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尿毒症患者几乎总是有胰岛素抵抗性,并且约有一半患者胰岛素分泌增多,籍此尚足以使糖耐量维持正常。而另一半患者的胰岛素分泌仍如常即呈现出糖耐量异常。有关这部分患者的胰岛素分泌受抑制的机理还不十分清楚。近来发现,可能是血液中甲状旁腺激素(PTH)浓度增高抑制了尿毒症患者胰岛素分泌,也可能与维生素D缺乏有关。为此,作者进行了一项临床试验,旨在检验补充1,25-二羟维生素D_3后是否能改善终末期肾衰竭患者的胰岛素分泌和糖耐量。
Uremic patients are almost always insulin resistant, and about half of patients have increased insulin secretion, which is sufficient to maintain normal glucose tolerance. The remaining half of patients with insulin secretion is still normal, showing abnormal glucose tolerance. The mechanism of inhibition of insulin secretion in this part of the patients is not yet clear. Recently, it was discovered that the increase of parathyroid hormone (PTH) concentration in the blood may inhibit insulin secretion in patients with uremia and may also be related to vitamin D deficiency. To this end, the authors conducted a clinical trial to test whether supplementing 1,25-dihydroxyvitamin D 3 can improve insulin secretion and glucose tolerance in patients with end-stage renal failure.