Department of Nephrology, Huashan Hospital of Fudan University, Shanghai, PR China.
Perit Dial Int. 2013 Jul-Aug;33(4):411-8. doi: 10.3747/pdi.2012.00037. Epub 2013 Mar 1.
Insulin resistance is associated with multiple risk factors for cardiovascular (CV) disease in the general population. Patients on peritoneal dialysis (PD) are more likely to develop insulin resistance. However, no evaluation of the impact of insulin resistance on CV disease morbidity or mortality in patients on PD has been performed.
Our prospective cohort study included all non-diabetic patients on PD at our center (n = 66). Insulin resistance was evaluated at baseline by the homeostasis model assessment method (HOMA-IR) using fasting glucose and insulin levels. The cohort was followed for up to 58 months (median: 41.3 months; interquartile range: 34.3 months). A multivariate Cox model was used to analyze the impact of insulin resistance on CV disease mortality.
Fourteen CV events occurred in the higher HOMA-IR group [IR-H (HOMA-IR values in the range 2.85 - 19.5), n = 33], but only one event occurred in the lower HOMA-IR group (IR-L (HOMA-IR values in the range 0.83 - 2.71), n = 33) during the follow-up period. Level of HOMA-IR was a significant predictor of CV events [risk ratio: 17.7; 95% confidence interval (CI): 2.10 to 149.5; p = 0.008]. In the IR-H group, 10 patients died (8 CV events), but in the IR-L group, only 4 patients died (1 CV event). Patients in the IR-H group experienced significantly higher CV mortality (hazard ratio: 9.02; 95% CI: 1.13 to 72.2; p = 0.04). Even after adjustments for age, systolic blood pressure, body mass index, C-reactive protein, triglycerides, resistin, and leptin, HOMA-IR remained an independent predictor of CV mortality (hazard ratio: 14.8; 95% CI: 1.22 to 179.1; p = 0.03).
Insulin resistance assessed using HOMA-IR was an independent predictor of CV morbidity and mortality in a cohort of nondiabetic patients on PD. Insulin resistance is a modifiable risk factor; the reduction of insulin resistance may reduce CV risk and improve survival in this group of patients.
胰岛素抵抗与普通人群心血管疾病的多种危险因素有关。腹膜透析（PD）患者更易发生胰岛素抵抗。然而，目前尚未对 PD 患者胰岛素抵抗对心血管疾病发病率或死亡率的影响进行评估。
我们的前瞻性队列研究纳入了我院所有非糖尿病 PD 患者（n=66）。基线时通过空腹血糖和胰岛素水平采用稳态模型评估法（HOMA-IR）评估胰岛素抵抗。该队列的随访时间最长为 58 个月（中位数：41.3 个月；四分位距：34.3 个月）。采用多变量 Cox 模型分析胰岛素抵抗对心血管疾病死亡率的影响。
在较高的 HOMA-IR 组（IR-H [HOMA-IR 值在 2.85-19.5 之间]，n=33）中发生了 14 例心血管事件，而在较低的 HOMA-IR 组（IR-L [HOMA-IR 值在 0.83-2.71 之间]，n=33）中仅发生了 1 例心血管事件。HOMA-IR 水平是心血管事件的显著预测因子[风险比：17.7；95%置信区间（CI）：2.10 至 149.5；p=0.008]。在 IR-H 组中，有 10 例患者死亡（8 例心血管事件），而在 IR-L 组中，仅有 4 例患者死亡（1 例心血管事件）。IR-H 组的心血管死亡率显著更高（风险比：9.02；95%CI：1.13 至 72.2；p=0.04）。即使在调整年龄、收缩压、体重指数、C 反应蛋白、甘油三酯、抵抗素和瘦素后，HOMA-IR 仍然是心血管死亡率的独立预测因子（风险比：14.8；95%CI：1.22 至 179.1；p=0.03）。
使用 HOMA-IR 评估的胰岛素抵抗是 PD 患者非糖尿病队列中心血管发病率和死亡率的独立预测因子。胰岛素抵抗是一个可改变的危险因素；降低胰岛素抵抗可能会降低该患者群体的心血管风险并改善其生存。
