Objective To observe the fasting glucose,serum insulin and lipid level in maintenance hemodialysis, calculate the insulin resistance index(HOMA-IR) and the insulin sensitivity index(ISI) to evaluate the relationship with insulin resistance(IR) ,to carry out correlation analysis with the corresponding index of 30 health examinations. Methods Forty-eight maintenance hemodialysis patients (observation group) and 30 healthy volunteers (control group) were included in this study. Fasting plasma glucose( FPG), glycosylated hemoglobin( HbAi c) , fasting insulin ( Fins), blood urea nitrogen(BUN), creatinine(Cr) , uric acid(UA) and lipid indexes were measured, and the relationship of them analyzed. Results BUN, Cr, UA, Fins, HbA] c, FPG and HOMA-IR were significantly higher in patients than in controls,but total cholesterol (TO , high density lipid protein cholesterol ( HDL-C) and low density lipid protein cholesteroKLDL—C) were significantly lower in controls, BUN(24. 9 + 5. 8) mmol/L vs (5.0±1.6) mmol/L( P < 0. 05) ; Cr(820±222) ^mol/L vs (73+ 17) nmol/L( P <0. 05); UA(397±96) ^mol/L vs (298 + 79) pmol/U P < 0.05); FIns(16 + ll) mU/L vs (11+ 5) mU/L( P <0. 05) ;FPG(6. 1 + 1.6) mmol/L vs (5. 1 + 0. 6) mmol/L (P < 0.05); HOMA-IR 4. 3 + 3. 2 vs 2.4+1.2 (P < 0. 05) ;TC(4. 2+1. 2) mmol/L vs (5. 3 + 1.1) mmol/L (P <0. 05); HDL-CO. 3 + 0. 5) mmol/L vs (1. 6 + 0. 4) mmol/L( P <0. 01) ;LDL-C(3. 0+1. 0) mmol/L vs (4. 1 + 1. 1) mmol/L ( P <0. 05). TC was negative correlated with FPG ( r = — 0. 3482, P <0. 05). HDL—C was negative correlated with FIns( r =— 0. 2603, P <0. 05). LDL —C was negative correlated with FPG ( r = — 0. 3289, P <0. 05), triglyceride was positively correlated with FPG and HOMA-IR ( r =0.371,0.368, P < 0. 05). Conclusion Lipid metabolic disorder existed in maintenance hemodialysis patients, HOMA-IR may participate in them.%目的 了解维持性血液透析患者的血糖、血脂和胰岛素抵抗情况.方法 选取我科维持性血液透析患者(观察组)48例,同时选取30例健康体检者(对照组),测定两组的空腹血糖(FPG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FIns)、尿素氮(BUN)、肌酐(Cr)、尿酸(UA)、血脂指标,计算稳态模型胰岛素抵抗指数(HOMA-IR)和胰岛素敏感指数(ISI).结果 与对照组比较,观察组BUN、Cr、UA、FIns、FPG和HOMA-IR水平升高,总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)降低,BUN (24.9±5.8)mmol/Lvs (5.0±1.6)mmol/L(P＜0.05); Cr(820±222)μmol/L vs (73±17)μmol/L(P＜0.05); UA(397±96)μmol/L vs (298±79)μmol/L(P ＜0.05); FIns(16+11)mU/L vs (11±5)mU/L(P＜0.05);FPG(6.1±1.6)mmol/L vs (5.1±0.6)mmol/L(P ＜0.05);HOMA-IR 4.3±3.2 vs 2.4±1.2 (P＜0.05);TC(4.2±1.2)mmol/L vs(5.3±1.1)mmol/L(P＜0.05); HDL-C( 1.3±0.5)mmol/L vs (1.6±0.4)mmol/L(P＜0.01);LDI-C(3.0±1.0)mmol/L vs (4.1±1.1)mmol/L(P＜0.05).在观察组,TC与FPG呈负相关(r=-0.3482,P＜0.05)；HDL-C与Fins呈负相关(r=-0.2603,P＜0.05)；LDI-C与FPG呈负相关(r=-0.3289,P＜0.05),而对照组仅TG与FPG、HOMA-IR呈正相关(r =0.371,0.368,P＜0.05).结论 维持性血液透析患者中存在脂代谢紊乱,可能参与胰岛素抵抗.
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