血液透析患者瘦素、脂联素水平与胰岛素抵抗的关系.docVIP

血液透析患者瘦素、脂联素水平与胰岛素抵抗的关系 徐文蔚 毛佩菊 刘欣颖 （上海市长宁区中心医院 肾内科 上海 200336） 摘要　目的: 探讨维持性血液透析患者瘦素、脂联素与胰岛素抵抗的关系。方法: 选择终末期肾病维持血液透(MHD) 40 例(MHD组) 及健康对照组(C 组) 40 例, 应用放免分析法测定血清瘦素, 同时检测空腹胰岛素(F IN S)、空腹血糖(FBS)、体重指数(BM I)及肾功能等指标, 计算胰岛素敏感指数( IS I) 和稳态模型胰岛素抵抗指数(Homa2IR ) 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F IN S、FBS、Homa2IR 明显高于对照组( P 均 0101) , IS I 明显低于对照组( P 0101)。校正BM I 差异后,MHD 组的血清瘦素水平高于对照组, 但差异无统计学意义( P 0105)。瘦素与BM I、F IN S、Homa2IR 呈明显正相关( P均 0101) , 瘦素与IS I 呈明显负相关( P 0101) , 但控制BM I、F IN S 的影响后, 瘦素与Homa2IR 及IS I 均无明显相关关系( P 0105)。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。 关键词　血液透析；瘦素;脂联素； 胰岛素抵抗 CORRELATION OF SERUM LEPTIN CONCENTRATION W ITH INSUL IN RESISTANCE IN HEMOD IALYSIS PATIENTS Abstract　Objective: To exp lore correlation of serum lep tin concentration w ith insulin resistance in hemodialysispatients. Methods: Serum lep tin w as measured by radioimmunoassay in hemodialysis patients ( n = 27) andhealthy controls( n = 30). Fasting insulin (F IN S) , Fasting blood sugar (FBS) ,Body mass index (BM I) and re2nal function indices w ere also determ ined. Insulin resistance w as evaluated, using insulin sensitivity index ( IS I)and Homa2IR. The relation betw een lep tin and these parametersw as analysed. Resul t: L ep tin levelw as h igher in theMHD group w hen BM Iw as corrected by covariance analysis, but not statistically significant. F IN S , FBSand Homa2IR inMHD group w ere significantly h igher than control group ( P 0. 01 respectively) , and IS Iw as low er ( P 0. 01). Serum lep tin concentration inMHD w as positively correlated to BM I , F IN S , Homa2IR ( P 0. 01) and inversely to IS I( P 0. 01). Partial correlation analysis show ed that lep tin concentration w as not significantly correlated to Homa2IR or IS I after controlling for BM I or F IN S ( P 0. 05). Conclusion: Relationbetw een L ep tin and insulin resistance may be mediated by body fat and insulin. Key words　hemodialysis; leptin; insulin resistance 胰岛素抵抗（insulin resistance，IR）不仅代谢综合征的中心环节，还是原发性高血压、缺血