老年健康查体人群中代谢相关共病及胰岛素抵抗与慢性肾脏病的相关性研究  

Correlation of metabolic comorbidities and insulin resistance with CKD in an elderly population taking physical exam

作　　者：杨光[1] 程柏凯 沈鑫 刘洋[1] 丁影 程庆砾[1] 郑延松[2] 赵佳慧[1] Yang Guang;Cheng Bokai;Shen Xin;Liu Yang;Ding Ying;Cheng Qingli;Zheng Yansong;Zhao Jiahui(Department of Geriatric Nephrology,Second Medical Centre&National Clinical Research Centre,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第二医学中心肾脏病科、国家老年疾病临床研究中心,北京100853 [2]解放军总医院第二医学中心健康医学科,北京100853

出　　处：《中华老年心脑血管病杂志》2025年第3期260-264,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家重点研发计划项目(2023YFC3605500);国家老年疾病临床医学研究中心开放课题(NCRCG-PLAGH-2024017)。

摘　　要：目的探讨老年健康查体人群中代谢相关共病、胰岛素抵抗(insulin resistance,IR)与慢性肾脏病(chronic kidney disease,CKD)之间的关系。方法纳入2009年12月至2021年5月在解放军总医院接受健康体检的老年人8358例,根据指南标准分为CKD组983例与非CKD组7375例。收集患者临床资料,计算IR指数估计的葡萄糖处置率(estimated glucose disposal rate,eGDR),应用Quasi-Bayesian进行因果中介分析。结果CKD组高血压、冠心病、糖尿病、高脂血症和高尿酸血症患病率显著高于非CKD组(P<0.01),CKD组eGDR显著低于非CKD组[(6.88±2.09)mg/(kg·min)vs(8.41±2.12)mg/(kg·min),P<0.01]。logistic回归分析结果显示,未调整协变量时,eGDR每增加1单位,CKD的发生风险降低29%(OR=0.714,95%CI:0.691~0.738,P<0.01)。调整后,eGDR与CKD风险仍显著相关(P<0.01)。中介分析显示,糖尿病和肱踝脉搏波传导速度在eGDR与CKD之间关系的中介效应占比最高(分别为14.2%和12.5%)。结论老年健康查体人群中胰岛素敏感性的降低与CKD的发生显著相关。糖尿病和动脉硬化在这一关联中起到中介作用。Objective To explore the relationship of metabolic comorbidities and insulin resistance(IR)with chronic kidney disease(CKD)among elderly individuals undergoing health exam.Methods A cross-sectional observational study was conducted on 8358 older adults who took health exam in Chinese PLA General Hospital between December 2009 and May 2021.According to the guidelines for CKD diagnostic criteria,they were divided into CKD group(983 cases)and non-CKD(7375 cases).Clinical data was collected,and the eGDR was calculated.Quasi-Bayesian method was used for causal mediation analysis.Results The prevalence of metabolic comorbidities including hypertension,CHD,DM,hyperlipidemia,and hyperuricemia was significantly higher in the CKD group than the non-CKD group(P<0.01).The eGDR was obviously lower in the CKD group than the non-CKD group[6.88±2.09 mg/(kg·min)us 8.41±2.12 mg/(kg·min),P<o.01].Logistic regression analysis revealed that,without adjusting covariates,each 1-unit increase in eGDR was associated with a 29%reduction in the risk of developing CKD(OR=0.714,95%CI:0.691-0.738,P<0.01),and after adjusting covariates,eGDR remained significantly negatively association with the risk of CKD(P<o.01).Mediation analysis indicated that DM and brachial-ankle pulse wave velocity accounted for the highest proportions of the mediating effect in the relationship between eGDR and CKD(14.2%and 12.5%,respectively).Conclusion In the elderly population undergoing health exam,reduced insulin sensitivity is significantly associated with the development of CKD.Diabetes and arteriosclerosis exert mediating effect in this association.

关 键 词：慢性病共病 代谢疾病 胰岛素抵抗 数据相关性 

分 类 号：R692[医药卫生—泌尿科学] R587.1[医药卫生—外科学]