厄贝沙坦对维持血液透析患者胰岛素抵抗影响的相关研究

目的探讨厄贝沙坦对维持血液透析患者胰岛素抵抗的影响。方法以40例稳定规律透析且近2周未用血管紧张素AT1受体阻滞剂或血管紧张素转化酶抑制剂药物的血液透析患者为研究对象，逐步换用厄贝沙坦降压并使血压保持基本稳定，分别于换用厄贝沙坦降压治疗前及治疗5周和10周时，透析当天空腹抽血检测血生化、空腹血糖和空腹胰岛素，评估胰岛素抵抗指数。结果提示厄贝沙坦治疗后患者高密度脂蛋白、甘油三酯、血肌酐、尿素氮、白蛋白、血钾、甲状旁腺素和空腹血糖无明显变化，总胆固醇、低密度脂蛋白有所下降，但空腹胰岛素由（13．5-4-3．7）uIU／m1降至（9．1±2．3）uIU／ml，且胰岛素抵抗指数由（3．5±1．5）降至（2．2±0．8），治疗前后比较差异有统计学意义（P〈0．01）。结论厄贝沙坦能改善稳定规律血液透析患者胰岛素抵抗状态。

Related research on effects of irbesartan to insulin resistance in patients with maintenance hemodialysis

Objective To investigate the effect of irbesartan in the treatment of insulin resistance in patients with maintenance hemodialysis. Methods Forty patients undergoing maintenance hemodialysis without ARB or ACEI within 2 weeks were enrolled. Anti-hypertensive agents were replaced by irbesartan gradually to maintain stable blood pressure. Before and after 5 or 10 weeks of treatment, blood biochemical profiles, fasting blood glucose, fasting plasma insulin, insulin resistance index （HOMA-IR） were recorded. Results Our results showed that irbesartan did not affect high-density lipoprotein （HDL）, triglyceride（TG）, SCr, BUN, Alb, K^＋, and PTH, although led to a significant decrease in total cholesterol （TC） and low density lipoprotein （LDL）. Following irbesartan treatment, FPG did not change significantly, but fasting insulin decreased from （13.5±3.7） uIU/ml to （9.1±2.3） uIU/ml at 10 week （P〈0.01） and HOMA.IR decreased from （3.5±1.5） to （2.2±0.8） at 10 week （P〈0.01）. Conclusion These results suggest that insulin relsistance in patients with MHD may be improved by irbesartan.