血液透析患者瘦素水平与胰岛素抵抗的关系研究

目的:观察血液透析患者血清瘦素和胰岛素抵抗的影响,并探讨瘦素与胰岛素抵抗的关系。方法:选择尿毒症维持性血液透析(MHD)患者40例(MHD组)及健康对照组40名。放射免疫法测定血清瘦素及空腹胰岛素(FINS)、同时检测空腹血糖(FBS)、体重指数(BMI)及肾功能等指标,计算胰岛素敏感指数(ISI)和稳态模型胰岛素抵抗指数(HOMA-IR)作为胰岛素抵抗指标,分析瘦素与各项参数的关系。结果:MHD组FBG、FINS、HOMA-IR均明显高于对照组(P<0.01),ISI明显低于对照组(P<0.01)。校正BMI与否,两组血清瘦素差异均无统计学意义(P>0.05)。两组血清瘦素与BMI、FINS、HOMA-IR均呈明显正相关关系(P<0.01),瘦素与ISI呈明显负相关关系(P<0.01),但控制BMI、FINS的影响后,瘦素与HOMA-IR及ISI均无明显相关关系(P>0.05)。结论:瘦素与胰岛素抵抗的关系可能是通过对体脂和胰岛素的影响而间接发生联系。

Correlation of serum leptin concentration with insulin resistance in hemodialysis patients

Objective： To explore the correlation between serum leptin concentration and insulin resistance in patients receiving hemodialysis. Methods ： Forty patients receiving maintenanee hemodialysis （ MHD ） and 40 heahhy controls were enrolled in the study. Serum lepting and fasting insulin（FINS） were measared by radio immuno-assay. Fasting blood sugar（FBS） , body mass index（BMI） and renal function indexes were also detected. Insulin resistance was also evaluated using insulin sensitivity index（ISI） and HOMA-IR. The relation between leptin and these parameters was analyzed. Results：FBG, FINS and HOMA-IR in MHD group were significantly higher than those in control group（ P 〈0.01 ） ,while ISI was significantly lower（ P 〈0.01 ）. The leptin level was higher in MHD group when BMI was correeted by covarianee analysis,but the difference was not statistieally significant; Serum leptin concentration in MHD group was positively correlated to BMI ,FINS and HOMA-IR（ P 〈 0.01 ） , but negatively to ISI（ P 〈 0. 01 ）. Partial correlation analysis showed that leptin concentration was not significantly correlated to HOMA-IR or ISI after BMI or FINS were controlled （ P 〉 0. 05 ）. Conclusions：Relations between leptin and insulin resistance may be mediated by body fat and insulin.