摘要
目的:研究原发性IgA肾病(IgA nephropathy,IgAN)患者中糖代谢异常及胰岛素抵抗(insulin resistance,IR)的发生率及相关危险因素。方法:回顾性分析107例IgAN患者(IgAN组)和106例健康对照者(对照组)的口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)结果,并收集一般临床及实验室资料,计算胰岛素抵抗指数(HOMA-IR)和胰岛素敏感性指数(ISI),评估糖代谢异常及胰岛素抵抗发生率。结果:IgAN组糖代谢异常的发生率高于对照组;IgAN组血压、血清肌酐、尿酸、三酰甘油、胆固醇、低密度脂蛋白、血糖(空腹及OGTT2h)、血清胰岛素(空腹及OGTT2h)、HOMA-IR均高于对照组,血清白蛋白、高密度脂蛋白、ISI低于对照组,差异均有统计学意义(P<0.05)。年龄(OR=1.061)、24h尿蛋白定量(OR=1.387)、三酰甘油(OR=2.553)是IgAN患者发生糖代谢异常的独立危险因素。与糖代谢正常的IgAN患者相比,合并糖代谢异常的IgAN患者年龄、BMI、24h尿蛋白定量、三酰甘油、空腹血糖、OGTT2h血糖及血清胰岛素、HOMA-IR均较高(P<0.05),而高密度脂蛋白、ISI较低(P<0.05)。IgAN合并IR的患者BMI、24h尿蛋白定量、三酰甘油、空腹血糖、空腹血胰岛素、OGTT2h血糖及血清胰岛素水平均显著高于不伴IR的IgAN患者(P<0.05),血肌酐、高密度脂蛋白、ISI则较低(P<0.05);BMI(OR=0.059,P<0.05)、血清白蛋白(OR=0.033,P<0.01)、24h尿蛋白定量(OR=0.077,P<0.05)为IgAN患者发生胰岛素抵抗的独立危险因素。结论:IgAN患者糖代谢异常的发生率高于正常人,存在明显的高胰岛素血症及胰岛素抵抗;年龄、24h尿蛋白定量、三酰甘油是IgAN患者发生糖代谢异常的独立危险因素;BMI、血清白蛋白、24h尿蛋白定量为IgAN患者发生胰岛素抵抗的独立危险因素。
Objective：To investigate the prevalence and risk factors of insulin resistance and abnormal glucose metabolism in IgA nephropathy（IgAN） patients.Methods：We retrospectively analyzed oral glucose tolerance test（OGTT） results and clinical data of 107 IgAN patients（IgAN group） and 106 health controls（Control group）.HOMA-IR,ISI and glucose metabolism were evaluated.Results：Patients with abnormal glucose metabolism was higher in IgAN group than in control group.Compared with health controls,patients with IgAN had higher blood pressure,serum creatinine,uric acid,triglyceride,cholesterol,low density lipoprotein（LDL）,fasting blood glucose,fasting insulin,OGTT 2-hour blood glucose,OGTT 2-hour insulin and HOMA-IR,but had lower serum albumin,high density lipoprotein（HDL） and ISI.Age（OR = 1.061）,24 hour proteinuria（OR = 1.387） and triglyceride（OR =2.553） are independent risk factors of abnormal glucose metabolism in IgAN patients.Compared with IgAN patients with normal glucose metabolism,Age,BMI,24 hour proteinuria,triglyceride,fasting blood glucose,OGTT 2-hour blood glucose,OGTT 2 hour insulin,HOMA-IR were significantly higher,while HDL,ISI were significantly lower in IgAN patients with abnormal glucose metabolism.BMI,24 hours proteinuria,triglyceride,fasting blood glucose,fasting insulin,OGTT 2 h blood glucose and OGTT 2 hour insulin were significantly higher,while serum creatinine,HDL,ISI were significantly lower in IgAN patients with insulin resistance（IR） than in IgAN without IR.BMI（OR = 0.059,P 〈 0.05）,serum albumin（OR = 0.033,P 〈 0.01） and 24 hour proteinuria（OR =0.077,P 〈0.05） are independent risk factors of insulin resistance in IgAN patients.Conclusion：The prevalence of abnormal glucose metabolism in IgAN was higher than in healthy controls.Age,24 hour proteinuria and triglyceride are independent risk factors of abnormal glucose metabolism in IgAN patients.BMI,serum albumin and 24 hour proteinuria are independent risk factors of insulin resistance for IgAN patients.
出处
《中国中西医结合肾病杂志》
2012年第6期495-500,共6页
Chinese Journal of Integrated Traditional and Western Nephrology
关键词
IGA肾病
胰岛素抵抗
糖代谢异常
IgA nephropathy Insulin resistance Abnormal glucose metabolism
