成年1型糖尿病患者伴发胰岛素抵抗的影响因素

Influencing factor for insulin resistance in adults with type 1 diabetes mellitus

目的探讨成年1型糖尿病(T1DM)患者肾功能指标与胰岛素抵抗(IR)的相关性。方法选择2017年10月至2022年10月郑州大学附属郑州中心医院收治的60例T1DM患者为研究对象。收集患者的性别、年龄、腰围、臀围等一般资料,并计算腰臀比(WHR);采用化学试剂法测定血清三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)和血清肌酐(Scr)水平,并计算TG/HDL-C比值;采用双缩脲法测定尿白蛋白(UA)和尿肌酐,计算尿白蛋白/肌酐比值(UACR)。采用估算葡萄糖处置率(eGDR)评估IR,依据是否伴有IR将患者分为IR组和无IR组。比较IR组和无IR组患者的年龄、性别、WHR、TG、LDL-C、HDL-C、Scr、TG/HDL-C、UACR及eGDR,应用Pearson分析相关指标与eGDR的相关性,logistic回归分析IR的影响因素。结果IR组男性患者比例及HbA1c、LDL-C和UACR水平显著高于非IR组,eGDR显著低于非IR组(P<0.05);2组患者的年龄、WHR、HDL-C、Scr、TG、TG/HDL-C比较差异无统计学意义(P>0.05)。Pearson相关性分析显示,HbA1c、UACR、Scr和LDL-C与eGDR呈负相关(r=-0.474、-0.462、-0.388、-0.480,P<0.05),年龄、HDL-C、TG、TG/HDL-C与eGDR无相关性(r=0.320、0.908、0.516、0.596,P>0.05)。Logistic回归分析结果显示,LDL-C、Scr、UACR是IR的影响因素(比值比=6.790、1.099、1.538,P<0.05)。结论UACR、Scr和LDL-C是成年T1DM患者伴IR的影响因素,其异常增高会增加患者发生IR的风险,监测UACR、Scr的变化可以及时发现IR。

Objective To investigate the influencing factor for insulin resistance(IR)in adult patients with type 1 diabetes mellitus(T1DM).Methods Sixty patients with T1DM admitted to Zhengzhou Central Hospital Affiliated to Zhengzhou University from October 2017 to October 2022 were selected as the research subjects.The patient′s gender,age,waist circumference and hip circumference were collected,and the Waist to hip ratio(WHR)was calculated.The levels of serum triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C)and serum creatinine(Scr)were measured by chemical reagent method,and TG/HDL-C value was calculated.The urinary albumin(UA)and urine creatinine was measured by the biuret method,and the ratio of urinary albumin to creatinine(UACR)was calculated.IR in the patients was evaluated by estimated glucose disposal rate(eGDR),and the patients was divided into the IR group and non IR group based on whether IR was present.The age,gender,WHR,TG,LDL-C,HDL-C,Scr,TG/HDL-C,UACR and eGDR of patients were compared between the IR group and non IR group.The correlation between relevant indicators and eGDR was analyzed by Pearson correlation analysis,the influencing factors of IR was analyzed by logistic regression analysis.Results The proportion of male patients and the levels of HbA1c,LDL-C and UACR of patients in the IR group were significantly higher than those in the non IR group,eGDR was significantly lower than that in the non IR group(P<0.05);there was no statistically significant difference in the age,WHR,HDL-C,Scr,TG,TG/HDL-C of patients between the two groups(P>0.05).Pearson correlation analysis showed that HbA1c,UACR,Scr,and LDL-C were negatively correlated with eGDR(r=-0.474,-0.462,-0.388,-0.480;P<0.05);the age,HDL-C,TG,TG/HDL-C were not correlated with eGDR(r=0.320,0.908,0.516,0.596;P>0.05).Logistic regression analysis showed that LDL-C,Scr and UACR were risk factors for IR(odds ratios=6.790,1.099,1.538;P<0.05).Conclusion UACR,Scr,and LDL-C are risk factors for IR in adult T1DM patients,and their abnormal increase can increase the risk of developing IR,monitoring the changes of UACR and Scr can timely find IR.