关键词: 肾小球肾炎,IGA, 胰岛素抵抗, 肾素-血管紧张素系统

Abstract: Background　Insulin resistance （IR） is the central link and the pathogenic basis of metabolic syndrome as well as the independent risk factor leading to kidney damage and eventually renal failure.Objective　To discuss the occurrence of IR and the relationship between IR and basic clinical indexes of IgAN,activity of renin-angiotensin-aldosterone system （RAAS） and pathological severity.Methods　94 patients who met inclusion criteria and visited the First Nephrology Department of Shengjing Hospital of China Medical University from June 2013 to December 2014 were retrospectively selected as objects of study.According to the results of final diagnosis,they were divided into IgAN group （44 cases）,membranous nephropathy （MN） group （26 cases） and minimal change disease （MCD） group （24 cases）.General data of patients were collected,including gender,age,body mass index （BMI）,systolic pressure,diastolic pressure,24 h urinary protein quantitative,albumin,hemoglobin,creatinine,glomerular filtration rate （eGFR）,uric acid,fasting blood glucose （FBG）,fasting insulin （FINS）,rennin,AngⅡ,aldosterone,triglycerides,cholesterol,low density lipoprotein,c-reactive protein（CRP）.The HOMA-IR was calculated and the incidence of IR was recorded.The pathological severity of IgAN was evaluated,including MEST score,glomerular sclerosis rate and crescent rate.Results　MN group was significantly higher in the levels of BMI,24 h urinary protein quantitative,eGFR,triglycerides,cholesterol and low density lipoprotein and lower in the levels of albumin,creatinine and AngⅡ than those of IgAN group （P<0.05）.MCD group was significantly higher in the levels of 24 h urinary protein quantitative,eGFR,triglycerides,cholesterol and low density lipoprotein and lower in the levels of albumin,creatinine and AngⅡthan those of IgAN group （P<0.05）.The HOMA-IR and incidence rate of IR in MN group and MCD group were lower than those of IgAN group （P<0.05）.There was no linear correlation between HOMA-IR and age,24 h urinary protein quantitative,albumin,hemoglobin,eGFR,renin,aldosterone,cholesterol,low density lipoprotein,MEST score,glomerular sclerosis rate and crescent rate （P>0.05）.HOMA-IR was positively correlated with BMI,systolic pressure,diastolic pressure,creatinine,uric acid,AngⅡ,triglycerides and CRP （P<0.05）.The results of linear regression analysis showed that there was a linear regression relationship between HOMA-IR and BMI,systolic pressure,diastolic pressure,creatinine,uric acid,AngⅡ,triglycerides and CRP （P<0.05）.Conclusion　Most IgAN patients have IR,which is positively correlated with basic clinical indexes （BMI,systolic pressure,diastolic pressure,creatinine,uric acid,triglycerides,CRP） and the activity of RAAS,but has nothing to do with pathological severity.

Key words: Glomerulonephritis,IGA, Insulin resistance, Renin-angiotensin system