二甲双胍、格列美脲对2型糖尿病患者游离脂肪酸的影响

Effects of glimepiride and metformin on free fatty acid in patients with Type 2 diabetes mellitus

目的 :观察二甲双胍、格列美脲对 2型糖尿病 (T2DM)患者游离脂肪酸 (FFA)的影响 ,并探讨T2DM中FFA与胰岛素抵抗 (IR)的关系。方法 :采用前瞻性、病例对照研究 ,将 94例T2DM患者分成单用格列美脲治疗组(n =33)、单用二甲双胍治疗组 (n =2 9)、两药合用治疗组 (n =32 ) ,疗程 6个月。采用酶比色法测血清游离脂肪酸。结果 :格列美脲组治疗后FFA水平无变化 ,二甲双胍组和两药合用组治疗后FFA水平明显下降 (P <0 .0 5和P <0 .0 0 1)。组间比较 ,治疗后FFA的下降率两药合用组比格列美脲组明显 (P <0 .0 5 )。多元逐步回归分析显示FFA水平与HOMA(homeostasismodelassessment)胰岛素抵抗 (HOMA IR)关系密切 ,且FFA下降率与治疗分组有关。结论 :二甲双胍单用或与格列美脲合用不仅能降低BMI,改善血糖、IR ,还能降低FFA水平 。

Objective To investigate the effect of glimepiride and metformin on free fatty acid(FFA) in patients with Type 2 diabetes mellitus and to further study the relationship between free fatty acid and insulin resistance in patients with Type 2 diabetes mellitus.Methods A prospective and case-control study was conducted. Ninty-four patients with Type 2 diabetes mellitus (35～70 year-old) were divided into 3 groups: glimepiride treated group (n=33), metformin treated group (n=29) and glimepiride plus metformin treated group (n=32). These patients were followed up for 6 months. Free fatty acids were measured by using an enzymatic colorimetry.Results The concentration of FFA didn′t significantly change in the glimepiride treated group at the end of treatment, but it obviously decreased in the metformin treated group and in the glimepiride plus metformin treated group (P<0.05 and P<0.001,respectively). The decrease of FFA in the glimepiride plus metformin treated group was more obvious than that in the glimepiride treated group (P<0.05). The fasting serum FFA concentration is positively related to HOMA-IR(homeostasis model assessment-insulin resistance) and the choice of drugs by stepwise regression analysis. Conclusion Metformin alone or metformin plus glimepiride can decrease FFA levels, body weight index, blood glucose and insulin resistance. FFA level can reflect the index of insulin resistance to some degree.