Iglesias P, Grande C, Méndez J, Fernandez-Reyes M J, Bajo M A, Selgas R, Díez J J
Department of Endocrinology, Hospital Universitario La Paz, Madrid, Spain.
Adv Perit Dial. 1996;12:71-6.
It is known that serum insulin-like growth factor binding protein-1 (IGFBP-1) concentrations are inversely related to insulin levels both in healthy and diabetic subjects. The aim of the present study was to assess serum IGFBP-1 levels in a group of patients undergoing peritoneal dialysis (PD) and to evaluate their relationship with serum insulin concentrations. Thirty-five patients [19 males, 16 females; age (mean +/- SEM) 53.2 +/- 2.5 years; range 18-78; duration of continuous ambulatory peritoneal dialysis 33.1 +/- 6.0 months; Kt/V 2.00 +/- 0.05; normalized protein catabolic rate 1.00 +/- 0.05 g/kg/day] were studied. Nine patients were diabetics. In all patients, baseline IGFBP-1, insulin, and growth hormone (GH) levels were determined. Fasting IGFBP-1 levels were elevated in 19 (54%) patients and were normal in 16 patients. In all patients, high levels of serum insulin levels (> 25 microU/mL) were observed. Baseline IGFBP-1 levels were only slightly higher in diabetic patients (53.7 +/- 14.6 vs 40.5 +/- 8.2 micrograms/L,NS), however, serum levels of GH were similar in both groups (3.0 +/- 1.8 vs 2.9 +/- 0.5 microgram/L, NS). There was no correlation between fasting insulin and IGFBP-1 levels both in the whole group (r = 0.2; NS) and the diabetic (r = 0.2; NS) and nondiabetic (r = 0.3; NS) subgroups, despite high fasting insulin levels. We could only find a significant positive correlation between fasting glucose and IGFBP-1 levels in the diabetic group (r = 0.7, p < 0.05). Our data suggest that adult patients undergoing PD show hyperinsulinemia associated with normal or high serum IGFBP-1 levels. This suggests that insulin does not affect IGFBP-1 production in this group of patients. It could be explained, at least in part, by the insulin resistance present in uremia.
众所周知，在健康人和糖尿病患者中，血清胰岛素样生长因子结合蛋白-1（IGFBP-1）浓度均与胰岛素水平呈负相关。本研究的目的是评估一组接受腹膜透析（PD）患者的血清IGFBP-1水平，并评估其与血清胰岛素浓度的关系。研究了35例患者[19例男性，16例女性；年龄（均值±标准误）53.2±2.5岁；范围18 - 78岁；持续非卧床腹膜透析时间33.1±6.0个月；Kt/V 2.00±0.05；标准化蛋白分解代谢率1.00±0.05 g/kg/天]。9例患者为糖尿病患者。测定了所有患者的基线IGFBP-1、胰岛素和生长激素（GH）水平。19例（54%）患者空腹IGFBP-1水平升高，16例患者正常。所有患者均观察到高水平的血清胰岛素水平（>25微单位/毫升）。糖尿病患者的基线IGFBP-1水平仅略高（53.7±14.6对40.5±8.2微克/升，无显著性差异），然而，两组患者的血清GH水平相似（3.0±1.8对2.9±0.5微克/升，无显著性差异）。尽管空腹胰岛素水平较高，但在整个组（r = 0.2；无显著性差异）、糖尿病亚组（r = 0.2；无显著性差异）和非糖尿病亚组（r = 0.3；无显著性差异）中，空腹胰岛素与IGFBP-1水平均无相关性。我们仅在糖尿病组中发现空腹血糖与IGFBP-1水平之间存在显著正相关（r = 0.7，p < 0.05）。我们的数据表明，接受PD的成年患者表现出高胰岛素血症，同时伴有正常或高血清IGFBP-1水平。这表明胰岛素在这组患者中不影响IGFBP-1的产生。这至少可以部分地用尿毒症中存在的胰岛素抵抗来解释。
