CAJ | 학술논문

目的研究非糖尿病维持性腹膜透析患者胰岛素抵抗(IR)的临床特点.方法选取128例非糖尿病维持性腹膜透析患者,禁食12h后抽取清晨空腹静脉血5ml,测定血清甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL)、空腹血糖(FBG)、空腹胰岛素(FINS)、血肌酐(Scr)、血白蛋白(ALB)、甲状旁腺素(PTH),计算胰岛素抵抗指数(HOMA-IR)及胰岛素敏感性指数(ISI).结果多元线性相关分析结果显示BMI、FBG、TG、TC的偏回归系数与IR的差异均有统计学意义(均P<0.05).根据HOMA-IR值将患者分为无IR组(78例)和IR组(50例),IR组占39.1%,两组患者性别、年龄、BMI、TC、HDL、Scr的差异均无统计学意义(均P>0.05).IR组的FBG、TG、ALB均高于无IR组,而ISI则低于无IR组,两组间的差异有统计学意义(P<0.05).对不同透析时间的患者进行分析,结果显示TG、TC水平在透析1~2年内有所下降,而后随着透析时间的增加而增高.HOMA-IR及ISI不受透析时间影响.结论非糖尿病维持性腹膜透析患者易出现IR,高TG水平与其有较强的相关性.
목적연구비당뇨병유지성복막투석환자이도소저항(IR)적림상특점.방법선취128례비당뇨병유지성복막투석환자,금식12h후추취청신공복정맥혈5ml,측정혈청감유삼지(TG)、총담고순(TC)、고밀도지단백(HDL)、공복혈당(FBG)、공복이도소(FINS)、혈기항(Scr)、혈백단백(ALB)、갑상방선소(PTH),계산이도소저항지수(HOMA-IR)급이도소민감성지수(ISI).결과다원선성상관분석결과현시BMI、FBG、TG、TC적편회귀계수여IR적차이균유통계학의의(균P<0.05).근거HOMA-IR치장환자분위무IR조(78례)화IR조(50례),IR조점39.1%,량조환자성별、년령、BMI、TC、HDL、Scr적차이균무통계학의의(균P>0.05).IR조적FBG、TG、ALB균고우무IR조,이ISI칙저우무IR조,량조간적차이유통계학의의(P<0.05).대불동투석시간적환자진행분석,결과현시TG、TC수평재투석1~2년내유소하강,이후수착투석시간적증가이증고.HOMA-IR급ISI불수투석시간영향.결론비당뇨병유지성복막투석환자역출현IR,고TG수평여기유교강적상관성.
Objective To investigate the clinical characteristics and related factors of insulin resistance in non-diabetic patients with continuous peritoneal dialysis. Methods One hundred and twenty eight non-diabetic patients undergoing continu-ous ambulatory peritoneal dialysis (CAPD) were enrol ed in the study. Parameters including height, weight, body mass index (BMI), fast blood glucose(FBG), serum insulin and lipid levels were measured. Homeostasis model assessment-insulin resistance (HOMA-IR) and insulin sensitivity index(ISI) were calculated to evaluate the insulin resistance in these patients. Results Multiple linear regression analysis results showed that partial regression coefficient was 0.189 for BMI (P<0.05), 0.418 for FBG (P<0.01), 0.296 for serum triglyceride(TG)(P<0.01) and-0.189 for total cholesterol(TC)(P<0.05). There were 78 patients in non-insulin re-sistance group (HOMA-IR<2.69) and 50 in insulin resistance group (HOMA-IR≥2.69). No significant difference existed be-tween these two groups in age, sex, BMI, TC, HDL and Scr. The FBG, TG, ALB levels in insulin resistance group were signifi-cantly higher and ISI was lower than those in non-insulin resistance group. TG and TC levels were decreasing with the time course of dialysis, whereas HOMA-IR and ISI were not affected by dialysis course. Conclusion Non-diabetic patients with peritoneal dialysis tend to develop insulin resistance, which is associated with multiple factors, particularly with high triglyceride levels.