Ahmad Iram, Zelnick Leila R, Robinson Nicole R, Hung Adriana M, Kestenbaum Bryan, Utzschneider Kristina M, Kahn Steven E, de Boer Ian H
Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington, Seattle, Washington;
Division of Nephrology, Department of Medicine, Kidney Research Institute, University of Washington, Seattle, Washington.
Am J Physiol Endocrinol Metab. 2017 Mar 1;312(3):E175-E182. doi: 10.1152/ajpendo.00394.2016. Epub 2017 Jan 10.
Insulin sensitivity can be measured by procedures such as the hyperinsulinemic euglycemic clamp or by using surrogate indices. Chronic kidney disease (CKD) and obesity may differentially affect these measurements because of changes in insulin kinetics and organ-specific effects on insulin sensitivity. In a cross-sectional study of 59 subjects with nondiabetic CKD [estimated glomerular filtration rate: (GFR) <60 ml·min·1.73 m] and 39 matched healthy controls, we quantified insulin sensitivity by clamp (SI), oral glucose tolerance test, and fasting glucose and insulin. We compared surrogate insulin sensitivity indices to SI using descriptive statistics, graphical analyses, correlation coefficients, and linear regression. Mean age was 62.6 yr; 48% of the participants were female, and 77% were Caucasian. Insulin sensitivity indices were 8-38% lower in participants with vs. without CKD and 13-59% lower in obese compared with nonobese participants. Correlations of surrogate indices with SI did not differ significantly by CKD or obesity status. Adjusting for SI in addition to demographic factors, Matsuda index was 15% lower in participants with vs. without CKD ( = 0.09) and 36% lower in participants with vs. without obesity ( = 0.0001), whereas 1/HOMA-IR was 23% lower in participants with vs. without CKD ( = 0.02) and 46% lower in participants with vs. without obesity ( < 0.0001). We conclude that CKD and obesity do not significantly alter correlations of surrogate insulin sensitivity indices with SI, but they do bias surrogate measurements of insulin sensitivity toward lower values. This bias may be due to differences in insulin kinetics or organ-specific responses to insulin.
胰岛素敏感性可通过高胰岛素正葡萄糖钳夹技术等方法或使用替代指标来测量。慢性肾脏病（CKD）和肥胖可能因胰岛素动力学变化及对胰岛素敏感性的器官特异性影响而对这些测量产生不同影响。在一项对59例非糖尿病CKD患者[估计肾小球滤过率：（GFR）<60 ml·min·1.73 m²]和39例匹配的健康对照者的横断面研究中，我们通过钳夹技术（SI）、口服葡萄糖耐量试验以及空腹血糖和胰岛素水平来量化胰岛素敏感性。我们使用描述性统计、图形分析、相关系数和线性回归，将替代胰岛素敏感性指标与SI进行比较。平均年龄为62.6岁；48%的参与者为女性，77%为白种人。与无CKD的参与者相比，有CKD的参与者胰岛素敏感性指标低8% - 38%，与非肥胖参与者相比，肥胖参与者的胰岛素敏感性指标低13% - 59%。替代指标与SI的相关性在CKD或肥胖状态方面无显著差异。除人口统计学因素外，在调整SI后，有CKD与无CKD的参与者相比，松田指数低15%（P = 0.09），有肥胖与无肥胖的参与者相比，松田指数低36%（P = 0.0001），而1/HOMA - IR在有CKD与无CKD的参与者相比低23%（P = 0.02），在有肥胖与无肥胖的参与者相比低46%（P < 0.0001）。我们得出结论，CKD和肥胖不会显著改变替代胰岛素敏感性指标与SI之间的相关性，但它们确实会使胰岛素敏感性的替代测量值偏向较低值。这种偏差可能是由于胰岛素动力学差异或对胰岛素的器官特异性反应所致。
