天津医药

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慢性肾脏病非透析患者血尿脂联素与胰岛素抵抗的变化及相互关系

俞燕   

  1. 江苏省南通大学附属医院肾内科
  • 收稿日期:2012-10-18 修回日期:2013-02-14 出版日期:2013-07-15 发布日期:2013-07-15
  • 通讯作者: 俞燕

Relationship of Adiponectin and Insulin Resistance in Patients with Chronic Kidney Disease

YU Yan   

  1. Department of Nephrology, Affiliated Hospital of Nantong University, Nantong 226001, China
  • Received:2012-10-18 Revised:2013-02-14 Published:2013-07-15 Online:2013-07-15
  • Contact: YU Yan

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摘要： 【摘要】 目的 探讨慢性肾脏病（CKD）非透析患者血、尿脂联素（ADPN）水平与胰岛素抵抗（IR）状态的关系。方法 选择 487 例 CKD 2~5 期非透析住院患者， 另 30 例健康体检者作为对照组。 ELISA 法测定血、尿 ADPN， 放射免疫法测定空腹胰岛素（FINS）， 常规检查血常规、肝肾功能、血糖、血脂和 24 h尿蛋白定量、内生肌酐清除率(Ccr)以及体质量指数（BMI）。 比较血、尿ADPN 水平和胰岛素抵抗指数（Homa-IR）在各组间的差异， 分析ADPN 与 Homa-IR之间的关联以及与有关指标的相关性。 结果 CKD 非透析患者血、尿ADPN 水平以及 Homa-IR均高于对照组（P < 0.05），随着肾功能下降， 血、尿 ADPN 和 Homa-IR 逐渐升高（P <0.05）， CKD 3~5 期高 Homa-IR 患者血 ADPN 值也明显升高。CKD 非透析患者血、尿 ADPN 和 Homa-IR与血脂呈正相关， 与血红蛋白、血白蛋白呈负相关， 与 24 h 尿蛋白定量呈正相关（均 P < 0.05）。 结论 CKD 非透析患者随着肾功能减退， 血与尿ADPN 升高、IR明显， 且与血脂、血红蛋白和白蛋白以及尿蛋白具有相关性， 动态监测血尿ADPN水平对判断CKD 非透析患者的代谢紊乱具有一定的临床意义。

关键词: 肾疾病, 脂联素, 胰岛素抵抗, 脂类, 血清白蛋白, 血红蛋白类, 尿蛋白

Abstract: [Abstract]   Objective   To investigate the changes of serum and urinary adiponectin (ADPN) levels and insulin resistance (IR) states in patients with chronic kidney disease (CKD) and to explore their relationship. Methods   487 patients with CKD stages 2-5 and 30 healthy subjects served as control group were enrolled in the study. ADPN levels in serum and urine samples were examined by ELISA and fasting insulin by radioimmunoassay. Blood routine test, liver and kidney functions, blood glucose, serum lipids, 24h urinary protein excretion and endogenous creatinine clearance rate were observed, and body mass index calculated. The differences of ADPN levels in serum and urine samples and homeostasis model assessment for insulin resistance (Homa-IR) were compared among the groups. Results   The serum and urine ADPN levels and Homa-IR in CKD patients were higher than those of the control group (P<0.05) and the worse of renal function, the higher of ADPN and Homa-IR levels (P<0.05). The CKD stages 3-5 patients with high Homa-IR had higher serum ADPN levels. The ADPN levels and Homa-IR were positively related to lipid parameters and 24h urinary protein, and negatively correlated with hemoglobin and serum albumin (P<0.05). Conclusion   CKD patients had higher ADPN level and more significant IR. The ADPN and IR were also correlated with serum lipids, hemoglobin, albumin and urinary protein. Dynamic monitor of ADPN level may have clinical significance in judging metabolic disorders in CKD patients.

Key words: kidney diseases, adiponectin, Insulin Resistence, lipids, Serum albumin, hemoglobins, urinary protein