高通量血液透析对糖尿病肾病维持性血液透析患者胰岛素抵抗的影响

目的 观察高通量血液透析对糖尿病肾病维持性血液透析患者胰岛素抵抗的影响.方法 选择南京医科大学附属无锡人民医院透析中心糖尿病肾病维持性血液透析患者60例,随机分为高通量透析和低通量透析2组,治疗3个月,分别观察2组患者治疗前、后稳态模式评估法评价的胰岛素抵抗指数(homeostasis model assessment of insulin resistance index,HOMA-IR)、白细胞介素6(interleukin6,IL-6)、甲状旁腺素(parathyroid hormone,PTH)、Kt/V等指标的变化.结果 高通量组的HOMA-IR、IL-6、PTH均较治疗前有显著下降(P＜0.05),而低通量组的HOMA-IR、IL-6、PTH治疗前后差异无统计学意义(P＞0.05).结论 高通量透析较低通量透析能明显改善糖尿病肾病终末期肾衰竭维持性血液透析患者的胰岛素抵抗.

Effect of high-flux hemodialysis On insulin resistance in diabetic kidney disease patients with maintenance hemodialysis

Objective To investigate the effect of high-flux hemodialysis on insulin resistance in diabetic kidney disease patients with maintenance hemodialysis.Methods We recruited 60 diabetic kidney disease patients with maintenance hemodialysis and randomly divided them into two groups.Patients in each group were treated using either Fx 60（high-flux dialyzer） or F7 HPS（low-flux dialyzer） for 3 months.Fasting blood glucose,hemoglobin Alc,fasting insulin,IL-6,PTH,etc.,were determined at the start and end of the study.Results No changes in fasting blood glucose,hemoglobin Alc and kt/v were detected in the 2 groups after the treatment for 3 months,but significant changes in fasting insulin,homeostasis model assessment of insulin resistance index（HOMA-IR）,IL-6 and PTH were found in the high-flux group.Conclusions This short-term study demonstrates that high-flux dialyser provides a better effect on insulin resistance than does the low-flux dialyser for diabetic kidney disease patients on maintenance hemodialysis.