中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2015年
4期
251-255
,共5页
武蓓%赵慧萍%芦丽霞%乔婕%武向兰%门春翠%王梅
武蓓%趙慧萍%蘆麗霞%喬婕%武嚮蘭%門春翠%王梅
무배%조혜평%호려하%교첩%무향란%문춘취%왕매
腹膜透析%胰岛素抗药性%透析液,葡萄糖
腹膜透析%胰島素抗藥性%透析液,葡萄糖
복막투석%이도소항약성%투석액,포도당
Peritoneal dialysis%Insulin resistance%Dialysate,glucose
目的 观察非糖尿病腹膜透析患者的胰岛素抵抗(IR)指数改变,分析其相关影响因素.方法 选择2012年8月北京大学人民医院的非糖尿病腹膜透析患者56例为研究对象.采用横断面研究方法,在相同条件下测定患者身高、体质量、体质量指数(BMI)、空腹血糖、空腹胰岛素及血脂等生化指标及透析充分性指标.按稳态模式评估公式计算胰岛素抵抗指数(HOMA-IR).按照患者IR中位数水平分为高胰岛素抵抗(高IR)组和低胰岛素抵抗(低IR)组,比较两组患者生化及透析充分性等指标的差异,分析影响患者胰岛素抵抗的危险因素.结果 与低IR(HOMA-IR＜1.79,n=27)组相比,高IR(HOMA-IR≥1.79,n=29)组患者年龄较大[(57.9±14.2)岁比(48.7±14.5)岁];每日腹透液葡萄糖含量较高[(138.7±28.5) mmol/L比(114.0±21.5) mmol/L];腰臀比较高[(0.91±0.08)比(0.86±0.07)];BMI较高[(23.0±3.0) kg/m2比(21.2±3.1) kg/m2];三酰甘油较高[(2.51±1.36) mmol/L比(1.42±0.48) mmol/L];高密度脂蛋白胆固醇(HDL)较低[(1.00±0.27) mmol/L比(1.23±0.32)mmol/L];尿素清除指数(Kt/V)较低[(1.74±0.37)比(2.08±0.56)].多因素logistic回归结果显示,年龄(β=0.122,P=0.033)、血三酰甘油(β=1.798,P=0.030)和每日腹透液葡萄糖含量(β=0.094,P=0.031)与胰岛素抵抗程度相关.结论 过多腹透液葡萄糖暴露是非糖尿病腹膜透析患者发生胰岛素抵抗的危险因素.
目的 觀察非糖尿病腹膜透析患者的胰島素牴抗(IR)指數改變,分析其相關影響因素.方法 選擇2012年8月北京大學人民醫院的非糖尿病腹膜透析患者56例為研究對象.採用橫斷麵研究方法,在相同條件下測定患者身高、體質量、體質量指數(BMI)、空腹血糖、空腹胰島素及血脂等生化指標及透析充分性指標.按穩態模式評估公式計算胰島素牴抗指數(HOMA-IR).按照患者IR中位數水平分為高胰島素牴抗(高IR)組和低胰島素牴抗(低IR)組,比較兩組患者生化及透析充分性等指標的差異,分析影響患者胰島素牴抗的危險因素.結果 與低IR(HOMA-IR＜1.79,n=27)組相比,高IR(HOMA-IR≥1.79,n=29)組患者年齡較大[(57.9±14.2)歲比(48.7±14.5)歲];每日腹透液葡萄糖含量較高[(138.7±28.5) mmol/L比(114.0±21.5) mmol/L];腰臀比較高[(0.91±0.08)比(0.86±0.07)];BMI較高[(23.0±3.0) kg/m2比(21.2±3.1) kg/m2];三酰甘油較高[(2.51±1.36) mmol/L比(1.42±0.48) mmol/L];高密度脂蛋白膽固醇(HDL)較低[(1.00±0.27) mmol/L比(1.23±0.32)mmol/L];尿素清除指數(Kt/V)較低[(1.74±0.37)比(2.08±0.56)].多因素logistic迴歸結果顯示,年齡(β=0.122,P=0.033)、血三酰甘油(β=1.798,P=0.030)和每日腹透液葡萄糖含量(β=0.094,P=0.031)與胰島素牴抗程度相關.結論 過多腹透液葡萄糖暴露是非糖尿病腹膜透析患者髮生胰島素牴抗的危險因素.
목적 관찰비당뇨병복막투석환자적이도소저항(IR)지수개변,분석기상관영향인소.방법 선택2012년8월북경대학인민의원적비당뇨병복막투석환자56례위연구대상.채용횡단면연구방법,재상동조건하측정환자신고、체질량、체질량지수(BMI)、공복혈당、공복이도소급혈지등생화지표급투석충분성지표.안은태모식평고공식계산이도소저항지수(HOMA-IR).안조환자IR중위수수평분위고이도소저항(고IR)조화저이도소저항(저IR)조,비교량조환자생화급투석충분성등지표적차이,분석영향환자이도소저항적위험인소.결과 여저IR(HOMA-IR＜1.79,n=27)조상비,고IR(HOMA-IR≥1.79,n=29)조환자년령교대[(57.9±14.2)세비(48.7±14.5)세];매일복투액포도당함량교고[(138.7±28.5) mmol/L비(114.0±21.5) mmol/L];요둔비교고[(0.91±0.08)비(0.86±0.07)];BMI교고[(23.0±3.0) kg/m2비(21.2±3.1) kg/m2];삼선감유교고[(2.51±1.36) mmol/L비(1.42±0.48) mmol/L];고밀도지단백담고순(HDL)교저[(1.00±0.27) mmol/L비(1.23±0.32)mmol/L];뇨소청제지수(Kt/V)교저[(1.74±0.37)비(2.08±0.56)].다인소logistic회귀결과현시,년령(β=0.122,P=0.033)、혈삼선감유(β=1.798,P=0.030)화매일복투액포도당함량(β=0.094,P=0.031)여이도소저항정도상관.결론 과다복투액포도당폭로시비당뇨병복막투석환자발생이도소저항적위험인소.
Objective To observe insulin resistance (IR) in non-diabetic peritoneal dialysis (PD) patients,and analyze its related factors.Methods The non-diabetic PD patients who had been on stable PD at least three months were eligible to enroll.The patients were measured for their height,weight,waist to hip ratio,fasting glucose,fasting insulin,lipids and other biochemical indicators,dialysis adequacy indicators in August 2012,and divided into two groups depended on median HOMA-IR in August 2012.Results A total of 56 patients were enrolled and divided into two groups according to median HOMA-IR,including high IR group (HOMA-IR≥ 1.79,n=29) and low IR group (HOMA-IR ＜ 1.79,n=27).Compared to low IR group,high IR group were older [(57.9±14.2) years vs (48.7±14.5) years],had higher daily dialysate glucose load [(138.7±28.5) mmol/L vs (114.0± 21.5) mmol/L],higher waist-to-hip ratio [(0.91±0.08) vs (0.86±0.07)],higher BMI [(23.0±3.0) kg/m2 vs (21.2±3.1) kg/m2],higher triglycerides [(2.51±1.36) mmol/L vs (1.42±0.48) mmol/L],lower high-density lipoprotein cholesterol [(1.00±0.27) mmol/L vs (1.23±0.32) mmol/L],and lower Kt/V [(1.74±0.37) vs (2.08±0.56)].Multivariate logistic regression showed that age (β=0.122,P=0.033),triglycerides (β=1.798,P=0.030) and daily dialysate glucose load (β=0.094,P=0.031) associated with the degree of insulin resistance.Conclusion More dialysate glucose exposure is a risk factor of the occurrence of insulin resistance in non-diabetic patients with peritoneal dialysis.
