谷氨酰胺降低2型糖尿病患者血糖的机制探讨  

A study on the action and mechanism of glutamine in reducing postprandial glycemia in type 2 diabetes mellitus

作　　者：杨露[1] 成玮[1] 丁长花[1] 宋敬云 林红梅[1] 胡艳艳[2] 陈晶波[1] 黄勤[1] 

机构地区：[1]第二军医大学附属长海医院内分泌科,上海200433 [2]上海市第十人民医院内分泌科,上海200072

出　　处：《东南国防医药》2015年第2期127-130,178,共5页Military Medical Journal of Southeast China

摘　　要：目的明确口服谷氨酰胺（glutamine,Glu）是否通过升高胰高糖素样肽-1（glucagon-like peptide-1,GLP-1）对早期2型糖尿病（type 2 diabetes mellitus,T2DM）患者餐后血糖和胰岛功能有改善作用。方法选取9例血糖控制良好且病程小于3年的T2DM患者,首次试验患者晨起空腹仅给予低脂餐（作为对照组）,第二次试验用低脂餐前口服100 mg西格列汀,第三次试验用低脂餐前口服30 g Glu,每次试验间隔1-2周,观察进餐前后血糖、胰岛素、C肽、胰高糖素样肽-1（glucagon-like peptide-1,GLP-1）等水平及曲线下面积（area under curve,AUC）。结果与对照组比较,Glu和西格列汀均可显著降低餐后血糖水平（均P〈0.05）,且Glu的早期降低血糖作用更为明显（P〈0.01）;与对照组比较,Glu组GLP-1水平在进餐后呈增高趋势,葡萄糖依赖性促胰岛素分泌多肽（glucose-dependent insulinotropic peptide,GIP）水平在餐后60 min到180 min间显著升高（P〈0.05）;与自身基线值（空腹）比,服用Glu后血游离脂肪酸（free fatty acids,FFA）水平在餐后60、120和180 min均显著降低（均P〈0.05）。结论 Glu可升高GLP-1水平,改善早期T2DM患者餐后血糖,疗效与西格列汀相当,但确切机制尚未阐明。Objective To test whether glutamine（Glu） ameliorates postprandial glycemia and pancreatic islet function through elevation of glucagon-like peptide-1（GLP-1） in subjects with early-stage type 2 diabetes mellitus（T2DM）.Methods We recruited 9 type 2 diabetics in good glycemic control and with duration less than 3 years.Subjects were given low-fat breakfast only on the first visit.100 mg sitagliptin and 30 g glutamine（Glu） were administered before the low-fat meal respectively on the second and the third visits.Visits were conducted 1-2 weeks apart.Blood glucose,insulin,C-peptide,GLP-1 of each patient before and after the meal were assayed.The measurement and area under curve（AUC） of each parameter were analyzed.Results Compared with control,Glu and sitagliptin both significantly reduced postprandial glycemic response（both P〈0.05） and it had a more obvious effect in reducing postprandial glycemia at an early stage（P〈0.01）.Compared with control,Glu tended to increase postprandial GLP-1 levels and significantly increased glucose-dependent insulinotropic peptide（GIP） levels 60 to 180 minutes after the meal（P〈0.05）.Compared with their own baseline values,subjects on glutamine tended to have higher postprandial levels of GLP-1 and significantly higher levels of GIP 60 to 180 minutes after the meal（P〈0.05）.Compared with its baseline values,Glu caused a more pronounced reduction in serum free fatty acid（FFA） levels at the 60,120 and 180 minutes postprandially（all P〈0.05）.Conclusion Glu could increase circulating GLP-1 levels and alleviate postprandial glycemia in patients with early-stage T2 DM.The therapeutic effect of Glu is close to that of sitagliptin but the exact mechanism remains to be elucidated.

关 键 词：2型糖尿病 谷氨酰胺 胰高糖素样肽-1 葡萄糖依赖性促胰岛素分泌多肽 

分 类 号：R587.1[医药卫生—内分泌]