中国血液净化

›› 2002, Vol. 1 ›› Issue (9): 10-13.

• 论著 • 上一篇    下一篇

1,25(OH)2D3对尿毒症病人胰岛素分泌低下及胰岛素抵抗的影响

李宓 邹和群 张杰   

  1. 519000 珠海，中山大学第五附属医院（李宓，邹和群） 519000 珠海，暨南大学第三医学院（张杰）
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2002-09-19 发布日期:2002-09-19

  • Received:1900-01-01 Revised:1900-01-01 Online:2002-09-19 Published:2002-09-19

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摘要： 【摘要】目的 了解1,25(OH)2D3对尿毒症血液透析病人的糖耐量异常、胰岛素分泌低下及胰岛素抵抗的影响。方法 将24名尿毒症血液透析病人（平均年龄371岁），分为组，每组12人，治疗组（第一组）口服1，25（OH）2D3，对照组（第二组）口服无活性的维生素D。另设健康对照组6人。在治疗前和治疗4周后对血中以下指标进行检测：①糖耐量。②胰岛素浓度。③胰岛素分泌时相。④胰岛素敏感度⑤甲状旁腺素（PTH）。结果 两组治疗前后PTH无变化。两组治疗前均存在糖耐量异常、胰岛素分泌低下、胰岛素敏感度下降、1，25（OH）2D3浓度下降及甘油三脂升高。第一组治疗4周后上述指标均有明显改善而第二组无明显变化。结论 1，25（OH）2D3可改善尿毒症血液透析病人的胰岛素分泌低下及胰岛素抵抗同时缓解高甘油三脂血症。

关键词: 尿毒症, 血液透析, 胰岛素抵抗

Abstract: 【Abstract】 Objective The effect of oral 1.25-dihydoxyvitamin D3 [1.25(OH)2D3] , therapy on defects in insulin secretion and insulin resistace was examined in patients on maintence hemodialysis (HD). Methods 12 patients (Group I 39&#61617;2 years old)were studied before after four weeks of oral 1，25（OH）2D3therapy (0.25μgqd.Po.), during which time the serum parathyroid hormone (PTH) concentrations did mot change. Another 12 patients (Group II 35&#61617;1years old ) were studide before and after rour weeks of oral dihydrotachysteral (0.8&#61617;0.1 mg).Serum PTH also did not change in Group II. Serum glucose concentration oral glucose tolerance test (OGTT) early-phase and late-phase insulin secretion. Linsulin sensitivity and plasma triglycerides were test before and after four weeks therapy. Rasults serum glucose concentrations during OGTT test were high in GroupI before used 1.25(OH)2D3 comparad with controls and these normalized following four weeks of oral 1.25(OH)2D3. Serum glucose concentrations during OGTT were alse higher in Group II before used vitamin D compared with controls and did not change following four weeks of oral Vtimin D. Insulin sensitivity during studies in Group I before used 1.25(OH)2D3 was low (13&#61617;1.5mmol/m2/min) compared with controls (16&#61617;0.5mmol/m2/min) (P<0.01) and was normalized following therepy (17&#61617;1.2mmol/m2/min P>0.05). Insulin sensitivity was alse low in Group II at the beginning of the study and did not change at the end of the four weeks period. Both early-phase and late-phase insulin secretion were low in Group I before used 1.25(OH)2D3 compared with controls and normalized following oral 1.25(OH)2D3 therapy. Both early-phase and late-phase insulin secretion were also low in Group II at the beginning of the study and did not change after four weeks with Vitimin D treatment. Plasma tirglycerides were elevated in Group I before treatment(2.13&#61617;0.5mmol/l) compared with control (0.75&#61617;0.2mmol/l P<0.01) and were normalized (0.95&#61617;0.12mmol/l P>0.05) following oral 1.25(OH)2D3 therapy. Plasma triglycerides did not change in Group II during the study period. Conclusion Oral 1.25(OH)2D3 therapy corrected glucose intolerance、insulin resistance lypoinsulinemia as well as hypertriglyceridmia in patients on HD.

Key words: Hemodialysis, Insulin resistance