老年2型糖尿病病人估计肾小球滤过率与胰岛素抵抗及胰岛B细胞功能的相关性研究

doi:10.3969/j.issn.1003-9198.2023.12.008

摘要/Abstract

摘要： 目的探讨老年T2DM病人估计肾小球滤过率(eGFR)与胰岛素抵抗及胰岛B细胞功能的相关性。方法将944例老年T2DM病人按eGFR水平分为eGFR正常组315例[eGFR≥90 mL/(min·1.73 m²)]、eGFR轻度下降组357例[eGFR为60～＜90 mL/(min·1.73 m²)]及eGFR中重度下降组272例[eGFR<60 mL/(min·1.73 m²)]。所有病人均行口服葡萄糖耐量试验(OGTT)及胰岛素释放试验,根据服糖后0、30、60、120 min葡萄糖及胰岛素水平,计算胰岛素抵抗指标[胰岛素抵抗指数(HOMA-IR)、GluAUC30×InsAUC30]、胰岛分泌功能指标[胰岛B细胞功能指数(HOMA-β)、ΔI30/ΔG30、InsAUC30、IG30、InsAUC120、IG120]。分析eGFR与胰岛素抵抗和胰岛分泌功能指标的相关性。结果随着eGFR水平逐渐降低,HOMA-IR、GluAUC30×InsAUC30、HOMA-β、ΔI30/ΔG30、InsAUC30、IG30、InsAUC120和IG120的水平逐渐升高(均P＜0.05)。校正混杂因素后,线性回归分析显示,eGFR与HOMA-IR、GluAUC30×InsAUC30、HOMA-β、ΔI30/ΔG30、InsAUC30、IG30、InsAUC120及IG120仍均呈负相关(均P＜0.01)。结论老年T2DM病人胰岛素抵抗及胰岛细胞代偿性分泌对eGFR水平有显著影响。

关键词: 2型糖尿病, 估计肾小球滤过率, 胰岛素抵抗, 胰岛B细胞功能

Abstract: Objective To explore the association of estimated glomerular filtration rate (eGFR)with insulin resistance and β-cell function in the elderly patients with type 2 diabetes mellitus(T2DM). Methods A total of 944 elderly patients with T2DM were divided into three groups according to the level of eGFR:normal renal function group[eGFR≥90 mL/(min·1.73 m²), n=315], mild renal dysfunction group [eGFR: 60-<90 mL/(min·1.73 m²), n=357] and moderate and severe renal dysfunction group[eGFR<60 mL/(min·1.73 m²), n=272]. All the patients underwent oral glucose tolerance test (OGTT) and insulin releasing test. According to the levels of blood glucose and insulin 0, 30, 60 and 120 min after taking glucose, the insulin resistance indexes [homeostasis model assessment of insulin resistance (HOMA-IR),GluAUC30×InsAUC30] and islet secretion function indexes (HOMA-β, ΔI30/ΔG30, InsAUC30, IG30, InsAUC120, IG120) were counted. The correlations of eGFR with insulin resistance and β-cell function indexes were analyzed. Results With the decrease of the level of eGFR, HOMA-IR, GluAUC30×InsAUC30, HOMA-β, ΔI30/ΔG30, InsAUC30, IG30, InsAUC120 and IG120 increased gradually (all P<0.05). After adjustment for confounders, eGFR was still negatively correlated with HOMA-IR, GluAUC30×InsAUC30, HOMA-β, ΔI30/ΔG30, InsAUC30, IG30, InsAUC120 and IG120(all P<0.01). Conclusions eGFR is negatively influenced by insulin resistance and compensatory secretion of islet cells in the elderly patients with T2DM.

Key words: type 2 diabetes mellitus, estimated glomerular filtration rate, insulin resistance, β-cell function

中图分类号:

R 587.1

代玲俐, 俞匀. 老年2型糖尿病病人估计肾小球滤过率与胰岛素抵抗及胰岛B细胞功能的相关性研究[J]. 实用老年医学, 2023, 37(12): 1219-1223.

DAI Ling-li, YU Yun. Association of estimated glomerular filtration rate with insulin resistance and β-cell function in elderly patients with type 2 diabetes mellitus[J]. Practical Geriatrics, 2023, 37(12): 1219-1223.

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