Torun Dilek, Oguzkurt Levent, Sezer Siren, Zumrutdal Aysegul, Singan Metin, Adam Fatma Ulku, Ozdemir Fatma Nurhan, Haberal Mehmet
Baskent University Faculty of Medicine, Department of Nephrology, Adana Teaching and Medical Research Center, Adana, Turkey.
Perit Dial Int. 2005 Nov-Dec;25(6):596-600.
The aim of this study was to evaluate hepatic subcapsular steatosis (HSS) and its association with clinical parameters in nondiabetic continuous ambulatory peritoneal dialysis (CAPD) patients and in diabetic CAPD patients receiving intraperitoneal (IP) or subcutaneous (SC) insulin.
Cross-sectional study.
A tertiary-care university hospital.
28 CAPD patients (17 males and 11 females; mean age 53.5 +/- 14 years; mean CAPD duration 22.8 +/- 9 months) were included in the study. 14 patients had type II diabetes mellitus and 14 were nondiabetics. In the diabetic group, 8 patients were receiving IP insulin and 6 were receiving SC insulin.
HSS was diagnosed on computed tomography without contrast administration. Other data collected were body mass index (BMI), weekly Kt/V, peritoneal equilibration test (PET) results, daily insulin dosage, duration of diabetes mellitus, duration of insulin treatment, dialysate glucose load, and serum findings for alanine aminotransferase, aspartate aminotransferase, albumin, and lipid profiles.
HSS was detected in 5 of the 8 diabetics who were receiving IP insulin. None of the diabetics receiving SC insulin and none of the nondiabetic patients exhibited HSS. Daily insulin dosage [108 (95 - 108.5) vs 54 (36 - 72) U/day, p = 0.02], BMI [31 (30.5 - 36) vs 26.6 (26 - 30) kg/m2, p = 0.02], serum triglyceride level [194 (184 - 505) vs 69 (61 - 82) mg/dL, p = 0.04], and PET creatinine levels [D/P2 creat: 0.67 (0.54 - 0.74) vs 0.50 (0.50 - 0.56), p = 0.05; D/P4 creat: 0.75 (0.64 - 0.86) vs 0.60 (0.59 - 0.62), p = 0.02] were higher in diabetic patients receiving IP insulin who had HSS than in those who did not have HSS. PET glucose levels [D0/D2 glu: 0.40 (0.37 - 0.45) vs 0.50 (0.48 - 0.51), p = 0.03; D0/D4 glu: 0.36 (0.26 - 0.38) vs 0.44 (0.38 - 0.48), p = 0.04] were lower in diabetic patients receiving IP insulin who had HSS than in those who did not have HSS.
Our results suggest that IP insulin plays a more important role in the pathogenesis of HSS than glucose levels in diabetic CAPD patients. They also indicate that HSS is associated with higher daily insulin requirement, obesity, hypertriglyceridemia, and high peritoneal transport rate in diabetic CAPD patients receiving IP insulin.
本研究旨在评估非糖尿病持续性非卧床腹膜透析（CAPD）患者以及接受腹腔内（IP）或皮下（SC）胰岛素治疗的糖尿病CAPD患者的肝包膜下脂肪变性（HSS）情况及其与临床参数的关联。
横断面研究。
一所三级护理大学医院。
28例CAPD患者（17例男性和11例女性；平均年龄53.5±14岁；平均CAPD疗程22.8±9个月）纳入研究。14例患者患有II型糖尿病，14例为非糖尿病患者。在糖尿病组中，8例患者接受IP胰岛素治疗，6例患者接受SC胰岛素治疗。
通过非增强计算机断层扫描诊断HSS。收集的其他数据包括体重指数（BMI）、每周Kt/V、腹膜平衡试验（PET）结果、每日胰岛素剂量、糖尿病病程、胰岛素治疗时间、透析液葡萄糖负荷以及丙氨酸氨基转移酶、天冬氨酸氨基转移酶、白蛋白和血脂谱的血清检测结果。
在接受IP胰岛素治疗的8例糖尿病患者中，有5例检测到HSS。接受SC胰岛素治疗的糖尿病患者和非糖尿病患者均未出现HSS。接受IP胰岛素治疗且有HSS的糖尿病患者的每日胰岛素剂量[108（95 - 108.5）U/天对54（36 - 72）U/天，p = 0.02]、BMI[31（30.5 - 36）对26.6（26 - 30）kg/m²，p = 0.02]、血清甘油三酯水平[194（184 - 505）对69（61 - 82）mg/dL，p = 0.04]以及PET肌酐水平[D/P2肌酐：0.67（0.54 - 0.74）对0.50（0.50 - 0.56），p = 0.05；D/P4肌酐：0.75（0.64 - 0.86）对0.60（0.59 - 0.62），p = 0.02]均高于未出现HSS的患者。接受IP胰岛素治疗且有HSS的糖尿病患者的PET葡萄糖水平[D0/D2葡萄糖：0.40（0.37 - 0.45）对0.50（0.48 - 0.51），p = 率0.03；D0/D4葡萄糖：0.36（0.26 - 0.38）对0.44（0.38 - 0.48），p = 0.04]低于未出现HSS的患者。
我们的结果表明，在糖尿病CAPD患者中，IP胰岛素在HSS发病机制中比血糖水平发挥更重要的作用。这些结果还表明，HSS与接受IP胰岛素治疗的糖尿病CAPD患者更高的每日胰岛素需求量、肥胖、高甘油三酯血症和高腹膜转运率相关。
