二甲双胍对代谢综合征患者葡萄糖代谢率及脂肪因子水平的影响  

Effects of Metformin on Glucose Metabolic Rate and Adipokins in Patients with Metabolic Syndrome

作　　者：叶建红[1] 黎锋[2] 刘天[1] 麦伟华[1] 郎江明[1] 

机构地区：[1]广州中医药大学附属佛山市中医院内分泌科,佛山528000 [2]中山大学附属第二医院内分泌科,广州510120

出　　处：《华中科技大学学报（医学版）》2011年第2期173-177,共5页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：广东省科技计划(No.2007B080702015);广东省医学科研基金(No.A2007632);佛山市科技攻关计划(No.200708018)资助项目

摘　　要：目的探讨代谢综合征（MS）患者葡萄糖代谢率（M）、脂肪水平变化及二甲双胍治疗对其的影响。方法筛选36~60岁MS患者15例和健康对照组20例。采用高胰岛素-正常血糖钳夹技术检测M,评估胰岛素抵抗（IR）程度;检测血浆、血浆抵抗素（resistin）、脂联素（adiponectin）、瘦素（leptin）浓度及空腹胰岛素（FINS）、血糖、血脂等生化指标。MS患者给予二甲双胍500 mg口服,3次/d,治疗12周,于治疗结束后重复检测M、血浆resistin、adiponectin与leptin浓度等。结果①MS组的腰围（WC）、体重指数（BMI）、空腹血糖（FPG）、2h血糖（2hPG）、FINS及甘油三酯（TG）等均显著高于对照组,高密度脂蛋白-胆固醇（HDL-C）明显低于对照组,差异均有统计学意义（均P〈0.05）。高胰岛素正常血糖钳夹试验稳态时（120~150 min）,MS组的M显著低于对照组,差异有统计学意义（P〈0.01）。两组的血浆resistin水平无显著性差异（P〉0.05）;MS组的血浆leptin水平显著高于对照组,adiponectin水平显著低于对照组,差异均有统计学意义（均P〈0.01）。②治疗12周后,MS组的BMI、WC、FINS、FPG及2hPG明显降低,与治疗前相比差异均有统计学意义（P〈0.05,P〈0.01）,TG、胆固醇（TC）、HDL-C及低密度脂蛋白-胆固醇（LDL-C）等无显著性变化。③治疗前后M分别为（4.01±1.29）和（6.53±1.15）mg·kg-1·min-1,治疗12周后,MS组M明显升高（P〈0.05）。④治疗前后MS组血浆resistin,adiponectin水平无显著变化（均P〉0.05）,leptin水平显著降低（P〈0.01）。结论二甲双胍治疗可以减轻MS患者的IR,其机制可能与体重减轻及leptin抵抗改善有关。Objective To investigate the effects of metformin on glucose metabolic rate（M）and plasma resistin,adiponectin and leptin levels in patients with metabolic syndrome（MS）.Methods Fifteen patients with MS aged from 36 to 60 years were selected as MS group,and 20 healthy adults served as control group.Glucose metabolic rate was evaluated by using hyperinsulinemic euglycemia clamp technique.Plasma adiponectin and leptin concentrations were determined by using enzyme linked immunosorbent assay.Blood pressure,waist circumference（WC）and body mass index（BMI）were measured.The patients in MS group were given metformin（500 mg every time,three times every day for 12 weeks）.After treatment,M and plasma resistin,adiponectin and leptin levels were evaluated secondly.Results ①WC,BMI,FPG,2-h plasma glucose（2hPG）,FINS and TG in MS group were significantly higher than those in control group（P0.05 for all）.During the steady state（120-150 min）in the hyperinsulinemic euglycemia clamp,M in MS group was significantly lower than that in control group（P0.01）.There was no significant difference in plasma resistin levels between MS group and control group（P0.05）.Plasma adiponectin levels in MS group were significantly lower than those in control group（P0.01）.Plasma leptin levels in MS group were significantly higher than those in control group（P0.01）;②After treatment for 12 weeks,BMI,WC,FINS,FPG and 2hPG were significantly decreased（P0.05,P0.01）,while TG,TC,HDL-C and LDL-C had no significant change（P0.05）;③After treatment for 12 weeks,M was significantly increased[（4.01±1.29） vs（6.53±1.15） mg·kg-1·min-1,P0.05];④After treatment for 12 weeks,plasma resistin and adiponectin levels had no significant change（P0.05 for each）.Plasma leptin levels were significantly decreased after treatment for 12 weeks（P0.01）.Conclusion In patients with MS,metformin treatment improved insulin sensitivity and decreased plasma leptin levels significantly without significant changes of

关 键 词：代谢综合征 高胰岛素-正常血糖钳夹试验 葡萄糖代谢率 二甲双胍 脂肪因子 

分 类 号：R589[医药卫生—内分泌]