非糖尿病慢性肾脏病患者胰岛素抵抗发生情况及影响因素分析

    Analysis of the incidence and related factors of insulin resistance in patients with non-diabetic nephropathy

    • 摘要: 目的 分析非糖尿病慢性肾脏病(non-diabetic chronic kidney disease,non-diabetic CKD)患者胰岛素抵抗(insulin resistance,IR)发生情况,研究非糖尿病CKD患者IR相关影响因素。方法 分析2017年3月至2018年3月在昆明医科大学第六附属医院(玉溪市人民医院)肾中心住院符合入选标准的非糖尿病CKD患者,检测其相关生化等指标,分析其IR发病情况及相关因素的影响。结果 (1)本中心目标患者CKD1~5期IR发生率分别为24.53%、29.76%、28.40%、26.42%、24.42%,各期IR发生率比较差异无统计学意义(P>0.05)。血液透析组(hemodialysis group,HD)、腹膜透析组(peritoneal dialysis group,PD)、非透析组(Non-dialysis group,ND)IR发生率分别为21.58%、20.28%、17.14%,各组间IR发生率差异无统计学意义(P>0.05)。(2)Spearman等级相关性分析:体重指数、血钙、三酰甘油与胰岛素抵抗指数呈正相关,碳酸氢盐、血红蛋白、铁、总胆固醇与胰岛素抵抗指数呈负相关,余指标与胰岛素抵抗指数无明显相关性(P>0.05)。(3)进一步二元Logistic回归分析:正常三酰甘油(OR=0.360、P=0.001)、正常体重指数(OR=0.272、P=0.004)、正常血红蛋白水平(OR=0.301、P=0.001)是胰岛素抵抗发生的保护因素,代谢性酸中毒(OR=6.264、P=0.025),25(OH)2D3缺乏(P=0.004,OR=3.032)是胰岛素抵抗发生的危险因素。结论 (1)本中心CKD各期均存在胰岛素抵抗,但各期IR发生率差异无统计学意义。在血液透析、腹膜透析、非透析、不同年龄组间胰岛素抵抗差异也无统计学意义。(2)正常三酰甘油、正常体重指数、正常血红蛋白水平是胰岛素抵抗发生的保护因素,代谢性酸中毒,25(OH)2D3缺乏是胰岛素抵抗发生的危险因素。

       

      Abstract: Objective To explore the incidence of insulin resistance(IR) and examine the IR-related factors in patients with non-diabetic chronic kidney disease (CKD).Methods From March 2017 to March 2018,non-diabetic CKD hospitalized patients fulfilling the inclusion criteria were analyzed.And the relevant biochemical parameters were recorded.Results The incidence of IR in CKD1-5 phase was 24.53%,29.76%,28.40%,26.42% and 24.42% respectively and no inter-group statistical difference existed in IR incidence (P>0.05).Correlation analysis indicated that body mass index (BMI),calcium and triglyceride were positively correlated with IR;hemoglobin,iron and total cholesterol were negatively correlated with HOMA-IR.Other parameters were not correlated with IR.Further binary Logistic regression revealed that normal triglyceride (OR=0.360、P=0.001),normal BMI (OR=0.272,P=0.004) and normal hemoglobin level (OR=0.301,P=0.001) were protective factors of IR.Metabolic acidosis (OR=6.264,P=0.025) and 25(OH)2D3 deficiency (P=0.004,OR=3.032) were risk factors of IR.Conclusion IR occurs in all stages of CKD.However,no statistical difference exists in the incidence of IR in all stages.No significant difference in IR exists among hemodialysis,abdominal dialysis,non-dialysis and different age groups.Normal triglyceride,normal BMI and normal hemoglobin level are protective factors for IR.And metabolic acidosis and 25(OH)2D3deficiency are risk factors for IR.

       

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