阿卡波糖和非诺贝特对糖耐量低减伴高脂血症患者胰岛素敏感性和β细胞分泌功能的影响  

Effects of acarbose versus fenofibrate on insulin sensitivity and [I cell secretion in impaired glucosetolerance with hypertrigtyceridemia

作　　者：郭行端[1] 刘衍宇[1] 成俊芬[1] 梁金花[1] 叶志东[1] 刘君海[1] 张德良[1] 黄惠莉[1] 

机构地区：[1]广东医学院第二附属医院,湛江524000

出　　处：《中华老年医学杂志》2012年第5期406-409,共4页Chinese Journal of Geriatrics

摘　　要：目的比较阿卡波糖和非诺贝特对糖耐量低减（IGT）合并高三酰甘油（TG）血症患者胰岛素敏感性和胰岛B细胞分泌功能的影响。方法80例入选者平均年龄（53±12）岁，随机分为阿卡波糖组（28例）、非诺贝特（30例）和对照组（22例），为期3个月。治疗前后测空腹血糖（FPG）、餐后2h血糖（2hPG）、血脂，行口服葡萄糖耐量试验（OGTT），计算胰岛素抵抗指数（HOMA—IR）、早相胰岛素分泌指数（A130／△G30）和胰岛细胞分泌指数（HOMA=口）。结果阿卡波糖组治疗后FPG、2hPG和HOMI—IR显著下降（均P〈0．01），△130／△G30和HOMA—B显著改善（分别P〈0．01，P〈0．05）；非诺贝特组治疗后TG、总胆固醇（Tc）和HOMI—IR显著下降（均P〈0．01），A130／AG30显著改善（P〈O．05）；阿卡波糖组改善胰岛素抵抗和早相胰岛分泌功能作用优于非诺贝特组，两者比较差异有统计学意义（分别P〈0．01，P％0．05）。对照组上述指标无改变。A130／△G30改善与FPG、2hPG和TG下降显著相关（r=0．5812，0．6327，0．3872，P〈0．01）；HOMI-IR改善与2hPG、TG、Tc下降呈显著相关（r=0．813、0．467、0．290，P〈0．01）。老年组HOMA—IR、△130／△G30和HOMA—β低于非老年组（P〈0．01），阿卡波糖短期干预治疗改善胰岛素抵抗作用老年组优于非老年组（P〈O．05）。结论随着年龄的增长，胰岛B细胞功能逐渐减退。阿卡波糖短期干预治疗和非诺贝特短期调脂治疗均能改善IGT合并高TG血症患者早相胰岛素分泌，减轻胰岛素抵抗，但阿卡波糖优于非诺贝特，可能减轻糖毒性较减轻脂毒性更有利于IGT合并高TG血症患者胰岛分泌功能及胰岛素抵抗的改善。Objective To investigate the effects of aearbose versus fenofibrate on insulin secretion and insulin resistance in the subjects with impaired glucose tolerance （IGT） and hypertriglyceridemia. Methods Eighty subjects were allocated to acarbose group （28 cases）, fenofibrate group （30 cases）, and control group （22 cases） without intervention for 3 months, and also divided into elderly （46 cases） and younger groups （34 cases）. Fasting blood samples were collected for measuring fasting plasma glucose and lipid. Oral glucose tolerance test （OGTT） were carried out with measurement of plasma insulin and glucose before ad after treatment. Early insulin secretion indexes（AI30//XG30）, insulin secretion indexes （HOMA-） and insulin resistance indexes （HOMA-IR）were calculated. Results After 3-months of treatment, the lipid profile was evidently improved in fenofibrate group. Levels of triglyceride （TG） and total cholesterol （TC） were significantly reduced （ both P 0.01 ）, I30//G30 was significantly increased （ P〈0.05 ） and HOMA-IR was decreased （P〉0.01）. In acarbose group, levels of fasting plasma glucose （FPG）, 2 hours postprandial plasma glucose （2 hPG） and HOMA-IR were reduced （all P〈0.01）, GI30/AG30 and HOMA-were enhanced （P〉0. 01 or P〉O. 05）. No change of above indicators was found in thecontrol group. Compared with fenofibrate group, acarbose group had higher AI30/AG30 （P（0.05）, HOMA-13 （P（0.01） and lower HOMA-IR （P%0.01）. The improvement of zΔGI^0/ΔG30 was correlated with the decreasing of plasma FPG, 2 hPG and TG（r=0. 5812, 0. 6327, 0. 3872, P% 0.01）, while HOMA-IR was related with the decreasing of plasma 2 hPG, TG and TC（r=0. 8126, 0.4671, 0.2895, P%0.01）. HOMA-IR, Δ0/AG30 and HOMA-13 were lower （P%0.01） and acarbose improved insulin resistance better （P（0.05） in the elderly than in the younger with type 2 diabetes. Conclusions Pancreatic 18-cell function declines gradually with aging, acarbose m

关 键 词：糖尿病前期 高甘油三酯血症 胰岛素抗药性 

分 类 号：R587.1[医药卫生—内分泌]