150例慢性肾脏病患者胰岛素抵抗指数的分布及其相关因素分析  

Distribution and associated factors of homeostasis model assessment 2-insulin resistance （HOMA2-IR） in150 cases of chronic kidney disease

作　　者：武晓春[1] 方奕[1] 唐利群[1] 徐玲玲[1] 孙治平[1] 杨俊伟[1] 

机构地区：[1]南京医科大学第二附属医院肾脏科,南京210011

出　　处：《临床肾脏病杂志》2013年第12期550-553,共4页Journal Of Clinical Nephrology

摘　　要：目的观察慢性肾脏病患者胰岛素抵抗指数的分布及其相关因素。方法分析在南京医科大学第二附属医院肾脏科住院并确诊为慢性肾脏病的150例患者的病历资料，通过稳态模型分析法（HOMA2模型）定量评价胰岛素抵抗等指标。结果慢性肾脏病患者胰岛素抵抗指数均值为（2．85±1．67），其中非糖尿病和2型糖尿病患者分别为（2．74±1．54）、（3．00±1．82）（P=0．356）。随着肾小球滤过率的降低，胰岛素抵抗指数呈增加趋势（Pfortrend＜0．01）。进行有序Logistic回归分析，单因素模型中胰岛素抵抗指数相关因素包括logl0（全段甲状旁腺素）、血磷、心力衰竭、高血压病史、尿蛋白、纤维蛋白原、胱抑素C、尿酸、收缩压、高密度脂蛋白胆固醇、肾小球滤过率、碳酸氢根，多因素模型中相关因素包括血磷、胱抑素C、血红蛋白、体质量指数、肾小球滤过率。患者的胰岛素分泌功能指数均值为（169．1％±91）．2％），其中2型糖尿病患者低于非糖尿病患者（P=0．000），胰岛素敏感性指数均值为（49．7％±31．3％），非糖尿病患者与2型糖尿病患者相似且均降低（P=0．838）。结论本研究发现慢性肾脏病患者普遍存在胰岛素抵抗，并且随着肾脏损害的进展呈加重趋势。重视与慢性肾脏病有关的相关因素包括甲状旁腺素、血磷、尿蛋白、胱抑素C、血红蛋白、肾小球滤过率等。Objective To investigate the distribution and association factors of homeostasis model assessment 2-insulin resistance （HOMA2-IR） in patients with chronic kidney disease （CKD）. Methods Totally 150 adult CKD patients who were hospitalized were included in this study. CKD was defined according to K/I^QI guideline. Glomerular filtration rate （GFR） was estimated using the MDRD equation （GFR = 170 ~ SCr- age-76 Yx BUN o. 17o x Alb^18 X 0. 762 （for women） [mI- rain 1. （1.73 m2） 121. Insulin resistance（IR） was assessed quantitatively with HOMA2-IR index. Re- sults The HOMA2-IR in 150 CKD patients was （2. 85 ± 1.67）. In non-diabetes and type 2 diabetes CKD patients HOMA2-IR was （2. 74± 1.54） and （3.00 ± 1.82） respectively （P = 0. 356）. With the decrease of GFR, HOMA2-IR had a increasing trend （P for trend 〈. 01）. Ordinal logistic regression analysis revealed that the associated factors of HOMA2-IR included log10 （intact parathyroid hor- mone）, inorganic phosphate, heart failure, hypertension, urine protein, fibrinogen, Cystatin C, uric acid, systolic BP,HDL-Cho, GFR, and bicarbonate in univariate model, and those included inorganic phos- phate,Cystatin C, hemoglobin, BMI, and GFR in multivariate model. In those patients, HOMA2-~/0 B （insulin secretion index） was （ 169. 1 ~ ＋ 9/）. 2~6 ）, and HOMA2-~ S （ insulin sensitivity index） was （49.7~ ＋ 31.3%）. Conclusions In CKD patients regardless of type 2 diabetes, RI is common, and with the deterioration of renal functions, RI shows an increased trend. The associated factors of CKD include parathyroid hormone, inorganic phosphate, urine protein, Cystatin C, hemoglobin, and GFR.

关 键 词：胰岛素抵抗 糖尿病 慢性肾脏病 

分 类 号：R587.1[医药卫生—内分泌]