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胰岛素抵抗与慢性肾脏病的相关性研究
作者:张文  解为慈  杨军娥 
单位:天门市第一人民医院/湖北科技学院附属医院 内分泌科, 湖北 天门 431700
关键词:胰岛素抵抗 稳态模型胰岛素抵抗指数 甘油三酯血糖指数 慢性肾脏病 受试者工作特征曲线 
分类号:R587;R692
出版年·卷·期(页码):2021·49·第一期(39-45)
摘要:

目的: 研究稳态模型胰岛素抵抗指数(HOMA-IR)、甘油三酯血糖指数(TyG指数)与慢性肾脏病(CKD)的关系。方法: 以参加2009年中国健康与营养调查的人群为研究样本,利用Logistic回归分析分析HOMA-IR、TyG指数预测CKD的患病风险,采用受试者工作特征(ROC)曲线分析评估HOMA-IR、TyG指数诊断CKD的效能。结果: CKD组胰岛素抵抗指标(HOMA-IR及TyG指数)、体脂指数指标(内脏脂肪指数及脂质蓄积指数)、炎症指数指标(超敏C反应蛋白)显著高于非CKD组(P<0.01)。随着HOMA-IR、TyG指数水平增高,CKD患病率也升高。校正年龄、性别、吸烟、饮酒、血压、胆固醇、糖尿病因素后,HOMA-IR、TyG指数第4四分位数组CKD的患病风险相对于第1四分位数组分别增加1.849、1.844倍(P<0.05)。HOMA-IR诊断胰岛素抵抗的曲线下面积AUC(95%CI)为0.592 (0.581~0.603),切点值为2.831,敏感度为54.14%,特异度为62.17%。TyG指数诊断CKD的AUC(95%CI)为0.607 (0.597~0.618),切点值为3.62,敏感度80.25%,特异度为38.06%。结论: 胰岛素抵抗与CKD有关,HOMA-IR、TyG指数是CKD的独立影响因素,可以预测CKD患病风险。

Objective: To investigate the relationship between homeostasis model assessment of insulin resistance (HOMA-IR), triglyceride-glucose (TyG) index and chronic kidney disease (CKD).Methods: Participants in the 2009 Chinese Health and Nutrition Surveywere selected as study samples. Logistic regression analysis was used to analyze the risk of HOMA-IR and TyG index in predicting CKD, and receiver operating characteristic(ROC) curve analysis was used to evaluate the efficacy of HOMA-IR and TyG index in diagnosing CKD. Results: HOMA-IR, TyG index, body fat index (visceral fat index, lipid accumulation index) and inflammatory index (high sensitivity C-reactive protein) in CKD group were significantly higher than those in non-CKD group(P<0.01).The prevalence of CKD increased with the level of HOMA-IR, TyG index. After adjusting for age, sex, smoking, alcohol consumption, blood pressure, cholesterol, and diabetes, the risk of CKD increased 1.849,1.844-fold in the 4th quartile of HOMA-IR and TyG index compared with the first quartile, respectively(P<0.05). The area under the ROC curve AUC[95% confidence interval (CI)] of HOMA-IR for diagnosing CKD was 0.592 (0.581-0.603), the cut off value was 2.831, the sensitivity was 54.14%, and the specificity was 62.17%. The area under the ROC curve AUC (95% CI) of TyG index for diagnosing CKD was 0.607 (0.597-0.618), the cut off value was 3.62, the sensitivity was 80.25%, and the specificity was 38.06%.Conclusion: Insulin resistance is associated with CKD. HOMA-IR and TyG index are independent influencing factors of CKD, which can predict the risk of CKD.

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