Relationship between abdominal fat accumulation and insulin resistance in hemodialysis patients
Relationship between abdominal fat accumulation and insulin resistance in hemodialysis patients
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DOI：
10.1291/hypres.31.83
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发表时间：
2008-01-01
影响因子：
5.4
通讯作者：
Tomino, Yasuhiko
中科院分区：
文献类型：
--
作者：
Gohda, Tomohito;Gotoh, Hiromichi;Tomino, Yasuhiko
众所周知，肥胖和胰岛素抵抗与2型糖尿病的发生密切相关。然而，肾脏疾病中胰岛素抵抗的确切发病机制尚未阐明。本研究旨在阐明血液透析（HD）患者腹部（内脏和皮下）脂肪蓄积对胰岛素抵抗和各种临床参数（包括C反应蛋白（CRIP））的影响。通过CT在脐水平评价内脏和皮下脂肪面积（VFA和SFA）。采用稳态模型胰岛素抵抗指数（HOMA-IR）评价80例HD患者的胰岛素抵抗。胰岛素抵抗和CRP与体重指数、VFA和SFA等脂肪相关指标密切相关。单因素回归分析显示，HOMA-IR与BMI、VFA、SFA、TG、RLP-胆固醇、CRP呈正相关。多元逐步回归分析显示，SFA和RLP-胆固醇是影响HD患者HOMA-IR的主要因素。CRP与BMI、VFA、SFA、TG、高密度脂蛋白胆固醇、动脉粥样硬化指数（AI）、免疫反应性胰岛素（IRI）、HOMA-IR呈显著正相关。多元逐步回归分析显示，VFA和HDL-胆固醇是影响HD患者CRP的主要因素。总之，HD患者的胰岛素抵抗和CRP与BMI、VFA和SFA等脂肪相关参数相关。另外，SFA对胰岛素抵抗的贡献远高于VFA，而CRP则相反。
It is well known that obesity and insulin resistance are closely related to the development of type 2 diabetes. However, the exact pathogenic mechanism underlying the insulin resistance in renal disease has not been clarified. The purpose of the present study was to clarify the contribution of abdominal (visceral and subcutaneous) fat accumulation to insulin resistance and various clinical parameters, including C-reactive protein (CRIP), in hemodialysis (HD) patients. Visceral and subcutaneous fat areas (VFA and SFA) were evaluated at the umbilical level by CT. Insulin resistance was estimated by the homeostasis model assessment-insulin resistance index (HOMA-IR) in 80 HD patients. Insulin resistance and CRP seemed to be closely correlated with fat-related parameters such as body mass index (BMI), VFA and SFA. HOMA-IR was positively correlated with BMI, VFA, SFA, triglycerides (TG), remnant-like particle (RLP)-cholesterol and CRP in simple regression analysis. In multiple stepwise regression analysis, SFA and RLP-cholesterol were predominant determinants of HOMA-IR in HD patients. Furthermore, CRP was positively correlated with BMI, VFA, SFA, TG, high-density lipoprotein (HDL)-cholesterol, atherosclerosis index (AI), immunoreactive insulin (IRI) and HOMA-IR in simple regression analysis. In multiple stepwise regression analysis, VFA and HDL-cholesterol were predominant determinants of CRP in HD patients. In conclusion, insulin resistance and CRP were related to fat-related parameters such as BMI, VFA and SFA in HD patients. Furthermore, the contribution of SFA to insulin resistance was much higher than that of VFA, while the opposite relation was recognized for CRP.