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目的探讨痛风伴微量白蛋白尿患者胰岛素抵抗与红细胞膜胰岛素受体的关系。方法观察106例痛风患者,按是否合并微量白蛋白尿(MAU),将其分为MAU组和正常MAU组(NMAU),测定空腹、餐后2h血糖、胰岛素及空腹血脂、血尿酸(UA),并检测高、低亲和力红细胞膜胰岛素受体数目(R_1、R_2)和高、低亲和力常数(K_1、K_2),分析痛风伴MAU患者胰岛素抵抗与红细胞膜胰岛素受体的关系。结果MAU组空腹胰岛素(FINS)、甘油三酯(TG)、低密度脂蛋白(LDL-c)及胰岛素抵抗指数(HOMA-IR),分别为:(16±4)mU/L、(2.5±0.6)mmol/L、(3.2±0.5)mmol/L和3.6±1.2,正常MAU组分别为(13±3)mU/L、(2.3±0.8) mmol/L、(3.0±0.5)mmol/L及3.0±0.4,上述指标两组间比较差异有统计学意义(P<0.05)。痛风患者合并MAU红细胞膜胰岛素受体数目(R_1)较正常MAU组明显减少,两组间比较差异有统计学意义(P<0.05)。痛风患者合并MAU的Pearson相关分析结果示:HOMA-IR与年龄、体重指数(BMI)、TG、LDL-c、UA、UAER呈正相关(P<0.05或P<0.01),与R_1、R_2、K_1、K_2呈负相关(P<0.05或P<0.01)。多元线性逐步回归分析提示BMI、年龄、R_1是影响痛风合并MAU患者胰岛素抵抗的独立危险因素。结论痛风合并MAU时存在胰岛素抵抗,且与红细胞膜胰岛素受体数目减少密切相关。
Objective To investigate the relationship between insulin resistance and erythrocyte insulin receptor in patients with gout and microalbuminuria. Methods 106 patients with gout were divided into MAU group and normal MAU group (NMAU) according to whether they had microalbuminuria (MAU) or not. The fasting blood glucose, insulin, fasting blood lipids, serum uric acid (UA) (R_1, R_2) and high and low affinity constants (K_1, K_2) of high and low affinity erythrocyte membrane were measured. The relationship between insulin resistance and erythrocyte insulin receptor was analyzed in patients with gout and MAU. Results The levels of fasting insulin (FINS), triglyceride (TG), low density lipoprotein (LDL-c) and insulin resistance index (HOMA-IR) in MAU group were (16 ± 4) mU / 0.6 mmol / L, 3.2 ± 0.5 mmol / L and 3.6 ± 1.2, respectively. The normal MAU group was (13 ± 3) mU / L and And 3.0 ± 0.4, there was significant difference between the above two indexes (P <0.05). The number of insulin receptor (R_1) in patients with gout combined with MAU erythrocyte membrane was significantly lower than that in normal MAU group, the difference was statistically significant (P <0.05). Pearson correlation analysis showed that HOMA-IR was positively correlated with age, body mass index (BMI), TG, LDL-c, UA and UAER (P <0.05 or P <0.01) , K_2 was negatively correlated (P <0.05 or P <0.01). Multivariate linear stepwise regression analysis suggested that BMI, age, and R_1 were independent risk factors for insulin resistance in patients with gout and MAU. Conclusions There is insulin resistance in gout with MAU, which is closely related to the decrease of insulin receptor in erythrocyte membrane.