中国人群胰岛素抵抗代谢指数与慢性肾脏病及蛋白尿的相关性分析  

Associations of metabolic score for insulin resistance with chronic kidney disease and albuminuria in the Chinese population

作　　者：林海玲 邱山虎[3] 胡浩 刘钰 陈娟[2] 李婷婷[2] 刘佳宁 袁扬[2] 孙子林[1,2] Lin Hailing;Qiu Shanhu;Hu Hao;Liu Yu;Chen Juan;Li Tingting;Liu Jianing;Yuan Yang;Sun Zilin(Nanjing Medical University,Nanjing 211166,China;Department of Endocrinology,Zhongda Hospital,Institute of Diabetes,School of Medicine,Southeast University,Nanjing 210009,China;Department of General Practice,Zhongda Hospital,Institute of Diabetes,School of Medicine,Southeast University,Nanjing 210009,China)

机构地区：[1]南京医科大学,南京211166 [2]东南大学附属中大医院内分泌科、东南大学糖尿病研究所,南京210009 [3]东南大学附属中大医院全科医学科、东南大学糖尿病研究所,南京210009

出　　处：《中华内科杂志》2023年第3期281-289,共9页Chinese Journal of Internal Medicine

基　　金：国家重点研发计划 (2016YFC1305700)。

摘　　要：目的探讨胰岛素抵抗代谢指数(METS-IR)在中国人群中与慢性肾脏病(CKD)及蛋白尿的相关性。方法横断面研究。2018年1至12月对中国8个省10个地区20~70岁、居住满5年的常驻居民进行调查,检测空腹血糖、餐后2 h血糖、糖化血红蛋白(HbA_(1c))、血脂、肾功能、尿白蛋白/肌酐比值(UACR)等。纳入符合标准的5060人的资料。CKD定义为估算的肾小球滤过率(eGFR)<60 ml·min^(-1)·1.73 m^(-2)或UACR≥30 mg/g;蛋白尿定义为UACR≥30 mg/g。计算METS-IR,并依据METS-IR四分位数,分为Q1组(METS-IR≤32.19)、Q2组(METS-IR 32.20~37.10)、Q3组(METS-IR 37.11~42.58)和Q4组(METS-IR>42.58)。应用logistic回归模型分析METS-IR与CKD及蛋白尿的相关性,并进行分层分析。结果Q1~Q4组分别有1266、1266、1265、1263人,随着METS-IR增加(Q1至Q4组),空腹血糖、HbA_(1c)、甘油三酯、血尿酸、腰围、体重指数、收缩压和舒张压水平逐渐升高,男性占比逐渐增加(均P<0.05);CKD和蛋白尿的比例也显著升高(均P<0.05)。logistic回归分析显示,METS-IR每增加1,CKD和蛋白尿的患病风险均增加2%(OR=1.02,95%CI 1.01~1.03;OR=1.02,95%CI 1.01~1.03)。与Q1组相比,Q4组CKD及蛋白尿患病风险的OR值分别为1.57(95%CI 1.17~2.10)和1.46(95%CI 1.09~1.96)。分层分析显示,METS-IR的升高与CKD及蛋白尿的发生在女性(OR=1.62,95%CI 1.14~2.31;OR=1.53,95%CI 1.07~2.18)、HbA_(1c)<7.0%(OR=1.64,95%CI 1.21~2.23;OR=1.55,95%CI 1.14~2.11)、eGFR≥90 ml·min^(-1)·1.73 m^(-2)(OR=1.78,95%CI 1.27~2.49;OR=1.80,95%CI 1.28~2.53)、汉族(OR=1.56,95%CI 1.13~2.17;OR=1.41,95%CI 1.01~1.96)人群有显著相关性。结论METS-IR在中国人群中与CKD和蛋白尿存在关联,METS-IR越高,CKD和蛋白尿发生风险越大。Objective To explore the relationship between metabolic score for insulin resistance(METS-IR)and chronic kidney disease(CKD)and albuminuria in the Chinese population.Methods This cross-sectional study was conducted from January to December 2018 among residents aged 20 to 70 years in ten regions of eight provinces in China;all residents had lived in their region for more than 5 years.Various parameters were measured,included fasting blood glucose,2-hour postprandial blood glucose,glycosylated hemoglobin(HbA_(1c)),blood lipids,renal function,urinary albumin/creatinine ratio(UACR),etc.Data of 5060 subjects meeting the criteria were included in the study.CKD was defined as estimated glomerular filtration rate(eGFR)<60 ml·min^(-1)·1.73 m^(-2) or UACR≥30 mg/g.Albuminuria was defined as UACR≥30 mg/g.METS-IR was calculated and categorized into quartiles:Q1,METS-IR≤32.19;Q2,METS-IR 32.20-37.10;Q3,METS-IR 37.11-42.58;and Q4,METS-IR>42.58.The correlation between METS-IR and CKD and albuminuria was analyzed by binary logistic regression,and subgroup analyses were performed.Results There were 1266,1266,1265,and 1263 participants included in Q1-Q4 groups,respectively.With the increase of METS-IR quartile,various parameters increased,including age,fasting blood glucose,HbA_(1c),triglycerides,serum uric acid,waist circumference,body mass index,and systolic and diastolic blood pressure,and the proportion of males also increased(all P<0.05).The proportion of patients with CKD and albuminuria increased significantly with the increase in interquartile range(Q)of METS-IR(all P<0.05).Logistic regression analysis showed that for every 1-unit increment of METS-IR,the risk of CKD and albuminuria were both increased by 2%[for both:odds ratio(OR)=1.02,95%confidence interval(CI)1.01-1.03].Compared with the lowest METS-IR group(Q1),the ORs for CKD and albuminuria in the highest METS-IR group(Q4)were 1.57(95%CI 1.17-2.10)and 1.46(95%CI 1.09-1.96),respectively.In the subgroup analyses,increased METS-IR was significantly associated with

关 键 词：横断面研究 白蛋白尿 胰岛素抵抗代谢指数 慢性肾脏病 

分 类 号：R692[医药卫生—泌尿科学]