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目的:研究在非胰岛素依赖型糖尿病(noninsulindependentdiabetesmellitus,NIDDM)患者胰岛素敏感性与微量白蛋白尿是否存在相关性,以及胰岛素抵抗在糖尿病肾病(diabeticnephropathy,DN)发生中的作用。方法:观察381例非肥胖、非高血压的NIDDM患者的胰岛素敏感性指数,所有病人按是否合并微量白蛋白尿(microalbuminuria,mUAE)分组,胰岛素敏感指数(insulinsensitivityindex,ISI)用空腹血糖与空腹胰岛素乘积倒数的自然对数计算,并以Homamodel公式进行对照。结果:糖尿病合并mUAE患者胰岛素敏感指数低于不合并mUAE患者[(-4.460±0.790)与(-4.208±0.729),P=0.0059)]。Logistic多元回归分析显示ISI与发生微量白蛋白尿显著负相关(OR0.6996,95%CI0.5292～0.9251,P=0.0197),且独立于年龄、性别、体重指数、血压、血脂和糖化血红蛋白,Homamodel公式计算结果与ISI的结果一致。结论:在NIDDM患者出现白蛋白尿时存在胰岛素敏感性减低,胰岛素抵抗有可能是DN发病的独立危险因素。
Objective: To investigate whether there is a correlation between insulin sensitivity and microalbuminuria in patients with noninsulindependent diabetes mellitus (NIDDM) and the role of insulin resistance in the pathogenesis of diabetic nephropathy (DN). Methods: The insulin sensitivity index of 381 non-obese and non-hypertensive patients with NIDDM was observed. All patients were divided into two groups according to microalbuminuria (mUAE) group, insulin sensitivity index (ISI) The natural logarithm of the inverse of the product was calculated and compared using the Homamodel formula. Results: The insulin sensitivity index in diabetic patients with mUAE was lower than those without mUAE [(-4.460 ± 0.790) vs (-4.208 ± 0.729, P = 0.0059)]. Logistic multiple regression analysis showed a significant negative correlation between ISI and microalbuminuria (OR 0.6996, 95% CI 0.5292-0.9251, P = 0.0197) and independent of age, sex, body mass index, blood pressure, blood lipids and HbA1c, Homamodel formula is consistent with the results of ISI. Conclusion: There is a decrease of insulin sensitivity in patients with NIDDM when albuminuria occurs. Insulin resistance may be an independent risk factor for DN.