非诺贝特对高甘油三酯血症人群胰岛素抵抗和胰岛β细胞分泌功能的影响

Impact of fenofibrate on insulin resistance and insulin secretion in individuals with hypertriglyceridemia

目的观察非诺贝特对高甘油三酯（TG）血症人群的胰岛素抵抗和胰岛β细胞分泌功能的影响。方法正常糖耐量、高TG血症（TG≥2．3mmol／L）患者12例（HTG组），予非诺贝特200mg／d治疗3个月，于治疗前后应用高葡萄糖钳夹技术评价胰岛素敏感性和胰岛β细胞功能。并与正常糖耐量、正常血脂志愿者12名（NC组）进行比较。结果HTG组胰岛素敏感性指数（ISI）显著低于NC组；第一时相胰岛素分泌（1PH）稍低于NC组；第二时相胰岛素分泌（2PH）和最大胰岛素分泌（INS120-150）均明显高于NC组。HTG组非诺贝特治疗后，ISI较治疗前显著升高（18．35±1．76vs9．40±1．76，P〈0．01）；1PH变化无统计学意义[（247．7±32．9）mIU／Lvs（225．7±36．7）mIU／L，P=0．94]；2PH和INS120-150较治疗前降低[分别为（73．2±9．0）mIU／Lt8（106．0±11．3）mIU／L，P=0．014；（89．2±8．9）mIU／Lvs（141．6±13．8）mIU／L，P=0．005]。结论非诺贝特调脂治疗能显著改善高TG血症人群的胰岛素抵抗及高葡萄糖钳夹试验中的胰岛素分泌。

Objective To investigate the impact of fenofibrate on insulin resistance and insulin secretion in individuals with hypertriglyceridemia. Methods Twelve subjects with hypertriglyceridemia [ serum triglyceride （TG） ≥2.3 mmol/L] and normal glucose tolerance were selected as hypertriglyceridemia group （HTG group） and were given fenofibrate 200 mg/d orally for 3 months. Hyperglycemic clamp was performed to evaluate the insulin resistance and G-cell function in HTG group before and after treatment. Twelve individuals with both normal TG and normal glucose tolerance served as normal control group （ NC group）. Results Insulin sensitivity index （ISI） in HTG group was significantly lower than that in NC group. The first-phase insulin release （1PH） in HTG group was a slightly lower than that in NC group. The second-phase insulin release （2PH） and the maximum insulin secretion （INS120-150） were significantly higher in HTG group than those in NC group. As compared with pretherapy in HTG group, ISI was significantly increased after fenofibrate treatment （18.35±1.76vs9.40±1.76,P〈0.01） ; 1PH rose slightly after treatment [（247.7±32.9）mIU/Lvs（225.7±36.7）mIU/L,P=0.94] ;2PH （73.2±9.0）mIU/Lt8（106.0±11.3）mIU/L,P=0.014;（89.2±8.9）mIU/Lvs（141.6±13.8）mIU/L,P=0.005] were significantly decreased after treatment, respectively. Conclusion Fenofibrate can improve the insulin sensitivity and insulin secretion as demonstrated by hyperglycemic clamp technique in hypertriglyceridemia individuals.