西布曲明治疗肥胖的疗效及对肥胖患者血生化学和胰岛素敏感性指标的影响

Efficacy of sibutramine in the treatment of obesity and its effect on the blood biomechanical indexes and insulin sensitivity

目的：观察作用于中枢神经系统的减肥药西布曲明对单纯性肥胖症者体质量、腰臀比、血生化学指标及胰岛素敏感性指标的作用效果。 方法：①选择2002-12／2003-3福建医科大学附属协和医院门诊就诊的52例单纯性肥胖者，年龄18～65岁。均对实验目的知情同意，并配合实验。每日晨服用盐酸西布曲明胶囊1片，共12周。②每4周纳入对象回本院复诊1次，测定体质量、腰围、臀围，计算体质量指数[体质量(kg)／ 身高(m^2)]和腰臀比[腰围(cm)／臀围(cm)]。治疗前及治疗12周后采用全自动生化仪测定空腹血糖、总胆固醇、三酰甘油。采用化学发光免疫分析仪测定血清胰岛素水平。计算胰岛素抵抗指数(空腹血糖×空腹胰岛素／22．5)，胰岛素敏感指数[1／(空腹血糖×空腹胰岛素)]，β细胞功能[20×空腹胰岛素／(空腹血糖-3．5)]。③计量资料差异比较采用方差分析和t检验。 结果：单纯性肥胖者52例均进入结果分析。①盐酸西布曲明治疗12周后肥胖者体质量、体质量指数、腰围、臀围明显低于治疗前(t=3．24，3．16，4．06，1．99，P<0．05)，治疗前后腰臀比差异不明显。②治疗12周后血总胆固醇、三酰甘油水平明显低于治疗前[(5．00±0．83)，(1．15±0．75)mmol／L；(5．39±0．99)，(1．47±0．72)mmol／L，t=2．19，2．23，P<0．05]，而空腹血糖和低密度脂蛋白胆固醇无明显变化。③治疗前后胰岛素水平、胰岛素敏感指数、胰岛素抵抗指数和β细胞功能元明显变化(P>0．05)。 结论：盐酸西布曲明胶囊有显著减重效果，并能有效改善血脂，但对胰岛素敏感性指标无明显影响。

AIM： To observe the clinical efficacy of sibutramine, which is a drug for losing body mass actioning on central nerve system, on the body mass, waist-to-hip ratio, blood biochemical indexes and insulin sensitivity in patients with simple obesity. METHODS： ① Between December 2002 and March 2003, 52 patients with simple obesity aged 18-65 years, who were treated in the outpatient department of the Union Hospital affiliated to Fujian Medical University, participated in the study voluntarily. They took one tablet of sibutramine every morning for 12 weeks. ② The subjects were reexamined once every 4 weeks, their body mass, waist circumference and hip circumference were measured, and the body mass index [body mass （kg）/body height （m^2）] and waist-to-hip ratio [waist circumference （cm）/hip circumference （cm）] were calculated. Before treatment and 12 weeks after treatment, the fasting blood glucose, total cholesterol, triglyceride were detected with automatic biochemical meter. The level of serum insulin was detected with chemilumiy. The insulin resistance index （fasting blood glucosexfasting insulin/22.5）, insulin sensitivity index [1/（fasting blood glucosexfasting insulin）] and β cell function [20xfasting insulin/（ fasting blood glucose-3.5）] were calculated. ③ The differences of the measurement data were compared with the analysis of variance and the t test. RESULTS： All the 52 patients with simple obesity were involved in the analysis of results. ① The body mass, waist circumference and hip circumference at 12 weeks after the treatment of sibutramine were obviously lower than those before treatment （t=3.24,3.16,4.06,1.99,P〈 0.05）, and there was unobvious difference in the waist-to-hip ratio before and after treatment. ② The serum levels of total cholesterol and triglyceride at 12 weeks after treatment were markedly lower than those before treatment [（5.00±0.83）, （1.15±0.75） mmol/L;（5.39±0.99）,（1.47±0.72） mmol/L, t=2.19, 2.23, P 〈 0.05], but fasting blood glucose and low density lipoprotein cholesterol had no obvious changes. ③ There were no obvious changes in the insulin level, insulin sensitivity index, insulin resistance index and β cell function before and after treatment （P 〉 0.05）. CONCLUSION： Sibutramine capsule has a significant effect in reducing body mass, and effectively ameliorating blood lipids, but has no obvious influence on insulin sensitivity index.