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中华肾病研究电子杂志 ›› 2019, Vol. 08 ›› Issue (03) : 97 -101. doi: 10.3877/cma.j.issn.2095-3216.2019.03.001

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慢性肾脏病的胰岛素抵抗:评估方法的合理应用及营养管理的重新认识
张利1()   
  1. 1. 100853 北京,解放军总医院第一医学中心肾脏病科、解放军肾脏病研究所、肾脏疾病国家重点实验室(2011DAV00088)、国家慢性肾病临床医学研究中心、肾脏疾病研究北京市重点实验室
  • 收稿日期:2019-04-19 出版日期:2019-06-28
  • 通信作者: 张利
  • 基金资助:
    国家"973"计划项目(2015CB553605)

Insulin resistance in chronic kidney disease: rational application of assessment methods and re-recognition of nutrition management

Li Zhang1,()   

  1. 1. Department of Nephrology, First Medical Center of Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
  • Received:2019-04-19 Published:2019-06-28
  • Corresponding author: Li Zhang
  • About author:
    Corresponding author: Zhang Li, Email:
引用本文:

张利. 慢性肾脏病的胰岛素抵抗:评估方法的合理应用及营养管理的重新认识[J]. 中华肾病研究电子杂志, 2019, 08(03): 97-101.

Li Zhang. Insulin resistance in chronic kidney disease: rational application of assessment methods and re-recognition of nutrition management[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2019, 08(03): 97-101.

胰岛素抵抗(IR)是一种组织对胰岛素敏感性降低的病理状态,机体为维持正常血糖水平,导致循环胰岛素的代偿性升高。高胰岛素正常血糖钳夹是IR诊断的金标准,空腹血糖或胰岛素和口服葡萄糖耐量试验估算的胰岛素敏感指数是临床常用替代方法,两者结合可较好的评估慢性肾脏病(CKD)患者的IR。IR在CKD患者普遍存在。导致CKD-IR的机制主要涉及胰岛素受体后信号传导障碍。影响CKD-IR的因素包括不健康饮食、缺乏运动、代谢性酸中毒、贫血、维生素D缺乏、慢性炎症、氧化应激及脂肪因子失衡等。尽管IR与肾脏及心血管事件的相关性尚有争论,但越来越多的研究证实IR是CKD发生、进展及心血管并发症的危险因素。CKD-IR治疗包括:生活方式改变特别是植物为基础的饮食如地中海饮食、高血压防治计划(DASH)饮食、素食等结合有氧运动及阻力运动;二甲双胍、吡格列酮、RAS抑制剂、维生素D等药物治疗;以及透析治疗模式和膜材料的优化。

Insulin resistance (IR) is a pathological state in which target tissues fail to respond normally to insulin. A compensatory rising in circulating insulin to maintain normal blood glucose levels results in hyperinsulinemia. Hyperinsulinemic euglycemic clamp is the gold standard for diagnosis of IR. Insulin sensitivity index estimated by fasting blood glucose or insulin and oral glucose tolerance test is commonly used in clinical practice. The combination of the two methods can better evaluate the IR of patients with chronic kidney disease (CKD). IR is a common alteration in CKD patients. The mechanism leading to CKD-IR mainly involves post-insulin receptor signal transduction disorder. The etiology of CKD-IR includes unhealthy diet, physical inactivity, metabolic acidosis, anemia, vitamin D deficiency, chronic inflammation, oxidative stress, and adipokine derangement, etc. Although there is still debate about the correlation between IR and renal and cardiovascular events, more and more clinical studies have confirmed that IR is an independent risk factor for occurrence or progression of CKD and cardiovascular complications. Interventions including lifestyle modifications, especially plant-based diets such as Mediterranean diet, dietary approaches to stop hypertension (DASH) diet, vegetarian diet, combined with aerobic exercise or resistance exercise, plus pharmacological strategies with metformin, pioglitazone, renin-angiotensin system (RAS) inhibitors, vitamin D, as well as adaptations of dialysis mode and optimization of membrane materials, may improve IR in patients with CKD.

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