胰岛素对近端肾小管葡萄糖处理的影响:系统评价。
Effect of Insulin on Proximal Tubules Handling of Glucose: A Systematic Review.
机构信息
Department of Internal Medicine, School of Medical Sciences, University of Campinas, Zip Code: 13083-887, Brazil.
出版信息
J Diabetes Res. 2020 Jan 10;2020:8492467. doi: 10.1155/2020/8492467. eCollection 2020.
Renal proximal tubules reabsorb glucose from the glomerular filtrate and release it back into the circulation. Modulation of glomerular filtration and renal glucose disposal are some of the insulin actions, but little is known about a possible insulin effect on tubular glucose reabsorption. This review is aimed at synthesizing the current knowledge about insulin action on glucose handling by proximal tubules. . A systematic article selection from Medline (PubMed) and Embase between 2008 and 2019. 180 selected articles were clustered into topics (renal insulin handling, proximal tubule glucose transport, renal gluconeogenesis, and renal insulin resistance). . Insulin upregulates its renal uptake and degradation, and there is probably a renal site-specific insulin action and resistance; studies in diabetic animal models suggest that insulin increases renal SGLT2 protein content; human studies on glucose transport are few, and results of glucose transporter protein and mRNA contents are conflicting in human kidney biopsies; maximum renal glucose reabsorptive capacity is higher in diabetic patients than in healthy subjects; glucose stimulates SGLT1, SGLT2, and GLUT2 in renal cell cultures while insulin raises SGLT2 protein availability and activity and seems to directly inhibit the SGLT1 activity despite it activating this transporter indirectly. Besides, insulin regulates SGLT2 inhibitor bioavailability, inhibits renal gluconeogenesis, and interferes with NaKATPase activity impacting on glucose transport. . Available data points to an important insulin participation in renal glucose handling, including tubular glucose transport, but human studies with reproducible and comparable method are still needed.
肾脏近曲小管从肾小球滤液中重吸收葡萄糖并将其释放回循环中。调节肾小球滤过和肾脏葡萄糖处置是胰岛素的作用之一,但对于胰岛素对肾小管葡萄糖重吸收的可能作用知之甚少。本综述旨在综合目前关于胰岛素对近曲小管葡萄糖处理作用的知识。从 Medline(PubMed)和 Embase 中进行了 2008 年至 2019 年的系统性文章选择。选择了 180 篇文章,将其聚类为主题(肾脏胰岛素处理、近曲小管葡萄糖转运、肾脏糖异生和肾脏胰岛素抵抗)。胰岛素上调其肾脏摄取和降解,可能存在肾脏特异性胰岛素作用和抵抗;糖尿病动物模型的研究表明,胰岛素增加肾脏 SGLT2 蛋白含量;关于葡萄糖转运的人体研究较少,人体肾脏活检中葡萄糖转运蛋白和 mRNA 含量的结果存在冲突;糖尿病患者的最大肾脏葡萄糖重吸收能力高于健康受试者;葡萄糖在肾细胞培养物中刺激 SGLT1、SGLT2 和 GLUT2,而胰岛素增加 SGLT2 蛋白的可利用性和活性,尽管它间接激活该转运体,但似乎直接抑制 SGLT1 活性。此外,胰岛素调节 SGLT2 抑制剂的生物利用度,抑制肾脏糖异生,并干扰 NaKATPase 活性,从而影响葡萄糖转运。现有数据表明胰岛素在肾脏葡萄糖处理中起着重要作用,包括肾小管葡萄糖转运,但仍需要具有可重复和可比方法的人体研究。
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