腹膜透析营养不良患者中医证型与胰岛素抵抗的关系及相关因素分析  

Relationship between Chinese Medicine Syndromes of Malnutrition and Insulin Resistance and Analysis on Correlative Factors for the Patients Undergoing Peritoneal Dialysis

作　　者：李建英 梁青 黄克基 刘先英 

机构地区：[1]山东省青岛市海慈医疗集团,山东青岛266033

出　　处：《世界中西医结合杂志》2011年第10期859-861,共3页World Journal of Integrated Traditional and Western Medicine

基　　金：青岛市科技局立项项目(No.05-1-NS-75)

摘　　要：目的探讨维持性腹膜透析营养不良患者中医证型与胰岛素抵抗(IR)的关系以及影响IR的相关因素,探寻中医辨证防治本病的规律。方法 60例尿毒症维持性腹膜透析的(MPD)患者,根据主观综合营养评分法(SGA评分)符合营养不良,按照慢性肾衰竭中医辨证分型标准进行辨证分型。另设健康对照组30例。检测两组血清空腹胰岛素(FINS)、空腹血糖(FBG)等指标,计算稳态模型胰岛素抵抗指数(HOMA-IR)作为胰岛素抵抗指标,同时检测MPD患者血清白蛋白(ALB)、前白蛋白(PA),血红蛋白(HB)、总尿素清除指数KT/Vt和残肾尿素清除指数KT/Vr,分析不同中医证型与IR各项参数的关系以及HOMA-IR与其他各项指标的关系。结果 MPD组患者血清FBG、FINS、HOMA-IR均高于健康对照组(P<0.05或P<0.01),主证中脾肾阳虚证、阴阳两虚证及兼证中湿浊证患者血清FBG、FINS、HOMA-IR较其他三组均明显增高(P<0.05或P<0.01)。相关性分析显示血清白蛋白(ALB)、前白蛋白(PA)、KT/Vt和KT/Vr与HOMA-IR呈负相关。结论维持性腹膜透析营养不良患者普遍存在胰岛素抵抗,在脾肾阳虚证、阴阳两虚证、湿浊证表现最明显,胰岛素抵抗与营养状态、透析充分性及残肾功能密切相关。Objective To discuss the relationship between Chinese medicine syndromes of malnutrition and insulin resistance（IR）for the patients undergoing maintenance peritoneal dialysis（MPD）as well as the correlative factors of IR,and explore the law on the syndrome differentiation and treatment of this disease in Chinese medicine.Methods 60 cases of uremia undergoing MPD were selected.The cases in compliance with malnutrition according to the Subjective Global Assessment（SGA）were differentiated into different types of Chinese medicine in terms of chronic kidney failure.Besides,a health control group（30 cases）is set up.The serum fasting insulin（FINS）and fasting blood sugar（FBG）were detected in two groups.The homeostasis model assessment for insulin resistance（HOMA-IR）was calculated as the indicator of IR.Meanwhile,the serum albumin（ALB）,prealbumin（PA）,hemoglobin（HB）,the total urea clearance rate（KT/Vt）and the residual kidney urea clearance（KT/Vr）were detected for MPD patients.The relationship of different syndromes of Chinese medicine with each IR parameter,as well as between HOMA-IR and every indicator was investigated.Results The levels of FBG,FINS and HOMA-IR in MPD group were all higher than those in the healthy control group（P0.01 or P0.05）.For the main syndromes such as spleen and kidney yang deficiency and yin and yang deficiency,as well as the associated syndrome such as turbid damp syndrome,the levels of the serum FBG,FINS and HOMA-IR were all higher apparently than those in the other three groups（P0.01 or 0.05）.The correlative analysis displayed that the serum ALB,PA,KT/Vt and KT/Vr were positively correlated to HOMA-IR.Conclusions Insulin resistance presents universally in the patients with malnutrition undergoing MPD,which is much predominated in spleen and kidney yang deficiency syndrome,yin and yang deficiency syndrome and turbid damp syndrome.There is a close correlation of IR with nutrition,dialysis adequacy and residual renal function.

关 键 词：维持性腹膜透析 营养不良 中医辨证 胰岛素抵抗 

分 类 号：R587[医药卫生—内分泌]