| Objective: Chronic kidney disease (CKD) is a type of disease thatseverely affect the patient’s quality of life and threat the lives of patients. Ithas a lot of clinical complications and the prognosis is poor. CKD evennon-diabetic CKD patients have insulin resistance (IR), and IR is parallel withthe degree of renal dysfunction. Adipocytokines and inflammatory play animportant role in the development of IR. CKD patients are also widespreadmicro-inflammatory state, which seriously affect the progression of CKDpatients. Early intervention of IR and micro-inflammatory in CKD patients isbeneficial in delaying the progression of these patients. Recent study showsthat visfatin is an adipokine with similar hypoglycemic effect with insulin andpro-inflammatory role. Interleukin-18(IL-18) is an important inflammatorymediators involved in the IR. The purpose of this study is to detect whetherthe serum level of visfatin and IL-18in CKD patients can be predict IR andmicro-inflammatory, and to provide a basis for the clinical treatment of CKDand to slow down the progress of CKD.Methods:(1) We collected80cases of non-diabetic and non-dialysisCKD patients (primary disease were the primary chronic glomerulonephritis,male47and female33) from December2011to December2012in SecondHospital of Hebei Medical University hospital, which of CKD1~2group (20patients,12males and8females), CKD3group (20patients,12males and8females), CKD4group (20patients,13males and7females) and CKD5group (20patients,10males and10females). Meanwhile,20cases werecollected among the healthy examined people as normal control group.(2)Enzyme-linked immun osorbent assay (ELLSA) was used to detect serumvisfatin and IL-18levels of the subjects, and then compared between groups.(3) The concentrations of fasting blood glucose(FBG), fasting insulin(FINS), 2-hour postprandial blood glucose(PBG), glycosylated hemoglobin (HbA1c)，high-sensitivity C-reactive protein(hs-CRP), serum creatinine(Scr), totalcholesterol(TC), triglycerides(TG), high density lipoproteincholesterol(HDL-C), low density lipoprotein cholesterol(LDL-C), were alldetermined after admission, simultaneous determined of height, body weight,waist circumference, hip circumference and calculate body mass index(BMI),waist-to-hip ratio(WHR), glomerular filtration rate(GFR), and insulinresistance index (HOMA-IR).(4) Clinical indicators and experimental datawere expressed as x±s, groups were compared using analysis of variance andnon-parametric test, further pariwise comparisons using SNK analysis.(5)SPSS13.0statistical software was used to analyze the above mentioned data,in which process the significance was set at P＜0.05.Results:(1) Serum IL-18and visfatin levels in CKD patients werehigher than control group, and progressively increased with the renaldysfunction, patients of CKD5was higher than CKD1~4and patients CKD4was higher than1~2(P＜0.05,See Table1).(2) Serum IL-18was positiverelated to age, hs-CRP, FBG, FIN, PBG, HbA1c, HOMA-IR, TC, TG andLDL-C(r=0.223~0.463, P＜0.05), and negative related to eGFR andHDL-C(r=-0.566, r=-0.301, P＜0.05); serum visfatin was significantlypositive related to age, hs-CRP, FBG, FIN, PBG, HbA1c, HOMA-IR, TC, TGand LDL-C (r=0.216~0.406, P＜0.05), and negative related to eGFR andHDL-C(r=-0.370, r=-0.294, P＜0.05).(3) Bivariate correlation analysis ofIL-18and visfatin were significantly positive correlation(r=0.527, P＜0.01).(4) Visfatin as the dependent variable, multiple liner regression analysisshowed that hs-CRP, eGFR and HOMA-IR were the independent relatedfactors to visfatin, multiple liner regression equation: visfatin=6.59+0.94×hs-CRP-0.51×eGFR+0.036×HOMA-IR(F=8.704, P＜0.05); IL-18as thedependent variable, multiple liner regression analysis showed that hs-CRP,andeGFR were the independent related factors to IL-18, multiple liner regressionequation: IL-18=279.262+0.97×hs-CRP-0.63×eGFR (F=10.382, P＜0.05).Conclusions:(1) Compared with the normal control group, the extent of insulin resistance and inflammatory cytokines (IL-18, hs-CRP) levels ofchronic kidney disease patients were significantly increased.(2) With therenal dysfunction in chronic kidney disease patients, insulin resistance and thedisordered of lipid metabolism and microinflammation were progressiveincreased.(3) With the renal dysfunction in chronic kidney disease patients,serum IL-18and visfatin levels were elevated, both can be better response andassessment of inflammation state in the body, serum visfatin levels can bebetter response and assessment of insulin resistance in the body. |
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