胰岛素抵抗在尿毒症脂质代谢紊乱发生中的作用

目的 探讨胰岛素抵抗在尿毒症脂质代谢紊乱发生中的作用。方法 采用口服75g葡萄糖耐量试验和胰岛素释放试验方法，检测50例尿毒症患者和12例正常健康者胰岛素敏感指数（ISI）、机体糖利用率（M）、糖和胰岛素反应曲线下面积（AUCG、AUCINS），分析上述诸指标与血浆总胆固醇（Tch）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL－C）、高密度脂蛋白胆固醇（HDL－C）及LDL－C／HDL－C比值的关系。结果 （1）与正常对照组相比，尿毒症组ISI、M值显著低下，AUCG、AUCINS值显著增高。提示存在明显的胰岛素抵抗、高胰岛素血症和糖耐量异常；尿毒症组较正常对照组血浆TG、LDL－C水平及LDL－C／HDL－C比值显著增高，HDL－C水平显著低下，存在明显的脂质代谢紊乱。（2）与非胰岛素抵抗组相比，胰岛素抵抗组LDLKJ－C／HDL－C比值和LDL－C水平明显增高；相关分析显示血浆LDL－C水平与ISI呈显著负相关，与AUCINS呈显著正相关；LDL－C／HDL－C比值与ISI、M呈显著负相关，与AUCG呈显著正相关。结论 胰岛素抵抗及与其相关的高胰岛素血症、糖代谢异常与尿毒症脂质代谢紊乱的发生有关，但其机制尚待进一步探讨。

Effects of Insulin Resistance on Dyslipidemia in Uremia

Purpose To evaluate the effects of insulin resistance on dyslipidemia in uremia. Methods With oral glucose tolerance test(OGTT)and insulin release test(IRT),the insulin sensitivity index(ISI),glucose uptake rate(M),total areas under the glucose and insulin curves during OGTTs(AUCG,AUCINS)were measured in 50 uremic patients and 12 healthy subjects (matched in age,sex ratio and body mass index),and their associations with the parameters of serum lipids,including total cholesterol(Tch),triglyceride(TG),low density lipoprotein cholesterol(LDL C),high density lipoprotein cholesterol(HDL C) and LDL C/HDL C ratio were analyzed. Results (1) Compared with the control group,the uremic one had significant lower ISI and M values,significant higher AUCG and AUCINS values,and also had significant higher TG and LDL C level,lower HDL C level,and a significant higher LDL C/HDL C ratio;(2) The insulin resistant group had a significant higher LDL C value and a higher LDL C/HDL C ratio than the non insulin resistant one;(3) Simple linear regression analysis showed that LDL C had a significant negative correlation with ISI,a significant positive correlation with AUCINS,and the LDL C/HDL C ratio had a significant ne gative correlation with ISI and M,respectively,as well as a significant positive correlation with AUCG. Conclusions Insulin resistance,hyperinsulinemia,and impaired glucose tolerance had some definite associations with dyslipidemia in uremia,but the mechanism(s) remained to be investigated further.