Veterans Administration Tennessee Valley Healthcare System, Nashville, Tennessee, USA.
Clin J Am Soc Nephrol. 2011 Apr;6(4):767-74. doi: 10.2215/CJN.08070910. Epub 2011 Mar 24.
Insulin resistance (IR) is highly prevalent in chronic hemodialysis (CHD) patients and is associated with poor cardiovascular outcomes. Hyperinsulinemic euglycemic glucose clamp (HEGC) is the gold standard for measuring IR. The comparison of commonly-used indirect indices of IR to HEGC has not been adequately performed in this population. Furthermore, the validity of newly proposed adipokine-based IR indices has not been explored.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This is an observational study performed in a single center, involving 12 prevalent CHD patients (50 ± 9 years old, 100% African American, 33% women, body mass index of 34.4 ± 7.6 kg/m(2)) who were studied three consecutive times. IR was assessed by HEGC (glucose-disposal rate [GDR]), homeostatic model assessment of IR (HOMA-IR), HOMA-IR corrected by adiponectin (HOMA-AD), leptin adiponectin ratio (LAR), QUICKI, and the McAuley's index at each time point.
Eighty-three percent of the subjects displayed either glucose intolerance or overt insulin resistance by HEGC (GDR median, 5.71; interquartile range [IQR], 4.16, 6.81). LAR and HOMA-AD were the best correlates of IR measured by HEGC (r=-0.72, P<0.001, and -0.67, P<0.001), respectively. Fat percentage, interleukin-6, and adipokines (leptin, adiponectin, and resistin) were strongly associated with GDR. HEGC, LAR, and HOMA-AD had the best intraclass correlation coefficients.
IR is common in CHD patients. Adipokine-based indices are the best correlates of IR measurements by HEGC. HOMA-IR and QUICKI are reasonable alternatives. Use of these indices may allow better detection of alterations in insulin sensitivity in CHD patients.
胰岛素抵抗（IR）在慢性血液透析（CHD）患者中非常普遍，与不良心血管结局相关。高胰岛素正葡萄糖钳夹（HEGC）是衡量 IR 的金标准。在该人群中，尚未充分比较常用的 IR 间接指标与 HEGC。此外，新提出的基于脂联素的 IR 指数的有效性尚未得到探索。
设计、地点、参与者和测量方法：这是一项在单一中心进行的观察性研究，涉及 12 名现患 CHD 患者（50±9 岁，100%非裔美国人，33%女性，体重指数为 34.4±7.6kg/m²），他们连续 3 次接受研究。IR 通过 HEGC（葡萄糖处置率[GDR]）、稳态模型评估的胰岛素抵抗（HOMA-IR）、通过脂联素校正的 HOMA-IR（HOMA-AD）、瘦素脂联素比（LAR）、QUICKI 和 McAuley 指数在每个时间点进行评估。
83%的受试者通过 HEGC（GDR 中位数，5.71；四分位距[IQR]，4.16，6.81）显示葡萄糖耐量受损或明显胰岛素抵抗。LAR 和 HOMA-AD 是与 HEGC 测量的 IR 相关性最好的指标（r=-0.72，P<0.001 和-0.67，P<0.001）。脂肪百分比、白细胞介素-6 和脂联素（瘦素、脂联素和抵抗素）与 GDR 强烈相关。HEGC、LAR 和 HOMA-AD 的组内相关系数最好。
IR 在 CHD 患者中很常见。基于脂联素的指数是与 HEGC 测量的 IR 相关性最好的指标。HOMA-IR 和 QUICKI 是合理的替代指标。这些指数的使用可能有助于更好地检测 CHD 患者胰岛素敏感性的变化。
