血管紧张素转换酶抑制剂对慢性肾衰患者胰岛素拮抗的影响

Effect of two type of ACEI on Insulin Kesistance in Patients with Chronic Renal Failure

在观察慢性肾衰胰岛素拮抗发生的基础上,探讨两种类型的血管紧张素转换酶抑制剂（ACEI）对慢性肾衰患者胰岛素拮抗（IR）及糖耐量异常（IGT）的影响。方法:采用口服葡萄糖耐量试验（OGTT）和胰岛素释放试验（IRT）,检测56例不同程度慢性肾衰患者和20例正常对照者空腹及服糖后各时点血糖和胰岛素水平。治疗组20例患者服用苯那普利、20例服用卡托普利,观察两种药物对胰岛素拮抗及糖耐量异常的影响。结果:在肾功能失代偿后各期糖及胰岛素曲线下面积（AUCG、AUCINS）均高于对照组（P<0.05）,而肾功能代偿期AUCG、AUCINS无明显变化。使用两种ACEI治疗前后胰岛素敏感指数（ISI）、机体糖利用率（M）的变化有显著性差异（P<0.05）;与卡托普利组相比,苯那普利组更能提高ISI及M（P<0.05）。结论:IR和IGT存在于大多数尿毒症患者,且在慢性肾功能不全各期有一定差异,以尿毒症组尤为显著;苯那普利较卡托普利更能提高ISI、M,在改善胰岛素敏感性方面更具优势。

Objective:On the basis of observing the occurrence of insulin resistance(IR) and impaired glucose tolerance(IGT) in chronic renal failure, We try to investigate effects of two types of angiotensin coverting enzyme inhibitor(ACEI) on IR and IGT in patients with chronic renal failure. Methods: the oral glucose tolerance test(OGTT)and the insulin release test(IRT)were used to detect the blood sugar and insulin level of 56 cases with different degree of chronic renal failure, contrasted with 20 normal cases under conditions of fasting stomach and after taking sugar. 20 cases are chosen to take benapril while other 20 cases captopril in order to observe effect of two kinds of medicines on IR and IGT. Results:The total areas under the glucose and insulin curves during OGTTs(AUCG, AUCINS)of the objects at renal failure incompensatory stage are larger than those the contrasted group (P<0.05) ,but an renal failure cornpenstatory stage do not change obviously. Insulin sensitivity index(ISI)and glucose uptake rate(M) of pre-treatment and post-treatment are quite different in two types of ACEI.On improving the level of ISI and M,benapril is better than captopril(P< 0.05). Couclusion:IR and IGT are in most of uremic patients, there are some differences in different of chronic renal failure periods,especially in uremic group.Benapril can improve the level of ISI and M higher than captopril, and has advantage to improve the sensitivity of insulin.