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目的 :探讨慢性肾功能不全与胰岛素拮抗之间关系和血液透析的疗效。方法 :慢性肾功能不全患者 131例 ,分高血压组 5 7例 ,无高血压组 74例 ,血液透析组病人 37例。正常人 2 7例为对照组 ,用口服葡萄糖耐量试验测试各组空腹血糖、胰岛素水平、糖负荷后各时点血糖及胰岛素水平 ,计算胰岛素敏感指数 ( ISI)、糖利用率 ( M)和胰岛素拮抗发生率 ( IRR) ,血液透析病人于透析前后一天分别进行上述检查。结果 :慢性肾功能不全患者血糖较正常人高 ,而胰岛素水平显著增高 ,ISI、M显著低下 ,IRR显著增加。其中高血压组上述指标与无高血压组、正常人相比差异非常显著 ,无高血压组与正常人组相比 ,上述指标差异也有统计学意义。血液透析后 ,上述指数明显改善。结论 :慢性肾功能不全的人都存在着不同程度的胰岛素拮抗 ,伴有高血压者尤为显著 ,血液透析可改善尿毒症病人的胰岛素结抗。
Objective: To investigate the relationship between chronic renal insufficiency and insulin resistance and the effect of hemodialysis. Methods: 131 cases of chronic renal insufficiency, sub-hypertension 57 cases, 74 cases without hypertension, hemodialysis patients 37 cases. 27 normal subjects were taken as the control group. The fasting blood glucose and insulin levels, blood glucose and insulin levels at various time points were measured by oral glucose tolerance test, insulin sensitivity index (ISI), glucose utilization (M) and insulin Antagonist rate (IRR), hemodialysis patients in the day before and after dialysis were the above tests. Results: The patients with chronic renal insufficiency had higher blood glucose level, higher insulin level, lower ISI, M and higher IRR. Among them, the above indexes in hypertension group were significantly different from those in non-hypertension group and normal people. There was also a significant difference in the above indexes between hypertension-free group and normal people group. After hemodialysis, the above index improved significantly. Conclusion: There are different degrees of insulin antagonism in people with chronic renal failure, especially those with hypertension. Hemodialysis can improve insulin resistance in patients with uremia.