慢性肾脏病中胰岛素抵抗的测量。
Measurement of insulin resistance in chronic kidney disease.
机构信息
Division of Nephrology and Kidney Research Institute, Department of Medicine, Seattle VA Puget Sound Healthcare System, Washington, USA.
出版信息
Curr Opin Nephrol Hypertens. 2011 Nov;20(6):640-6. doi: 10.1097/MNH.0b013e32834b23c1.
PURPOSE OF REVIEW
Insulin resistance is a known complication of end-stage renal disease that also appears to be present in earlier stages of chronic kidney disease (CKD). It is a risk factor for cardiovascular disease and an important potential therapeutic target in this population. Measurement of insulin resistance is reviewed in the context of known pathophysiologic abnormalities in CKD.
RECENT FINDINGS
Insulin resistance in CKD is due to a high prevalence of known risk factors (e.g. obesity) and to unique metabolic abnormalities. The site of insulin resistance in CKD is localized to skeletal muscle. Estimates based on fasting insulin concentration may not adequately capture insulin resistance in CKD because they largely reflect hepatic defects and because CKD impairs insulin catabolism. A variety of dynamic tests are available to directly measure insulin-mediated glucose uptake.
SUMMARY
Insulin resistance may be an important therapeutic target in CKD. Complementary methods are available to assess insulin resistance, and each method has unique advantages, disadvantages, and levels of complexity. These characteristics, and the likelihood that CKD alters the performance of some insulin resistance measurements, must be considered when designing and interpreting clinical studies.
目的综述
胰岛素抵抗是终末期肾病的已知并发症，在慢性肾脏病（CKD）的早期阶段似乎也存在。它是心血管疾病的一个危险因素，也是该人群中一个重要的潜在治疗靶点。在 CKD 已知的病理生理异常的背景下，对胰岛素抵抗进行了测量。
最新发现
CKD 中的胰岛素抵抗是由于存在多种已知的危险因素（如肥胖）和独特的代谢异常。CKD 中的胰岛素抵抗部位定位于骨骼肌。基于空腹胰岛素浓度的估计值可能不能充分反映 CKD 中的胰岛素抵抗，因为它们主要反映了肝脏缺陷，而且 CKD 会损害胰岛素的代谢。有多种动态测试可用于直接测量胰岛素介导的葡萄糖摄取。
总结
胰岛素抵抗可能是 CKD 中的一个重要治疗靶点。有多种互补的方法可用于评估胰岛素抵抗，每种方法都有其独特的优点、缺点和复杂程度。在设计和解释临床研究时，必须考虑这些特征以及 CKD 改变某些胰岛素抵抗测量结果的可能性。
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