Deger Serpil Muge, Wang Ping, Fissell Rachel, Ellis Charles D, Booker Cindy, Sha Feng, Morse Jennifer L, Stewart Thomas G, Gore John C, Siew Edward D, Titze Jens, Ikizler Talat Alp
Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA.
CSRD&D, Veterans Administration Tennessee Valley Healthcare System, Nashville, TN, USA.
J Cachexia Sarcopenia Muscle. 2017 Jun;8(3):500-507. doi: 10.1002/jcsm.12179. Epub 2017 Feb 1.
Recent data suggest that sodium (Na ) is stored in the muscle and skin without commensurate water retention in maintenance hemodialysis (MHD) patients. In this study, we hypothesized that excessive Na accumulation would be associated with abnormalities in peripheral insulin action.
Eleven MHD patients and eight controls underwent hyperinsulinemic-euglycemic-euaminoacidemic clamp studies to measure glucose (GDR) and leucine disposal rates (LDR), as well as lower left leg Na magnetic resonance imaging to measure Na concentration in the muscle and skin tissue.
The median GDR and LDR levels were lower, and the median muscle Na concentration was higher in MHD patients compared with controls. No significant difference was found regarding skin Na concentration between group comparisons. Linear regression revealed inverse relationships between muscle Na concentration and GDR and LDR in MHD patients, whereas no relationship was observed in controls. There was no association between skin Na content and GDR or LDR in either MHD patients or controls.
These data suggest that excessive muscle Na content might be a determinant of IR in MHD patients, although the causality and mechanisms remain to be proven.
近期数据表明，维持性血液透析（MHD）患者的肌肉和皮肤中储存有钠（Na），但没有相应的水分潴留。在本研究中，我们假设过量的钠蓄积与外周胰岛素作用异常有关。
11例MHD患者和8例对照者接受了高胰岛素-正常血糖-正常氨基酸钳夹试验，以测量葡萄糖处置率（GDR）和亮氨酸处置率（LDR），并进行左小腿下部钠磁共振成像，以测量肌肉和皮肤组织中的钠浓度。
与对照组相比，MHD患者的GDR和LDR中位数较低，肌肉钠浓度中位数较高。组间比较中，皮肤钠浓度未发现显著差异。线性回归显示，MHD患者肌肉钠浓度与GDR和LDR呈负相关，而对照组未观察到相关性。MHD患者和对照组的皮肤钠含量与GDR或LDR均无关联。
这些数据表明，尽管因果关系和机制仍有待证实，但肌肉钠含量过高可能是MHD患者胰岛素抵抗的一个决定因素。
