空腹和糖负荷后胰岛素抵抗评估与慢性肾脏病的关系探讨

目的:研究比较在非糖尿病慢性肾脏病(chronic kidney disease,CKD)人群中空腹和糖负荷后来源胰岛素抵抗指标与eGFR的相关性。方法:选择71例CKD住院患者,根据中国人群校正的EPI公式评估eGFR。按照eGFR水平将入选患者分为eGFR<60 m L/min,60 m L/min≤eGFR<90 m L/min,eGFR≥90m L/min 3组。对患者完善实验室检查并行75 g葡萄糖负荷试验。分别采用糖负荷后胰岛素敏感指数(insulin sensitivity index,ISI)和空腹来源的稳态模型胰岛素抵抗指数(homeostatic model assessment of insulin resistance,HOMA-IR)指标评价胰岛素抵抗。ISI减低或HOMA-IR升高提示胰岛素抵抗。比较各组间临床资料,分析比较空腹和糖负荷后胰岛素抵抗指标与eGFR相关性。结果:中位eGFR为81.70 m L/min。ISI随eGFR下降有明显降低趋势(P<0.001),ISI与eGFR呈显著正相关(r=0.523,P<0.001)。HOMA-IR与随eGFR下降无明显变化,与eGFR无线性相关。结论:在CKD人群中随着eGFR的下降,糖负荷后ISI下降,即胰岛素抵抗加剧;而空腹来源的HOMA-IR与eGFR未见显著相关性。

Discussion on the relationship between insulin resistance assessment and chronic renal disease after fasting and sugar loading

Objective:To compare the correlation between insulin resistance index and eGFR after fasting and glucose load in patients with non-diabetic chronic kidney disease (CKD).Methods:71 cases of CKD hospitalized patients were selected to evaluate eGFR according to the EPI formula corrected by the Chinese population.In accordance with the level of eGFR,patients were divided into three groups(eGFR ＜ 60 mL/min,60 mL/min ≤ eGFR ＜ 90 mL/min,eGFR ≥ 90mL/min).75 g glucose load test for patients was treated as laboratory examination.Insulin resistance was evaluated by insulin sensitivity index (ISI) and homeostatic model assessment of insulin resistance (HOMA-IR),respectively.Reduction of ISI or raise of HOMA-IR suggests insulin resistance.The clinical data of each group was compared,and the correlation between insulin resistance index and eGFR after the fasting and sugar load was analyzed.Results:The median eGFR was 81.70 mL/min,ISI decreased significantly with decreasing of GFR (P ＜ 0.001),and ISI was positively correlated with eGFR (r =0.523,P ＜0.001).The decrease of HOMA-IR with eGFR was not significantly changed,and there was no linear correlation with eGFR.Conclusion:In the CKD population,insulin resistance increased with the decrease of eGFR and ISI after sugar loading,while no significant correlation is found between HOMA-IR from the fasting source and eGFR.