Dzúrik R, Spustová V, Janeková K
Institute of Preventive and Clinical Medicine, Bratislava, Slovakia.
Nephron. 1995;69(3):281-5. doi: 10.1159/000188471.
Patients with advanced renal failure suffer from almost constant insulin resistance (IR) which is a major risk factor of atherosclerosis and very probably also of glomerulosclerosis. However, data on IR in kidney disease patients with mild-to-moderate kidney function decrease are lacking. A group of 52 patients with various kidney diseases and decreased kidney function of different degree but not with advanced renal failure was evaluated. Almost half of them suffered from IR though they did not differ from insulin-sensitive patients in age, sex, prevalence of various kidney diseases, hypertension, clearance of endogenous creatinine, serum creatinine, urea, uric acid, hippurate or pseudouridine concentrations. They did not differ in the prevalence and degree of metabolic acidosis or in the concentration of plasma and total and free magnesium in erythrocytes. They were just slightly more obese and their serum TG and VLDL concentrations were increased and HDL concentration decreased. It is concluded that IR and dyslipoproteinemia develop in the early stages of kidney diseases and could participate in kidney disease progression since the beginning of kidney disease. It is suggested that early treatment of these alterations could decrease the progression of kidney disease more effectively than their treatment in advanced stages.
晚期肾衰竭患者几乎持续存在胰岛素抵抗（IR），这是动脉粥样硬化的主要危险因素，很可能也是肾小球硬化的主要危险因素。然而，关于轻度至中度肾功能减退的肾病患者的胰岛素抵抗数据尚缺。对一组52例患有各种肾病且肾功能有不同程度减退但未处于晚期肾衰竭的患者进行了评估。其中近一半患者存在胰岛素抵抗，尽管他们在年龄、性别、各种肾病的患病率、高血压、内生肌酐清除率、血清肌酐、尿素、尿酸、马尿酸盐或假尿嘧啶浓度方面与胰岛素敏感患者并无差异。他们在代谢性酸中毒的患病率和程度、血浆以及红细胞中总镁和游离镁的浓度方面也无差异。他们只是略胖一些，血清甘油三酯（TG）和极低密度脂蛋白（VLDL）浓度升高，高密度脂蛋白（HDL）浓度降低。得出的结论是，胰岛素抵抗和血脂蛋白异常在肾病早期就会出现，并且可能从肾病一开始就参与了肾病的进展。建议对这些改变进行早期治疗比在晚期治疗能更有效地降低肾病的进展。
