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在观察慢性肾衰胰岛素拮抗发生的基础上,探讨两种类型的血管紧张素转换酶抑制剂（ACEI）对慢性肾衰患者胰岛素拮抗（IR）及糖耐量异常（IGT）的影响。方法:采用口服葡萄糖耐量试验（OGTT）和胰岛素释放试验（IRT）,检测56例不同程度慢性肾衰患者和20例正常对照者空腹及服糖后各时点血糖和胰岛素水平。治疗组20例患者服用苯那普利、20例服用卡托普利,观察两种药物对胰岛素拮抗及糖耐量异常的影响。结果:在肾功能失代偿后各期糖及胰岛素曲线下面积（AUCG、AUCINS）均高于对照组（P<0.05）,而肾功能代偿期AUCG、AUCINS无明显变化。使用两种ACEI治疗前后胰岛素敏感指数（ISI）、机体糖利用率（M）的变化有显著性差异（P<0.05）;与卡托普利组相比,苯那普利组更能提高ISI及M（P<0.05）。结论:IR和IGT存在于大多数尿毒症患者,且在慢性肾功能不全各期有一定差异,以尿毒症组尤为显著;苯那普利较卡托普利更能提高ISI、M,在改善胰岛素敏感性方面更具优势。
To investigate the effects of two types of angiotensin-converting enzyme inhibitors (ACEI) on insulin resistance (IR) and impaired glucose tolerance (IGT) in patients with chronic renal failure, based on the observation of insulin resistance in chronic renal failure. Methods: Oral glucose tolerance test (OGTT) and insulin release test (IRT) were used to detect the fasting blood glucose and insulin levels in 56 patients with chronic renal failure and 20 normal controls. In the treatment group, 20 patients took benazepril and 20 patients took captopril. The effects of two drugs on insulin resistance and impaired glucose tolerance were observed. Results: The area under the curve of glucose and insulin (AUCG, AUCINS) in each stage after decompensation was higher than that in the control group (P <0.05), while the AUCG and AUCINS in the decompensated kidney had no significant changes. There were significant differences in the changes of insulin utilization index (ISI) between the two ACEIs before and after treatment (P <0.05). Compared with the captopril group, the benazepril group improved ISI And M (P <0.05). Conclusion: IR and IGT exist in most patients with uremia, and there are some differences in chronic renal failure in each stage, especially in uremia group; benazepril more than captopril can improve ISI, M, in improving Insulin sensitivity more advantages.