Davis T A, Klahr S, Karl I E
Am J Physiol. 1987 Jan;252(1 Pt 2):F138-45. doi: 10.1152/ajprenal.1987.252.1.F138.
Insulin resistance has been demonstrated in chronic renal failure patients and may be improved by exercise training, but the mechanisms have not been identified. In this study, the response of glucose uptake, glycogen synthesis, and glucose utilization via glycolysis (glycolytic utilization) to stimulation by insulin and/or acute exercise were determined in isolated muscles from rats with moderate renal insufficiency that were exercise trained or remained sedentary. Moderate renal insufficiency had no effect on the basal rate, insulin sensitivity, or insulin responsiveness of glucose uptake, glycogen synthesis, or glycolytic utilization in muscle. The enhanced insulin responsiveness of both glycogen synthesis and glucose uptake following acute exercise, noted in control animals, was less in rats with moderate renal insufficiency, but the enhanced basal rate and insulin sensitivity after exercise were unaffected by moderate renal insufficiency. Exercise training increased the insulin sensitivity and responsiveness of muscle glucose uptake and glycolytic utilization in rats with moderate renal insufficiency and in controls. The effects of acute exercise and exercise training on insulin responsiveness of glucose uptake were additive in controls but not in animals with moderate renal insufficiency. These findings are compatible with the concept that moderate renal insufficiency is associated with a postreceptor defect in insulin's action in muscle, detectable only following maximal stimulation of glucose transport by insulin and exercise, and partially correctable by exercise training.
胰岛素抵抗在慢性肾衰竭患者中已得到证实，运动训练可能会改善这种情况，但具体机制尚未明确。在本研究中，我们测定了来自中度肾功能不全大鼠且经过运动训练或保持久坐的离体肌肉对胰岛素和/或急性运动刺激的葡萄糖摄取、糖原合成以及通过糖酵解的葡萄糖利用（糖酵解利用）的反应。中度肾功能不全对肌肉中葡萄糖摄取、糖原合成或糖酵解利用的基础速率、胰岛素敏感性或胰岛素反应性没有影响。在对照动物中观察到的急性运动后糖原合成和葡萄糖摄取的胰岛素反应性增强，在中度肾功能不全的大鼠中则较弱，但运动后的基础速率增强和胰岛素敏感性不受中度肾功能不全的影响。运动训练增加了中度肾功能不全大鼠和对照大鼠肌肉葡萄糖摄取和糖酵解利用的胰岛素敏感性和反应性。急性运动和运动训练对葡萄糖摄取胰岛素反应性的影响在对照动物中具有叠加作用，但在中度肾功能不全的动物中并非如此。这些发现与以下概念相符：中度肾功能不全与肌肉中胰岛素作用的受体后缺陷有关，仅在胰岛素和运动对葡萄糖转运进行最大刺激后才可检测到，且可通过运动训练部分纠正。
