[Associations of metabolic score for insulin resistance with chronic kidney disease and albuminuria in the Chinese population].

Objective: To explore the relationship between metabolic score for insulin resistance (METS-IR) and chronic kidney disease (CKD) and albuminuria in the Chinese population. Methods: This cross-sectional study was conducted from January to December 2018 among residents aged 20 to 70 years in ten regions of eight provinces in China; all residents had lived in their region for more than 5 years. Various parameters were measured, included fasting blood glucose, 2-hour postprandial blood glucose, glycosylated hemoglobin (HbA1c), blood lipids, renal function, urinary albumin/creatinine ratio (UACR), etc. Data of 5 060 subjects meeting the criteria were included in the study. CKD was defined as estimated glomerular filtration rate (eGFR)<60 ml·min-1·1.73 m-2 or UACR≥30 mg/g. Albuminuria was defined as UACR≥30 mg/g. METS-IR was calculated and categorized into quartiles: Q1, METS-IR≤32.19; Q2, METS-IR 32.20-37.10; Q3, METS-IR 37.11-42.58; and Q4, METS-IR>42.58. The correlation between METS-IR and CKD and albuminuria was analyzed by binary logistic regression, and subgroup analyses were performed. Results: There were 1 266, 1 266, 1 265, and 1 263 participants included in Q1-Q4 groups, respectively. With the increase of METS-IR quartile, various parameters increased, including age, fasting blood glucose, HbA1c, triglycerides, serum uric acid, waist circumference, body mass index, and systolic and diastolic blood pressure, and the proportion of males also increased (all P<0.05). The proportion of patients with CKD and albuminuria increased significantly with the increase in interquartile range (Q) of METS-IR (all P<0.05). Logistic regression analysis showed that for every 1-unit increment of METS-IR, the risk of CKD and albuminuria were both increased by 2% [for both: odds ratio (OR)=1.02, 95% confidence interval (CI) 1.01-1.03]. Compared with the lowest METS-IR group (Q1), the ORs for CKD and albuminuria in the highest METS-IR group (Q4) were 1.57 (95%CI 1.17-2.10) and 1.46 (95%CI 1.09-1.96), respectively. In the subgroup analyses, increased METS-IR was significantly associated with CKD and albuminuria among women (CKD: OR=1.62, 95%CI 1.14-2.31; albuminuria: OR=1.53, 95%CI 1.07-2.18), individuals with HbA1c<7% (OR=1.64, 95%CI 1.21-2.23; OR=1.55, 95%CI 1.14-2.11), individuals with eGFR≥90 ml·min-1·1.73 m-2 (OR=1.78, 95%CI 1.27-2.49; OR=1.80, 95%CI 1.28-2.53), and the Chinese Han population (OR=1.56, 95%CI 1.13-2.17; OR=1.41, 95%CI 1.01-1.96). Conclusions: METS-IR is significantly associated with CKD and albuminuria in a Chinese population. Furthermore, the higher the METS-IR, the higher the risk of CKD and albuminuria.目的： 探讨胰岛素抵抗代谢指数（METS-IR）在中国人群中与慢性肾脏病（CKD）及蛋白尿的相关性。 方法： 横断面研究。2018年1至12月对中国8个省10个地区20~70岁、居住满5年的常驻居民进行调查，检测空腹血糖、餐后2 h血糖、糖化血红蛋白（HbA1c）、血脂、肾功能、尿白蛋白/肌酐比值（UACR）等。纳入符合标准的5 060人的资料。CKD定义为估算的肾小球滤过率（eGFR）<60 ml·min-1·1.73 m-2或UACR≥30 mg/g；蛋白尿定义为UACR≥30 mg/g。计算METS-IR，并依据METS-IR四分位数，分为Q1组（METS-IR≤32.19）、Q2组（METS-IR 32.20~37.10）、Q3组（METS-IR 37.11~42.58）和Q4组（METS-IR>42.58）。应用logistic回归模型分析METS-IR与CKD及蛋白尿的相关性，并进行分层分析。 结果： Q1~Q4组分别有1 266、1 266、1 265、1 263人，随着METS-IR增加（Q1至Q4组），空腹血糖、HbA1c、甘油三酯、血尿酸、腰围、体重指数、收缩压和舒张压水平逐渐升高，男性占比逐渐增加（均P<0.05）；CKD和蛋白尿的比例也显著升高（均P<0.05）。logistic回归分析显示，METS-IR每增加1，CKD和蛋白尿的患病风险均增加2%（OR=1.02，95%CI 1.01~1.03；OR=1.02，95%CI 1.01~1.03）。与Q1组相比，Q4组CKD及蛋白尿患病风险的OR值分别为1.57（95%CI 1.17~2.10）和1.46（95%CI 1.09~1.96）。分层分析显示，METS-IR的升高与CKD及蛋白尿的发生在女性（OR=1.62，95%CI 1.14~2.31；OR=1.53，95%CI 1.07~2.18）、HbA1c<7.0%（OR=1.64，95%CI 1.21~2.23；OR=1.55，95%CI 1.14~2.11）、eGFR≥90 ml·min-1·1.73 m-2（OR=1.78，95%CI 1.27~2.49；OR=1.80，95%CI 1.28~2.53）、汉族（OR=1.56，95%CI 1.13~2.17；OR=1.41，95%CI 1.01~1.96）人群有显著相关性。 结论： METS-IR在中国人群中与CKD和蛋白尿存在关联，METS-IR越高，CKD和蛋白尿发生风险越大。.