艾塞那肽对糖调节受损肥胖者血胰岛素及胰岛素抵抗的影响  

Effect of exenatide on serum insulin level and insulin resistance in obese subjects with impaired glucose regulation

作　　者：蒋建家[1] 牟伦盼[1] 林振忠[2] 孙炳庆[3] 苏劲波[1] 吴玉英[1] 庄玉君[1] 明德松[2] 

机构地区：[1]福建医科大学附属泉州第一医院内分泌科,362000 [2]福建医科大学附属泉州第一医院检验科,362000 [3]福建医科大学附属泉州第一医院影像科,362000

出　　处：《中华糖尿病杂志》2013年第8期481-485,共5页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：基金项目：泉州市科技计划项目（20LOZ21）

摘　　要：目的探讨艾塞那肽对糖调节受损（IGR）肥胖者血胰岛素及血糖的影响。方法选取2011年5月至2012年11月在福建医科大学附属泉州第一医院就诊的75例糖调节受损（IGR）肥胖者为研究对象，其中62例受试者符合入选条件，按基线胰岛素水平分为高胰岛素血症（HIns，32例）与非高胰岛素血症（NHIns，30例）2组，HIns以空腹胰岛素≥15mU／L和（或）口服葡萄糖耐量试验（OGTr）2h胰岛素≥80mU儿作为切点。测定基线及应用艾塞那肽5d及14d时的空腹与OGTF2h血浆血糖、胰岛素、C肽、体重等指标。以稳态模型评估的胰岛素抵抗指数（HOMA-IR）及Gutt胰岛素敏感指数评估胰岛素抵抗及敏感性。同一组治疗前后比较采用配对t检验，组间均数比较采用单因素方差分析，率的比较采用x。检验。结果两组的空腹及OGTr2h血糖在用药5d时较基线下降（t=4．42、9．78、4．00、8．66，均P〈0．05），HIns组空腹胰岛素在用药5d时较基线下降（t=2．07，P〈0．05），OGTr2h胰岛素在用药5d较基线时下降，用药14d较5d时进一步下降（F=24．17，P〈0．05）。HIns组HOMA—IR在用药5d时较基线下降（t=3．27，只〈0．05）。NHIns组HOMA—IR在用药5d及14d时较基线均无下降（均P〉0．05），HIns组Gutt胰岛素敏感指数在用药5d时较基线升高（t=-9．84，P〈0．05），14d时较5d时进一步升高（F=55．96，P、遗0．05）。NHIns组Gutt胰岛素敏感指数在用药5d时较基线升高（t=-4．27，P〈0．05）。HIns组与NHIns组体重在5d时较基线无下降，14d时均较5d时明显下降（t=14．13、12．00，均P〈0．05）。结论IGR肥胖人群短期应用艾塞那肽即可获益调节血糖、改善胰岛素抵抗、控制体重。Objective To investigate the effect of exenatide on serum insulin and plasma glucose in obese subjects with impaired glucose regulation（IGR）. Methods A total of 75 obese subjects with IGR were enrolled from May 2011 to November 2012 in Quanzhou First Hospital Affiliated Fujian Medical University. A total of 62 eligible subjects were divided into the hyperinsulinemia group （ HIns, fasting serum insulin t〉 15 mU/L and （or）2-hour serum insulin 〉i 80 mU/L post glucose load, n = 32 ） and the non- hyperinsulinemia group （ NHIns, n = 30 ） by the serum insulin level Fasting and 2h plasma glucose in OG~, insulin , C-peptide and body weight were measured at the baseline, D5 and D14 of exenatide treatment. Insulin resistance was evaluated by the homeostasis model assessment （HOMA-IR） and the gutt insulin sensitivity index. Paired t test was used to test within group change. One-way ANOVA was applied to compare differences of continuous variables between subgroups. Rates were compared by using the X2 test. Results Compared with the baseline, fasting and 2 h glucose significantly improved at D5 in the two groups, but without further decrease at D14 in the two groups （ t = 4.42, 9.78, 4.00, 8.66 with all P 〈 0.05 ）. Compared with the baseline, the fasting insulin significantly decreased at D5 in the HIns group（ t =2.07,P 〈0.05）. The 2 h insulin level significantly decreased at D5 with further reduction at D14 in the HIns group（ F = 24.17,P 〈 0.05 ）. No significant decrease was observed with the fasting and 2 h insulin in the NHIns group at D5 and D14. HOMA-IR significantly decreased at D5 in the HIns groups（t = 3.27 ,P 〈 0.05）, while showed no change at D5 and D14 in the NHIns group（all P 〉0.05）. Gutt insulin sensitivity index increased at D5 in the HIns groups（ t = - 9.84, P 〈 0.05 ） with further increase at D14 （ F = 55.96, P 〈 0.05）. Compared with the baseline, the Gutt insulin sensitivity index significantly increased at D5 in the NHIns group（ t = -4.27, P

关 键 词：艾塞那肽 肥胖 糖调节受损 高胰岛素血症 

分 类 号：R587.1[医药卫生—内分泌]