针刺对糖尿病前期患者瘦素及可溶性瘦素受体的影响  

Acupuncture Treatment Reduces Body Weight Possibly by Down-regulating Insulin and Leptin Resistance,and Up-regulating Soluble Leptin Receptor Level in Prediabetic Patients

作　　者：赵智明 刘春丽[2] 张群燕[2] 张蓓蓓[2] 郭郡浩[2] 袁爱红[2] 蔡辉[1,2] ZHAO Zhi-ming;LIU Chun-li;ZHANG Qun-yan;ZHANG Bei bei;GUO Jun-hao;YUAN Ai honge;CAI Hui(The First Clinical Medical College,Nanjing University of Chinese Medicine,Nanjing 210023,China;Department of Integrated Traditional Chinese and Western Medicine,Nanjing General Hospital of People＇ s Liberation Army,Nanjing 210002)

机构地区：[1]南京中医药大学第一临床医学院,南京210023 [2]南京军区南京总医院中西医结合科,南京210002

出　　处：《针刺研究》2018年第8期506-511,共6页Acupuncture Research

基　　金：中国博士后科学基金资助项目(No.20090461491)

摘　　要：目的:观察针刺对糖尿病前期患者血清瘦素(LP)及可溶性瘦素受体(sOB-R)的影响,探讨针刺防治糖尿病前期的可能作用机制。方法:选取糖尿病前期患者100例,依就诊时间顺序按随机数字表法分为针刺组(35例)、二甲双胍组(35例)及生活方式干预组(30例)。3组受试者均采取合理饮食、适度体育锻炼等生活方式干预。针刺组以肺俞、脾俞、胃俞、肾俞、足三里、三阴交为主穴进行针刺,每次留针30min,隔日1次,连续治疗12周。二甲双胍组给予口服二甲双胍片,每次0.5g,每日2次,连续治疗12周。观察各组患者治疗前后空腹血糖(FBG)、餐后2h血糖(2hPBG)、糖化血红蛋白(HbA1C)、血脂、体质量指数(BMI)、腰围(WC)、腰臀比(WHR)、胰岛素(FINS)、胰岛素敏感指数(HOMA-IR),以及血清LP及sOB-R水平的变化。结果:针刺组及二甲双胍组治疗后FBG、2hPBG、HbA1C、总胆固醇(TC)和甘油三酯(TG)均较治疗前明显下降(P<0.05,P<0.01),较生活方式干预组治疗后显著下降(P<0.05,P<0.01)。生活方式干预组治疗后与治疗前比较FBG明显下降(P<0.05)。针刺组治疗后BMI较治疗前及生活方式干预组明显下降(P<0.05);二甲双胍组治疗后与治疗前比较,BMI、WC和WHR均显著下降(P<0.01)。针刺组治疗后FINS、HOMA-IR、LP较治疗前明显下降(P<0.05,P<0.01),与生活方式干预组治疗后比较,HOMA-IR、LP显著下降(P<0.05,P<0.01);二甲双胍组治疗后与治疗前比较,FINS、HOMA-IR、LP均显著下降(P<0.01),与生活方式干预组治疗后比较显著下降(P<0.05,P<0.01)。针刺组及二甲双胍组治疗后与治疗前比较,sOB-R显著上升(P<0.01),且较生活方式干预组治疗后显著升高(P<0.01)。结论:针刺可以降低糖尿病前期患者FINS,减轻胰岛素抵抗和LP抵抗水平,该作用可能与针刺升高sOB-R水平有关。Objective To observe the effect of acupuncture of Feishu（BL 13）,Pishu（BL 20）,etc.on body weight,blood lipid,leptin（LP）and soluble leptin receptor（sOB-R）levels in prediabetic patients,so as to explore its mechanisms underlying treatment and prevention of prediabetes.Methods A total of 100 prediabetic patients were randomly assigned to medication（Metformin）group（n=35）,acupuncture group（n=35）and simple lifestyle intervention group（n=30）with random number table method.All the patients of the 3 groups were treated with lifestyle intervention（reasonable diet and moderate physical exercise）and ordered to stop administration of any hypoglycemic drugs during the treatment period.Bilateral Feishu（BL 13）,Pishu（BL 20）,Weishu（BL 21）,Shenshu（BL 23）,Zusanli（ST 36）and Sanyinjiao（SP 6）were punctured with filiform needles which were manipulated by lifting,thrusting and twirling repeatedly for about 2 min every 5 min during 30 minutes＇ needle retaining.The acupuncture treatment was conducted once every other day for 12 weeks.Patients of the medication group were ordered to orally take Metformin tablets（0.5 g/time,twice a day）for continuous 12 weeks.Body mass index（BMI）,waist circumference（WC）,waist-to-hip ratio（WHR）,2 h-postprandial blood glucose（2 h-PBG）,fasting blood glucose（FBG）,glycosylated hemoglobin（HbA1 c）,total cholesterol（TC）,triglyceride（TG）,fasting insulin（FINS）,serum LP and sOB-R levels were measured before and after the treatment.Results After the treatment,the BMI in the acupuncture group,and BMI,WC and WHR in the medication group were significantly decreased relevant to their own pre-treatment in each group（P〈0.05,P〈0.01）.Following the treatment,the levels of FBG,2 h-PBG,HbA1 C,TC,TG,FINS,HOMA-IR and LP in both acupuncture and medication groups,and FBG in the simple lifestyle intervention group were significantly decreased in comparison with their own pre-treatment in each group（P〈0.01,P〈0.05）,and the

关 键 词：糖尿病前期 针刺 瘦素 可溶性瘦素受体 胰岛素抵抗 

分 类 号：R246.1[医药卫生—针灸推拿学]