Icodextrine and insulin resistance in continuous ambulatory peritoneal dialysis patients
Icodextrine and insulin resistance in continuous ambulatory peritoneal dialysis patients
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DOI：
10.1080/08860220601166271
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发表时间：
2007-01-01
期刊：
影响因子：
3
通讯作者：
Sahin, Gulizar Manga
中科院分区：
文献类型：
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作者：
Canbakan, Mustafa;Sahin, Gulizar Manga
胰岛素抵抗在尿毒症患者中常见。基于葡萄糖的腹膜透析溶液具有长期代谢并发症，如高胰岛素血症、高脂血症和肥胖症。本研究的目的是检查使用含标准葡萄糖和艾考糊精溶液进行持续性非卧床腹膜透析（CAPD）的患者的胰岛素抵抗。我们研究了本中心的所有非糖尿病CAPD患者：44例患者接受CAPD治疗36.2 +/- 23.7个月。其中27人（男11人，女16人），平均年龄为46 - 16岁，用标准葡萄糖溶液（葡萄糖组）。其他17例患者（10例男性和7例女性），平均年龄为49 ± 16岁，白天接受标准葡萄糖溶液治疗，夜间接受艾考糊精留置治疗，中位时间为12 ± 6.3个月（艾考糊精组）。葡萄糖组和艾考糊精组的早晨空腹血清胰岛素水平分别为20.59 +/- 17.86和10.15 +/- 6.87（p = 0.0001）。葡萄糖组的稳态模型评估方法评分显著高于艾考糊精组（4.8 +/- 4.1 vs 2.3 +/- 1.7; p = 0.025）。HOMA评分与胰岛素、空腹血糖和甘油三酯水平呈显著正相关。艾考糊精组20例患者（74%）和葡萄糖组15例患者（88%）患有高血压，但两组之间无统计学显著差异（p = 0.13）。各组的体重指数和血糖、总胆固醇、LDL胆固醇、VLDL胆固醇、HDL胆固醇、甘油三酯、全段甲状旁腺激素（iPTH）和纤维蛋白原的血清水平无显著差异。总之，在CAPD患者中，长期夜间留置使用艾考糊精可降低血清胰岛素水平并增加胰岛素敏感性。
Insulin resistance is commonly observed in uremic patients. Glucose-based peritoneal dialysis solutions have long-term metabolic complications like hyperinsulinemia, hyperlipidemia, and obesity. The purpose of this study was to examine the insulin resistance in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) with standard glucose and icodextrin containing solutions. The entire non diabetic CAPD patients of our center were studied: forty-four patients in all who were on CAPD treatment for 36.2 +/- 23.7 months. Twenty-seven of them (11 male and 16 female) with a mean age of 46 16 years were treated with standard glucose solutions (glucose group). The other 17 patients (10 male and 7 female) with a mean age of 49 16 years were treated with standard glucose solutions during the day and icodextrin dwell during the night, for a median of 12 6.3 months (icodextrin group). Morning fasting serum insulin levels were 20.59 +/- 17.86 in the glucose group and 10.15 +/- 6.87 in the icodextrin group (p = 0.0001).Homeostasis Model Assessment Method scores of the glucose group were significantly higher (4.8 +/- 4.1 vs 2.3 +/- 1.7; p = 0.025) than the icodextrin group. A significant positive correlation of HOMA score with insulin, fasting plasma glucose, and triglyceride levels were found in HOMA (IR+) patients. Twenty patients of the icodextrin group (74%) and 15 patients of the glucose group (88%) were hypertensive, but there was no statistically significant difference between the two groups (p = 0.13). The groups showed no significant differences for body mass index and serum levels of glucose, total cholesterol, LDL cholesterol, VLDL cholesterol, HDL cholesterol, triglyceride, intact parathyroid hormone (iPTH), and fibrinogen. In conclusion, the use of icodextrin in the long nighttime dwell can reduce serum insulin levels and increase insulin sensitivity in CAPD patients.