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目的探讨住院非糖尿病患者胰岛素抵抗(IR)的特点及影响因素的分析。方法选取2010年至2012年住院的非糖尿病患者378例,其中高血尿酸(UA)组56例,高纤维蛋白原(FIB)组53例,甲减组55例,甲亢组54例,高同型半胱氨酸(Hcy)组51例,脂肪肝组55例,焦虑障碍组54例,各组均只有其中一项异常,另选择健康体检者50例,行空腹胰岛素、血糖检查,标准馒头餐后测0.5、1、2、3 h的血糖、胰岛素水平;计算胰岛素抵抗指数(HOMA-IR)、胰岛素敏感指数(ISI-composite),分析各因素与IR的相关性。结果高UA组、高FIB组、甲减组、甲亢组、焦虑组、高Hcy组、脂肪肝组患者HOMA-IR均高于对照组,ISI-composite均低于对照组(P均<0.05)。Spearman秩相关分析显示,UA、焦虑积分、脂肪肝、FIB、甲亢、甲减、Hcy等因素均与HOMA-IR呈正相关,而与ISIcomposite呈负相关(P<0.05,P<0.01);以ISI-composite为IR标准,Logistic回归分析结果显示,UA、焦虑积分、脂肪肝、FIB、甲亢、甲减、Hcy为独立影响IR的因子(P<0.05,P<0.01)。空腹血糖受损(IFG)组与糖耐量异常(IGT)组的HOMA-IR明显高于正常血糖(NGT)组,且IFG组>IGT组>NGT组;IGT组的ISI-composite明显低于NGT组,而IFG组与NGT组比较无统计学差异(P>0.05)。结论 UA、焦虑积分、脂肪肝、FIB、甲亢、甲减、Hcy等因素为独立影响IR的因子,对其进行干预治疗,可减少以IR为基础的疾病的发生,使患者从早期预防、治疗中获益。
Objective To investigate the characteristics and influential factors of insulin resistance (IR) in hospitalized non-diabetic patients. Methods A total of 378 non-diabetic inpatients from 2010 to 2012 were enrolled in this study. Among them, 56 were hyperuricemia (UA), 53 were high fibroin (FIB), 55 were hypothyroidism, 54 were hyperthyroidism, 51 cases of cysteine (Hcy) group, 55 cases of fatty liver group, 54 cases of anxiety disorder, each group is only one of the abnormalities, and the other 50 cases of healthy subjects, fasting insulin, blood sugar test, standard steamed bread meal Blood glucose and insulin levels were measured at 0.5, 1, 2 and 3 h after the test. HOMA-IR and ISI-composite were calculated and the correlation between IR and IR was analyzed. Results The levels of HOMA-IR in high UA group, high FIB group, hypothyroidism group, hyperthyroidism group, anxiety group, high Hcy group and fatty liver group were significantly higher than those in control group (all P <0.05) . Spearman rank correlation analysis showed that UA, anxiety score, fatty liver, FIB, hyperthyroidism, hypothyroidism, Hcy and other factors were positively correlated with HOMA-IR and negatively correlated with ISIcomposite (P <0.05, P <0.01) The result of Logistic regression analysis showed that UA, anxiety score, fatty liver, FIB, hyperthyroidism, hypothyroidism and Hcy were independent factors of IR (P <0.05, P <0.01). The levels of HOMA-IR in IFG group and IGT group were significantly higher than those in NGT group, IFG group> IGT group> NGT group, and IGT group was significantly lower than that in NGT group Group, while there was no significant difference between IFG group and NGT group (P> 0.05). Conclusions UA, anxiety score, fatty liver, FIB, hyperthyroidism, hypothyroidism, Hcy and other factors are independent factors of IR. Intervention therapy can reduce the incidence of IR-based diseases and make patients from early prevention and treatment Benefit.