School Of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Western Australia, Australia;
Am J Hypertens. 2013 Sep;26(9):1155-61. doi: 10.1093/ajh/hpt077. Epub 2013 Jun 4.
Insulin resistance (IR) and the metabolic syndrome (MetS) may contribute to cardiovascular risk in chronic kidney disease (CKD). We examine the association between IR and vascular function in CKD. Furthermore, we define the prevalence of MetS and examine the association between defining MetS and vascular function.
This cross-sectional study of 71 stage 3-4 CKD subjects assessed arterial stiffness (pulse wave velocity (PWV) and endothelial dysfunction (ED). IR was assessed using Homeostasis Model Assessment-IR (HOMA-IR). MetS was defined by the unified International Diabetes Federation and American Heart Association/National Heart Lung and Blood Institute criteria.
CKD subjects with HOMA-IR score above the median had significantly higher body mass index and waist circumference. They also had higher PWV, higher triglycerides with lower high-density lipoprotein concentration (P < 0.05). Age, systolic blood pressure, and HOMA-IR were independently associated with PWV, even after exclusion of diabetic subjects (n = 16) (P ≤ 0.05). MetS was more prevalent in CKD (78.9%) than controls (2.5%). MetS in CKD was associated with increased PWV (MetS(+) geometric mean = 9.5 m/s, 95% confidence interval (95% CI) = 8.9-10.2 m/s; vs. MetS(-) 8.1 m/s, 95% CI = 7.1-9.3 m/s; P = 0.03) but not ED. In a multiple logistic regression analysis, PWV higher than the median was independently associated with dysglycemia.
IR is independently associated with arterial stiffness, even in nondiabetic CKD. MetS is common and identified a subgroup of CKD patients with increased arterial stiffness, which is associated with dysglycemia.
胰岛素抵抗（IR）和代谢综合征（MetS）可能导致慢性肾脏病（CKD）患者的心血管风险增加。我们研究了 CKD 患者中 IR 与血管功能之间的关系。此外，我们定义了 MetS 的患病率，并研究了定义 MetS 与血管功能之间的关系。
本研究为横断面研究，纳入了 71 例 3-4 期 CKD 患者，评估了动脉僵硬度（脉搏波速度（PWV）和内皮功能障碍（ED）。使用稳态模型评估胰岛素抵抗（HOMA-IR）评估 IR。MetS 采用统一的国际糖尿病联合会和美国心脏协会/美国国立心肺血液研究所标准定义。
HOMA-IR 评分高于中位数的 CKD 患者的体质指数和腰围明显更高。他们的 PWV 更高，三酰甘油更高，高密度脂蛋白浓度更低（P < 0.05）。年龄、收缩压和 HOMA-IR 与 PWV 独立相关，即使排除了糖尿病患者（n = 16）（P ≤ 0.05）。CKD 患者的 MetS 患病率（78.9%）高于对照组（2.5%）。CKD 中的 MetS 与 PWV 增加相关（MetS(+)几何平均值 = 9.5 m/s，95%置信区间（95%CI）= 8.9-10.2 m/s；vs. MetS(-) 8.1 m/s，95%CI = 7.1-9.3 m/s；P = 0.03），但与 ED 无关。在多变量逻辑回归分析中，高于中位数的 PWV 与血糖异常独立相关。
即使在非糖尿病 CKD 患者中，IR 也与动脉僵硬度独立相关。MetS 很常见，并确定了一个亚组 CKD 患者的动脉僵硬度增加，这与血糖异常有关。
