Chronic Kidney Disease

目的探讨非糖尿病慢性肾脏病(CKD)患者胰岛素抵抗、胰岛β细胞功能和血糖随估算肾小球滤过率(eGFR)下降变化情况。方法选择2017年1—7月首都医科大学附属北京天坛医院肾内科住院的非糖尿病CKD患者68例,按照eGFR将入选患者分为3组:eGFR<60 ml·min^(-1)·(1.73 m^2)^(-1)为A组(21例),60ml·min^(-1)·(1.73 m^2)^(-1)≤eGFR<90 ml·min^(-1)·(1.73 m^2)^(-1)为B组(20例),eGFR≥90 ml·min^(-1)·(1.73 m^2)^(-1)为C组(27例)。行75 g口服葡萄糖耐量试验(OGTT),检测空腹和服糖后2 h血糖(G0和G120)及胰岛素(I0和I120)水平,计算糖负荷后胰岛素敏感指数(ISI)、胰岛β细胞功能指数。结果 3组患者G0和G120比较,差异均无统计学意义(P>0.05);3组患者ISI、胰岛β细胞功能指数比较,差异均有统计学意义(P<0.05);其中C组ISI较A组和B组升高,胰岛β细胞功能指数较A组降低(P<0.05)。Pearson相关分析显示,eGFR与ISI呈正相关(r=0.501,P<0.001);eGFR与胰岛β细胞功能指数呈负相关(r=-0.288,P=0.017)。eGFR与G0和G120无直线相关关系(r=0.006,P=0.962;r=-0.131,P=0.287)。结论非糖尿病CKD患者随着eGFR下降,胰岛素抵抗加剧,同时胰岛β细胞功能代偿性增强,最终维持OGTT G0和G120水平并未随e GFR下降变化。

Objective To investigate changes in insulin resistance,isletβ-cell function and blood glucose with decline in estimated glomerular filtration rate(eGFR)in non-diabetic patients with chronic kidney disease(CKD).Methods In this study,68 hospitalized non-diabetic CKD patients in the Department of Nephrology of Beijing Tiantan Hospital,Capital Medical University were recruited between January and July in 2017.The patients were divided into three groups according to their eGFR:eGFR<60 ml·min-1·(1.73 m2)-1 as group A(n=21),60 ml·min-1·(1.73 m2)-1≤eGFR<90 ml·min-1·(1.73 m2)-1 as group B(n=20),and eGFR≥90 ml·min-1·(1.73 m2)-1 as group C(n=27).A 75 g oral glucose tolerance test(OGTT)was performed to detect blood glucose(G0 and G120)and insulin(I0 and I120)levels fasting and 2 hours after sugar consumption.The insulin sensitivity index(ISI)and isletβ-cell function index were calculated.Results There were no significant differences in G0 and G120 levels among the three groups(P>0.05).The ISI and isletβ-cell function index in the three groups were statistically significant(P<0.05).In group C,the ISI was higher than that in either group A or B.The isletβ-cell function index in group C was lower than that in group A(P<0.05).Pearson correlation analysis showed that eGFR was positively correlated with ISI(r=0.501,P<0.001).There was a negative correlation between eGFR and the isletβ-cell function index(r=-0.288,P=0.017).There was no linear correlation between eGFR and G0 or G120(r=0.006,P=0.962;r=-0.131,P=0.287).Conclusion In the non-diabetic CKD patients,insulin resistance worsened as eGFR decreased.Simultaneouslyβ-cell function is well compensated thereby maintaining OGTT G0 and G120 levels when eGFR declined.