吡格列酮对初诊2型糖尿病患者肠源性内毒素水平的影响  

Effect of pioglitazone on gut-derived endotoxin in patients with newly-diagnosed type 2 diabetes mellitus

作　　者：王为幸[1] 李晓永[1] 苏青[1] 

机构地区：[1]上海交通大学医学院附属新华医院内分泌科,上海200092

出　　处：《内科理论与实践》2012年第4期293-296,共4页Journal of Internal Medicine Concepts & Practice

摘　　要：目的:观察吡格列酮对初诊2型糖尿病患者肠源性内毒素水平的影响,探讨其改善胰岛素抵抗的可能新机制。方法:97例初诊2型糖尿病患者按随机数字表法随机分为吡格列酮治疗组(49例)和二甲双胍治疗组(48例),治疗3个月后比较治疗前后血清肠源性内毒素及超敏C反应蛋白(hs-CRP)等相关生化指标的变化。以同期性别、年龄相匹配的健康体检者30名作为对照组。结果:①治疗前糖尿病组内毒素及hs-CRP水平均较正常对照组高(P<0.01);②吡格列酮治疗后空腹血糖(FPG)、血浆内毒素、hs-CRP及空腹胰岛素(FINS)水平均明显下降,差异有统计学意义(P<0.05),且内毒素的下降程度与FINS下降程度呈正相关(r=0.475,P<0.01);③二甲双胍治疗后患者FPG及FINS亦明显下降,但内毒素水平无明显改变(P>0.05);④2型糖尿病患者血浆内毒素水平与三酰甘油、总胆固醇、FINS、hs-CRP及稳态模型评估的胰岛素抵抗指数(HOMA-IR)呈正相关(P<0.05),校正性别、年龄及体质量指数(BMI)等影响因素后,HOMA-IR是血浆内毒素的独立相关因素。结论:吡格列酮治疗能降低初诊2型糖尿病患者的肠源性内毒素水平,该作用可能是吡格列酮改善机体胰岛素抵抗状态的机制之一。Objective To observe the effect of pioglitazone on gut-derived cndotoxin in newly-diagnosed patients with type 2 diabetes and to analyze a possible new mechanism of improvement of insulin resistance by pioglitazone. Methods Ninety seven newly-diagnosed type 2 diabetic patients were divided randomly into pioglitazone group （n=49） and metformin group （n=48）. The level of gut-derived endotoxin, high-sensitivity C-reactive protein （hs-CRP）, and other relative biochemical indicators were compared at baseline and after 12 weeks of treatment. Thirty gender- and age- matched healthy subjects served as controls. Results （1） Levels of gut-derived endotoxin and hs-CRP were significantly higher in type 2 diabetic patients than in matched controls （P〈0.01）. （2）Fasting plasma glucose （FPG）, serum gut-derived endotoxin, hs-CRP and fasting insulin （FINS） were reduced significantly after pioglitazone treatment （P〈0.05）, in addition, there was a positive correlation between change in FINS level and change in gut-derived endotoxin level （r=0.475 ,P〈 0.01）. （3）Although FPG and FINS also decreased after metformin treatment, the level of gut-derived endotoxin did not change significantly. （4）In type 2 diabetic patients, gut-derived endotoxin was positively correlated with triglyceride, total cholesterol, FINS, hs-CRP, and homeostasis model assessment of insulin resistance （HOMA-IR） （P〈0.05）. When controlled for gender, age, and body mass index （BMI）, HOMA-IR was an independent correlation factor of serum gut-derived endotoxin level. Conclusions Pioglitazone treatment could reduce gut-derived endotoxin in newly-diagnosed type 2 diabetic patients, which might be one of the factors playing a role in improving insulin resistance.

关 键 词：吡格列酮 2型糖尿病 肠源性内毒素 胰岛素抵抗 

分 类 号：R587.1[医药卫生—内分泌]