Unità Operativa di Nefrologia e Dialisi, Spedali Riuniti, Livorno, Italy.
Perit Dial Int. 2010 Jan-Feb;30(1):66-71. doi: 10.3747/pdi.2008.00155.
Insulin resistance (IR) is common among patients on dialysis and is worse among patients on peritoneal dialysis (PD) than among patients on hemodialysis. In this study we tested the hypothesis that administration of telmisartan, an angiotensin II type 1 receptor antagonist, might improve insulin sensitivity in patients on PD.
This was a crossover study of 30 nondiabetic patients with end-stage renal disease being treated with PD. Group A patients (n = 15) received telmisartan and other antihypertensive drugs for 4 months, followed by 4 months without telmisartan. Group B patients (n = 15) received their usual treatment for 4 months, followed by 4 months of treatment with telmisartan. Blood glucose and serum insulin levels were monitored and homeostasis model assessment method for IR (HOMA-IR) was calculated.
Treatment with telmisartan had no significant impact on serum glucose, potassium, and bicarbonate levels. However, telmisartan significantly reduced serum insulin levels and the HOMA index in groups A and B.
This study demonstrated that telmisartan, an angiotensin receptor type 1 antagonist, may effectively improve insulin sensitivity as measured by HOMA in patients treated with PD.
胰岛素抵抗（IR）在透析患者中很常见，腹膜透析（PD）患者的胰岛素抵抗比血液透析患者更严重。在这项研究中，我们检验了这样一个假设，即血管紧张素 II 型 1 受体拮抗剂替米沙坦的给药可能会改善 PD 患者的胰岛素敏感性。
这是一项 30 名非糖尿病终末期肾病 PD 患者的交叉研究。A 组（n = 15）患者接受替米沙坦和其他降压药物治疗 4 个月，然后停用替米沙坦 4 个月。B 组（n = 15）患者接受常规治疗 4 个月，然后接受替米沙坦治疗 4 个月。监测血糖和血清胰岛素水平，并计算胰岛素抵抗的稳态模型评估法（HOMA-IR）。
替米沙坦治疗对血清葡萄糖、钾和碳酸氢盐水平没有显著影响。然而，替米沙坦显著降低了 A 组和 B 组患者的血清胰岛素水平和 HOMA 指数。
这项研究表明，血管紧张素受体 1 拮抗剂替米沙坦可能有效改善 PD 治疗患者的胰岛素敏感性，这可以通过 HOMA 来衡量。
