慢性肾功能衰竭患者胰岛素抵抗的变化

Changes of insulin resistance in patients with chronic renal failure

目的 观察慢性肾功能衰竭 (CRF)患者不同时期胰岛素抵抗 (IR)的变化 ,并进一步探讨IR与肾衰的关系。方法 采用口服葡萄糖耐量试验 (OGTT)和胰岛素释放试验 (IRT) ,检测了 6 5例不同程度CRF患者和 2 0例健康对照组空腹及服糖各时点血糖和胰岛素水平 ,计算其胰岛素敏感指数 (ISI)、机体糖利用率 (M)、糖及胰岛素曲线下面积 (AUCG、AUCINS) ,分析上述变量与肌酐清除率的关系。结果 慢性肾功能衰竭各期AUCG、AUCINS显著增高 ,ISI、M显著低下 ,胰岛素抵抗显著增加 ,IR与肾衰程度呈正相关。血透和腹透可提高ISI。结论 多数慢性肾功能衰竭患者存在IR和糖耐量异常 ,且随肾功能损害进展而加重 ;IR可能加重慢性肾功能衰竭的进展。

Objective To study the changes of insulin resistance (IR) in different stages in patients with chronic renal failure (CRF) and investigate the relationship between IR and CRF.Methods The level of glucose and insulin in serum at each certain point of 65 CRF patients were measured by using oral glucose tolerance test (OGTT) and insulin release test (IRT) and compared with 20 healthy controls under conditions of fasting stomach and glucose load.Insulin sensitivity index(ISI),glucose uptake rate (M) and the total areas under the glucose and insulin curves (AUCG,AUCINS) were measured according to the results above.The relationship between the changes above and the creatinine clearance rate were analyzed.Results Most CRF patients had a significant higher level of AUCG,AUCINS and a significant lower level of ISI and M together with an increase of IR.IR had a positive correlation with the degree of renal failure.Hemodialysis and peritoneal dialysis could improve ISI.Conclusions IR and impaired glucose tolerance(IGT) exist in most patients with CRF and might make even worse the destroy of renal function proceeded.IR might deteriorate CRF.