非糖尿病维持性血液透析患者促红素反应性与胰岛素抵抗的相关性研究.docVIP

·3932 · GIP Chinese General Practice ecember 2011.Nol.14 N0. 12A · 论 著 · 非糖尿病维持性血液透析患者促红素反应性与胰岛素抵抗的 相关性研究 朱昭章，梁青桃，方如美 【摘要】 目的 探讨非糖尿病维持性血液透析 (MHD) 患者促红素敏感性与胰岛素抵抗的相关性及胰岛素抵抗 的可能危险因素。 方法 检测66例 MHD 患者及12例健康对照者的临床及生化指标，以重组人促红细胞生成素用量/ 血红蛋白比值 (rHuEPO/Hb) 作为促红素反应性指标，计算胰岛素抵抗指数 (HOMA-IR)。 结果 促红素抵抗组的 全段甲状旁腺激素 (iPTH)、 脂蛋白-a(Lp-a)、 超敏 C- 反应蛋白 (hs-CRP)、HOMA-IR 均较促红素敏感组增 高，差异有统计学意义 (P0.05); 促红素抵抗组的血清清蛋白 (Alb) 较促红素敏感组下降更为明显，差异有统计 学意义 (P0.05)。rHuEPO/Hb 与 HOMA-IR 呈正相关 (r=0.361,P0.05); 非条件Logistic 逐步回归分析显示， HOMA-IR 的影响因素为Ip-a 和 hs-CRP(OR 值分别为2.244、2.510, P0.05)。 结论 促红素敏感性与胰岛素 抵抗密切相关， Lp-a 和hs-CRP 是胰岛素抵抗的危险因素。 【关键词】 血液透析；肾性贫血；促红细胞生成素；胰岛素抵抗 【中图分类号】 R459.52 【文献标识码】 A 【文章编号】 1007-9572(2011)-3932-04 Relationship between Insulin Resistance and Erythropoietin Responsiveness in Non-diabetic Patients Maintained on He- modialysis ZHU Zhao-zhang,LANC Qing-tao, FANG Ru-mei. Department of Nephrology, the No. 303 Hospital of the Chinese Peoples Liberation Army,Nanning 530021,China 【Abstract】 Objective To investigate the correlation belween erythropoietin(EPO)resistance and insulin resistance (IR)in non - diabetic patients maintained on hemodialysis(MHD)and to analyze the possible risk factors related to IR.Methods The clinical and laboratory data were measured in 66 MHD patients and 12 normal controls. The EPO resistance was defined according to the recombinant human erythropoietin(rHuEPO)dosage to Hb (rHuEPO/Hb) ratio, and insulin resist- ance was evaluated by using homeostasis model assessment insulin resistance index(HOMA-IR). Results The EPO resistance group had significantly higher serum parathyroid hormone, lipoprotein a, high - sensitivity C - reactive protein(hs-CRP), and HOMA-IR(P0.05),but lower serum albumin(P0.05)than the EPO sensitive group. There was a significant posi- tive correlation between rHuEPO/Hb and HOMA-IR(r=0.361,P0.05). Multiple stepwise regression analysis showed that the levels of