二甲双胍对2型糖尿病患者体脂分布及肝脏脂肪含量的影响

Effect of metformin on adipose tissue distribution and hepatic lipid content in patients with type 2 diabetes

目的比较新诊断的2型糖尿病患者经二甲双胍单药治疗前、后糖脂代谢、体脂分布、肝脏脂肪含量及胰岛B细胞功能与胰岛素敏感性的变化。方法采用治疗前、后自身对照的研究方法,予9例新诊断为2型糖尿病的患者口服二甲双胍250～500mg/次,每日3次,治疗24周。在试验前、后及期间,测量体重(Wt)、腰围(w)、臀围(H)。计算腰臀比(WHR)、体质指数(BMI)。测定空腹血糖(FPG)及餐后2h血糖(2hPG)、糖化血红蛋白(HbA_(1c))、空腹胰岛素(FIN)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白-胆固醇(HDL-c)、低密度脂蛋白-胆固醇(LDL-c)。试验前、后,采用MRI检查检测腹内、外及股部脂肪分布和含量,应用超声直方图技术进行肝脏脂肪含量半定量测量(计算衰减系数值),间接反映肝脏脂肪含量。采用精氨酸刺激试验测定胰岛B细胞功能,以稳态模型评估胰岛素抵抗指数(HOMA-IR)反映胰岛素敏感性。治疗前、后各指标变化的比较采用配对t检验。结果与治疗前相比,口服二甲双胍24周后的FPG、2hPG、HbA_(1c)、腹部内脏脂肪(VAT)、总腹部脂肪(TAAT)和大腿部筋膜下脂肪(SFAT)含量、Wt及WHR均明显下降(P值均<0.05);VAT、TAAT降幅分别为6.7%和7.9%。反映肝脏脂肪含量的肝脏左叶剑突下纵切位(LL)、右叶肋间切位(MR)、右叶肋下斜切位(OR)的衰减系数以及3个切面衰减系数均值均有降低趋势,但差异无统计学意义(P值均>0.05)。结论二甲双胍可改善2型糖尿病患者的糖代谢,并明显减少2型糖尿病患者VAT、TAAT及SFAT含量。

Objective To evaluate the effect of metformin on adipose tissue distribution, hepatic lipid content, glucose and lipid metabolism, and insulin sensitivity in patients with newly-diagnosed type 2 diabetes. Methods A self-control clinical trial was conducted with 9 newly-diagnosed patients with type 2 diabetes. The patients were given oral metformin 750-1 500 mg/d for 24 weeks. The body weight （Wt）, body mass index（BMI）, waist（W）, hip（H）, and waist hip ratio（WHR） were determined;the adipose tissue masses in abdomen and thigh were quantified by using magnetic resonance imaging （MRI）; hepatic lipid content was measured by using ultrasound histogram; B-cell function was evaluated by using arginine stimulating test; meanwhile, FPG, 2hPG, HbA1 c, HOMA-IR and serum lipids were also assessed. Then paired t-test was performed to analyze the changes of parameters before and after treatment. Results Compared with before treatment, FPG, 2hPG, and HbA1c, visceral adipose tissue （VAT）, total abdominal adipose tissue （TAAT）, and adipose tissue beneath the fascia （SFAT）, Wt, and WHR were all significantly decreased 24 weeks after treatment （P 〈 0.05）. VAT decreased by 6.7% and TAAT by 7. 9%. The decrease of hepatic lipid contents was not significant after treatment. Conclusion Metformin can not only improve glucose metabolism, but also decrease VAT, TAAT and SFAT in patients with type 2 diabetes.