血液透析患者颈总动脉僵硬度与胰岛素抵抗的关系  

Association of insulin resistance with common carotid arterial stiffness in hemodialysis patients

作　　者：周亦伦[1] 于泽兴 贾慧敏[3] 王清涛[3] 孟娟[1] 孙芳[1] 马丽洁[1] 刘靖[1] 韩彬[1] 孙倩美[1] 彭立人[1] 

机构地区：[1]首都医科大学附属北京朝阳医院肾内科,北京100020 [2]首都医科大学附属北京朝阳医院超声医学科,北京100020 [3]首都医科大学附属北京朝阳医院检验科,北京100020

出　　处：《中华肾脏病杂志》2008年第4期249-252,共4页Chinese Journal of Nephrology

摘　　要：目的探讨维持性血液透析患者颈总动脉僵硬度与胰岛素抵抗的关系。方法选取80例非糖尿病、病情稳定的血液透析患者为研究对象。采用超声血管壁跟踪系统（Echotracking）在血液透析结束后1h测定颈总动脉硬化参数β作为评价大动脉僵硬度的指标。胰岛素抵抗用内环境稳定模型评估胰岛素抵抗法（HOMA-IR）进行评价。常规检测血红蛋白、白蛋白、总胆固醇、高密度脂蛋白、低密度脂蛋白、三酰甘油、脂蛋白（a）、载脂蛋白A1、载脂蛋白B、C反应蛋白、钙、磷、肌酐。用独立样本t检验、Pearson及多元逐步回归法分析各参数关系。结果既往有心血管病史者颈总动脉硬化参数β大于无心血管病史者（11．41±4．13比9．75±3．63，P〈0．05）。Pearson相关分析显示，颈总动脉硬化参数B与HOMA-IR（r=0．321，P〈0．01、年龄（r=0．376，P〈0．01），脉压（r=0．267，P〈0．05）、透析龄（r=0．219，P〈0．05）呈正相关。多元逐步回归结果显示，HOMA-IR（β=0．228，P〈0．05）、年龄（β=0．308，P〈0．01）是颈总动脉硬化参数β增加的独立危险因素。结论 在血液透析患者，胰岛素抵抗可能通过参与大动脉僵硬的发生，导致心血管疾病发病率和病死率增加。Objective To investigate the association between arterial stiffness of the common carotid artery（CCA） and insulin resistance in hemodialysis patients. Methods Arterial stiffness index β of CCA was evaluated by an ultrasonic phase-lock Echo-tracking system in 80 stable non-diabetic hemodialysis patients. Insulin resistance was detected by the homeostasis model assessment method （HOMA-IR）. Plasma hemoglobin, serum albumin, total cholesterol, high density lipoprotein, low density lipoprotein, triglyceride, lipoprotein （a）, ApoA1, ApoB, CRP, calcium, phosphorus and creatinine were determined by standard methods. Results The stiffness index β was 11.41±4.13 in patients with previous cardiovascular disease （CVD） and 9.75±3.63 in those without CVD（P〈0.05）. The stiffness index β was positively correlated with HOMA-IR（r=0.321 ,P〈 0.01 ）, as well as with age（r=0.376,P〈0.01 ）, pulse pressure（r=0.267, P〈0.05 ）, and duration of hemodialysis （r=0.219, P〈0.05 ）. In stepwise multiple regression analysis, HOMA-IR （β=0.228, P〈 0.05）and age （β=0.308,P〈0.01） were identified as significant independent variables for stiffness index β of CCA. Conclusions Insulin resistance is associated with arterial stiffness in nondiabetic hemodialysis patients. The increased arterial stiffness may be the link between insulin resistance and cardiovascular morbidity as well as mortality in hemodialysis patients.

关 键 词：动脉硬化 胰岛素抗药性 血液透析 

分 类 号：R692.5[医药卫生—泌尿科学]