肾功能不全患者的降糖治疗  

Management of hyperglycemia in patients with diabetes mellitus and chronic kidney disease

作　　者：王昕怡[1] 邵加庆[2] 

机构地区：[1]南京大学医学院临床学院(南京军区南京总医院)内分泌科,南京医学硕士研究生210002 [2]南京大学医学院临床学院(南京军区南京总医院)医务部,南京210002

出　　处：《医学研究生学报》2013年第4期442-446,共5页Journal of Medical Postgraduates

摘　　要：糖尿病(diabetes mellitus,DM)是慢性肾脏疾病(chronic kidney disease,CKD)的主要原因,约44%接受透析的患者首发诊断为DM。DM合并CKD患者的血糖控制对预后有重要影响,同时此类患者的血糖水平和胰岛功能受多种因素影响。CKD早期即可出现胰岛素抵抗,增加了发生高血糖的风险;CKD晚期胰岛素和口服降糖药的清除延迟,导致发生低血糖的风险增高。因此,DM合并CKD的患者面临着高血糖和低血糖的双重风险,对此类患者实行严格的血糖控制并根据肾功能情况合理用药具有重要意义。文中将对不同分期的CKD及特殊治疗阶段如血液透析、腹膜透析和肾移植术后患者的血糖控制进行综述。Diabetes mellitus （DM） is a leading cause of chronic kidney disease （ CKD）, 44% of the patients starting dialysis therapy with DM as their primary diagnosis. Tight glycemic control decreases the risk of adverse kidney outcomes. Chronic renal failure is associated with insulin resistance and, in advanced renal failure, decreases insulin degradation, placing DM patients with CKD at the risk of both hyperglycemia and hypoglycemia. Therefore, it is important to monitor glycemia closely and reduce medication doses appro- priately based on the changes of kidney function in these patients. This article focuses on the appropriate use of available hypoglycemic agents for patients with different stages of CKD and those in special conditions such as hemodialysis, peritoneal dialysis and kidney transplant.

关 键 词：糖尿病 慢性肾病 血糖控制 

分 类 号：R587.1[医药卫生—内分泌]