Renal insulin resistance syndrome, adiponectin and cardiovascular events in patients with kidney disease: The mild and moderate kidney disease study
Renal insulin resistance syndrome, adiponectin and cardiovascular events in patients with kidney disease: The mild and moderate kidney disease study
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DOI：
10.1681/asn.2004090742
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发表时间：
2005-04-01
影响因子：
13.6
通讯作者：
Fliser, D
中科院分区：
文献类型：
--
作者：
Becker, B;Kronenberg, F;Fliser, D
研究了轻中度肾脏疾病患者胰岛素抵抗、脂联素和心血管(CV)发病率之间的关系。对227例不同程度肾功能不全的非糖尿病肾病患者和76例年龄、性别分布和体重指数相近的健康受试者进行了胰岛素敏感性(胰岛素抵抗稳态模型评估[HOMA-IR])和脂联素水平的测定。在肾病患者中，评估了与流行的心血管事件的相关性，并在前瞻性研究中评估了事件的心血管事件。患者组HOMA-IR显著高于健康人(3.59+/-3.55比1.39+/-0.51；P<；0.01)。在肾病患者中，HOMA-IR与体重指数(r=0.477；P<0.01)、甘油三酯(r=0.384；P<0.01)、脂联素水平(r=-0.253；P<0.01)、年龄(r=0.164；P<0.05)显著相关，但与肾功能无关。既往有心血管事件的患者明显年龄较大，HOMA-IR和血清甘油三酯水平较高，而脂联素血浆水平较低(均P<；0.05)。Logistic回归分析显示，年龄(P<；0.001)和脂联素(P<；0.002)是与流行的心血管事件相关的独立变量。在前瞻性研究中，中位随访时间为54个月。发生心血管事件的患者血糖显著升高，脂联素水平显著降低(均P<；0.05)。在慢性肾脏疾病患者中，胰岛素抵抗综合征甚至在肾功能不全的最早阶段就存在，这种综合征的几个组成部分与心血管事件有关。此外，低脂联素血症是轻中度肾功能衰竭患者的一种新的心血管危险因素。
The relationship among insulin resistance, adiponectin, and cardiovascular (CV) morbidity in patients with mild and moderate kidney disease was investigated. Insulin sensitivity (Homeostasis Model Assessment of Insulin Resistance [HOMA-IR]) and adiponectin plasma levels were assessed in 227 nondiabetic renal patients at different degrees of renal dysfunction and in 76 healthy subjects of similar age and gender distribution and body mass index. In renal patients, association with prevalent CV events was evaluated, and incident CV events were evaluated in a prospective study. HOMA-IR was markedly higher in patients than in healthy subjects (3.59 +/- 3.55 versus 1.39 +/- 0.51; P < 0.01). In renal patients, HOMA-IR was significantly correlated with body mass index (r = 0.477; P < 0.01), triglycerides (r = 0.384; P < 0.01), adiponectin plasma levels (r = -0.253; P < 0.01), and age (r = 0.164; P < 0.05), but not with renal function (GFR by iod-thalamate clearance). Patients with previous CV events were significantly older, had higher HOMA-IR and serum triglycerides, and had lower adiponectin plasma levels (all P < 0.05). Logistic regression analysis revealed age (P < 0.001) and adiponectin (P < 0.002) as independent variables related to prevalent CV events. In the prospective study, median follow-up was 54 mo. Patients who experienced CV events had significantly higher serum glucose and lower adiponectin plasma levels (both P < 0.05). In patients with chronic kidney diseases, a syndrome of insulin resistance is present even in the earliest stage of renal dysfunction, and several components of this syndrome are associated with CV events. Moreover, hypoadiponectinemia is a novel putative CV risk factor in patients with mild and moderate renal failure.