| 赵 洋,李 娇,许 卓,唐宽平,张 利,陈香美.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[J].,2018,(10):1892-1896 |
| 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 |
| 投稿时间：2018-01-07 修订日期：2018-01-30 |
| DOI：10.13241/j.cnki.pmb.2018.10.017 |
| 中文关键词: 慢性肾脏病 胰岛素抵抗 肥胖 |
| 英文关键词: Chronic kidney disease Insulin resistance Obesity |
| 基金项目:国家重点基础研究发展计划项目"973项目"（2015CB553605） |
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| 中文摘要: |
| 摘要 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/m2定义为肥胖，按照eGFR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、eGFR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、eGFR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。 |
| 英文摘要: |
| ABSTRACT 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 pa- rameters were detected, and the body mass index (BMI), BMI≥28 kg/m2 were defined as obesity, CKD was staged according to eGFR 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 inci- dence 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, eGFR. The HOMA-IR of non-obese CKD patients was posi- tively correlated with age, urea nitrogen, triglyceride, parathyroid hormone and CKD grade in non-obese CKD patient, but negatively cor- related with total protein, albumin, high density lipoprotein and eGFR. In Multiple regression analysis showed that BMI, blood urea nitro- gen, 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). Conclusion: The incidence of IR increased gradually with the progression of CKD, obesity, elevated blood urea ni- trogen, 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. |
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