罗格列酮可改善接受持续性非卧床腹膜透析的非糖尿病尿毒症患者的葡萄糖代谢。

Rosiglitazone improves glucose metabolism in nondiabetic uremic patients on CAPD.

作者信息

Lin Shih-Hua, Lin Yuh-Feng, Kuo Shi-Wen, Hsu Yu-Juei, Hung Yi-Jen

机构信息

Department of Medicine, Division of Nephrology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC China.

出版信息

Am J Kidney Dis. 2003 Oct;42(4):774-80. doi: 10.1016/s0272-6386(03)00844-8.

DOI:10.1016/s0272-6386(03)00844-8

PMID:14520628

Abstract

BACKGROUND

Insulin resistance, a strong risk factor for atherosclerotic vascular disease, is present in uremic patients without diabetes on continuous ambulatory peritoneal dialysis (CAPD) therapy. Amelioration of insulin resistance may reduce associated long-term cardiovascular complications. The aim of the study is to investigate the effects of rosiglitazone (ROS), an insulin sensitizer, on glucose metabolism in CAPD patients without diabetes.

METHODS

Fifteen uremic patients without diabetes on CAPD therapy were enrolled. All were administered ROS, 4 mg/d, for 12 weeks. A control group consisted of 15 age- and sex-matched healthy subjects. Oral glucose tolerance test (OGTT) results, fasting glucose and insulin levels, related blood biochemistry results, and C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha) levels were determined before initiation and at 4 and 12 weeks of therapy. Insulin resistance was evaluated using the homeostasis model assessment method (HOMA-IR). A whole-body insulin sensitivity index (ISI) and insulinogenic index for insulin production were calculated from OGTT results.

RESULTS

CAPD patients showed significantly greater HOMA-IR and glucose intolerance compared with healthy controls. After 4 and 12 weeks of ROS therapy, there were no significant changes in body weight, blood pressure, dialysis adequacy, hemoglobin level, hemoglobin A(1c) level, liver function, lipid profile, or intact parathyroid hormone, CRP, IL-6, or TNF-alpha levels. There was a significant decrease in HOMA-IR (3.2 +/- 0.6, 2.2 +/- 0.4, and 2.1 +/- 0.4; P < 0.05). During the OGTT, there was a significant decrease in the area under the glucose curve and a significant increase in ISI (3.5 +/- 0.4, 5.0 +/- 0.7, and 5.3 +/- 0.7; P < 0.05), but no significant change in insulinogenic index.

CONCLUSION

ROS improved insulin resistance in CAPD patients without diabetes. Whether long-term use of ROS reduces cardiovascular risk needs further study.

摘要

背景

胰岛素抵抗是动脉粥样硬化性血管疾病的一个重要危险因素，在接受持续性非卧床腹膜透析（CAPD）治疗的非糖尿病尿毒症患者中存在。改善胰岛素抵抗可能会减少相关的长期心血管并发症。本研究的目的是探讨胰岛素增敏剂罗格列酮（ROS）对非糖尿病CAPD患者糖代谢的影响。

方法

纳入15例接受CAPD治疗的非糖尿病尿毒症患者。所有患者均给予ROS，4mg/d，持续12周。对照组由15名年龄和性别匹配的健康受试者组成。在治疗开始前以及治疗4周和12周时测定口服葡萄糖耐量试验（OGTT）结果、空腹血糖和胰岛素水平、相关血液生化结果以及C反应蛋白（CRP）、白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）水平。使用稳态模型评估法（HOMA-IR）评估胰岛素抵抗。根据OGTT结果计算全身胰岛素敏感性指数（ISI）和胰岛素生成指数。

结果

与健康对照组相比，CAPD患者的HOMA-IR和葡萄糖不耐受明显更高。ROS治疗4周和12周后，体重、血压、透析充分性、血红蛋白水平、糖化血红蛋白A1c水平、肝功能、血脂谱或完整甲状旁腺激素、CRP、IL-6或TNF-α水平均无显著变化。HOMA-IR显著降低（分别为3.2±0.6、2.2±0.4和2.1±0.4；P<0.05）。在OGTT期间，葡萄糖曲线下面积显著减小，ISI显著增加（分别为3.5±0.4、5.0±0.7和5.3±0.7；P<0.05），但胰岛素生成指数无显著变化。