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血液透析对尿毒症胰岛素拮抗和糖代谢的影响
http://www.100md.com 《中华肾脏病杂志》 1998年第1期
血液透析|胰岛素拮抗|糖代谢|尿毒症,关键词:
血液透析对尿毒症胰岛素拮抗和糖代谢的影响

     鲍晓荣 吴兆龙 廖履坦 200032 上海医科大学中山医院肾内科 中华肾脏病杂志 1998 0 14 1


    关键词:血液透析;胰岛素拮抗;糖代谢;尿毒症 期刊 zhszbzz 0 论著 fur -->


    

目的 研究血液透析对尿毒症胰岛素拮抗和糖代谢的影响。方法 采用口服葡萄糖耐量试验(OGTT)和胰岛素释放试验(IRT)方法,检测22例血透(HD),22例非透析(ND)尿毒症者和12例正常者胰岛素敏感指数(ISI)、机体糖利用率(M)、糖和胰岛素反应曲线下面积(AUCG和AUCINS)。结果 (1)HD组糖负荷后血糖、胰岛素水平及其AUCG、AUCINS均显著低于ND组,但仍明显高于正常对照组;(2)HD组ISI、M值显著高于ND组,但明显低于正常对照组,其胰岛素拮抗(IR)和糖耐量异常(IGT)发生率均显著低于ND组:(3)胰岛素拮抗组血透时间显著短于非胰岛素拮抗组,透析时间与ISI有正相关趋势;(4)HD组较ND组血pH值、血HCO- 3 水平显著增高,但N-PTH水平显著低下。结论 HD可部分改善尿毒症胰岛素拮抗,高胰岛素血症和糖耐量异常。

Effects of hemodialysis on insulin resistance and glucose metabolism of uremia.

Bao Xiaorong, Wu Zhaolong, Liao Lutan. Division of Nephrology, Zhongshan Hospital, Shanghai Medical University, Shanghai 200032.

Objective To analyse the effects of hemodialysis on insulin resistance and glucose metabolism of uremia. Methods Oral glucose tolerance test (OGTT) and the insulin release test (IRT), insulin sensitivity index (ISI), glucose uptake rate (M) and total areas under the glucose and isulin curves during OGTTs (AUCG, AUCINS) were investigated in 22 hemodialysis (HD) and 22 non-dialysis (ND) uremic patients and 12 healthy controls. Results (1) The levels of blood glucose and serum insulin after glucose load and the values of AUCG and AUCINS in HD group were significantly lower than in ND one, but still significantly higher than in the controls; (2) The values of ISI and M in HD group were significantly higher than in ND one, but still significantly lower than in the controls. The incidences of insulin resistance and glucose intolerance in HD group were much lower than in ND one; (3) The dialysitic period in insulin resistant group was significantly shorter than that in non-insulin resistant one, and the dialysitic period had a positive correlation tendency with ISI; (4) HD patients had significantly increased blood pH and HCO- 3 values and decreased PTH levels than ND patients. Conclusion Hemodialysis can partly improve insulin resistance、hyperinsulinemia and glucose intolerance of uremia, and it might be related to the correction of metabolic acidosis and the clearance of PTH.

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