Background: The relationship between albuminuria and insulin resistance (IR) has not been clarified in previous studies. This study was conducted to examine whether IR is associated with albuminuria in subjects with diverse blood pressure and glycometabolism statuses.
Methods: This study included 34 136 participants whose data were drawn from a cross-sectional survey named the 2011 REACTION study. The participants were divided into six groups. The urinary albumin-creatinine ratio (UACR) and glomerular filtration rate (GFR) were used as markers of chronic kidney disease (CKD). Variance tests and logistic regression models were performed for homeostatic model assessment of insulin resistance (HOMA-IR) in relation to UACR and eGFR.
Results: First, UACR levels and HOMA-IR exhibited a positive correlation among participants (P < 0.05), and a negative correlation existed between GFR and HOMA-IR (P < 0.05). Second, in the hypertension with diabetes group, in individuals whose body mass index (BMI) was 18.5-24.0 kg/m2 , age was 50-60 years old, low density lipoprotein cholesterol (LDL-C) was 2.6-3.4 mmol/L or high density lipoprotein cholesterol (HDL-C) was 0.9-1.55 mmol/L, HOMA-IR was positively associated with UACR (P < 0.05). However, there was a negative correlation between GFR and HOMA-IR in the hypertension with diabetes group in individuals whose BMI was 18.5-24.0 kg/m2 or whose age was over 65 years old (P < 0.05).
Conclusions: In the context of different blood pressure and glycometabolism statuses, the positive correlation between UACR levels and HOMA-IR was affected by BMI, age, LDL-C, HDL-C, and GFR. In patients with hypertension and diabetes, the early detection and intervention of IR and related risk factors in patients with normal BMI may reduce the occurrence of microalbuminuria and delay the progression of CKD.
目的: 既往文献研究中未阐明尿白蛋白与胰岛素抵抗的关系, 因此我们进一步探讨了胰岛素抵抗与尿白蛋白在中国不同血压和糖代谢状态人群中的关系。 方法: 本研究共筛选纳入了34136名受试者, 研究数据来源于一项横断面调查, 即2011年“中国糖尿病患者肿瘤发生风险的纵向研究”(Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal study,REACTION)。将总人群根据不同血压及糖代谢状态分为六组。肾小球滤过率(GFR)和尿微量白蛋与肌酐比值(UACR)作为评估慢性肾脏疾病的标志物。计算稳态模型评估胰岛素抵抗指数(HOMA-IR), 采用方差检验和多因素Logistic回归模型来研究UACR、GFR与HOMA-IR的关系。 结果: 首先, 总人群中UACR水平与HOMA-IR有显著正相关关系(P<0.05), 而GFR和HOMA-IR之间呈负相关关系(P <0.05)。其次, 在同时患有糖尿病和高血压的人群中, 体重指数(BMI)处于18.5-24.0 kg/m2 , 年龄为50-60岁, 低密度脂蛋白胆固醇(LDL-C)为2.6-3.4 mmol/L或高密度脂蛋白胆固醇(HDL-C)为0.9-1.55 mmol/L的亚组人群里, HOMA-IR与UACR呈正相关(P <0.05)。然而, 在BMI为18.5-24.0 kg / m2 或年龄超过65岁的高血压合并糖尿病人群中, GFR与HOMA-IR存在负相关关系(P <0.05)。 结论: 在不同的血压和糖代谢状态下, UACR水平与HOMA-IR的正相关关系受BMI、年龄、LDL-C、HDL-C和GFR的影响。在高血压合并糖尿病患者中, 若早期对正常BMI患者的胰岛素抵抗及其相关的危险因素进行检测及干预, 可能会减低尿微量白蛋白的发生和延缓慢性肾脏疾病的进展。.
Keywords: Albuminuria; Diabetes; Hypertension; Insulin resistance [Correction added on 2 April 2020, after first online publication: Keywords have been added.]; 尿微量白蛋白; 糖尿病; 胰岛素抵抗; 高血压.
© 2019 The Authors. Journal of Diabetes published by Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.