氯沙坦对CAPD患者胰岛素抵抗和血脂联素水平的影响  

Impact of angiotensin II receptor blocker Losartan on insulin resistance and serum adiponectin in continuous ambulatory peritoneal dialysis patients

作　　者：潘瑜[1] 金惠敏[1] 

机构地区：[1]上海交通大学医学院附属第三人民医院肾脏内科,上海200043

出　　处：《中国血液净化》2008年第9期471-474,共4页Chinese Journal of Blood Purification

摘　　要：目的探讨氯沙坦对持续不卧床腹膜透析(CAPD)患者胰岛素抵抗和透析充分性的影响以及血脂联素与胰岛素抵抗和透析充分性的相关性。方法选择上海交通大学医学院附属第三人民医院肾脏内科腹膜透析患者25例随机分为腹膜透析组(N=12)、腹膜透析-氯沙坦组(N=13)。13例非透析慢性肾脏疾病患者作为对照组。治疗组给予氯沙坦100mg/d,观察时间6月。分别在0、3、6月测定胰岛素抵抗指数(HOMA-IR)、血脂、残余肾功能和透析充分性。结果腹膜透析-氯沙坦治疗组较对照组和腹膜透析组HOMA-IR水平下降,三酰甘油、血清胆固醇、低密度脂蛋白下降;总Ccr、腹膜Ccr、总Kt/V、腹膜Kt/V提高。CAPD患者脂联素水平与HOMA-IR、三酰甘油、低密度脂蛋白呈正相关;而与腹膜Ccr和腹膜Kt/V呈负相关。结论氯沙坦具有改善CAPD患者胰岛素抵抗和提高透析充分性的作用,能降低CAPD患者增高的血脂联素水平。Objective To observe the impact of angiotensin II receptor blocker Losartan on insulin resistance and dialysis adequacy in continuous ambulatory peritoneal dialysis （CAPD） patients, and to evaluate the correlation of serum adiponectin （ADPN） to insulin resistance and dialysis adequacy. Method We recruited 25 CAPD patients treated in this hospital and randomly divided them into two groups： peritoneal dialysis （PD） group （N=12） and Losartan＋PD group （N=13）. Eight end stage renal disease （ESRD） patients without dialysis were used as the control group. The homeostasis model assessment-insulin resistance index （HOMA-IR）, blood lipids, residual renal function and dialysis adequacy were evaluated at 0, 3 and 6 months after the treatment. Results In Losartan＋PD group, HOMA-IR, triglyceride, cholesterol and low density lipoproteins （LDL） were decreased, whereas total Ccr, peritoneal Ccr, total Kt/V and peritoneal Kt/V were increased, as compared with those in PD group and control group. Serum ADPN was positively correlated to triglyceride, cholesterol and LDL, and nega- tively correlated to peritoneal Ccr and peritoneal Kt/V. Conclusions Losartan improves insulin resistance and dialysis adequacy, and decreases serum ADPN levels in CAPD patients. Serum ADPN positively correlates to triglyceride, cholesterol and LDL, and negatively correlates to peritoneal Ccr and peritoneal Kt/V.

关 键 词：氯沙坦 脂联素 胰岛素抵抗 透析充分性 

分 类 号：R459.5[医药卫生—治疗学]