西洋参茎叶总皂苷对冠心病血糖异常患者胰岛素敏感性的影响

Effect of Panax Quinquefolius Saponin on Insulin Sensitivity in Patients of Coronary Heart Disease with Blood Glucose Abnormality

目的观察西洋参茎叶总皂苷(panax quinquefolius saponin,PQS)对冠心病血糖异常患者血糖、血脂及胰岛素敏感性的影响。方法选择冠心病心绞痛并血糖异常患者84例,即:空腹血糖损害(IFG)或糖耐量异常(IGT)或2型糖尿病(T2DM),随机分为PQS组(43例)和常规西药治疗组(简称常规组,41例)。PQS组在西药常规治疗的同时加口服PQS,连续用药治疗4周,用药前后检测患者空腹血糖(FPG)、空腹胰岛素(FINS)、总胆固醇(TC)、甘油三脂(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL- C)。计算胰岛素敏感指数(ISI)、稳态模型的胰岛素抵抗指数(Homa-IR)和β细胞功能(Homa-β)。结果两组治疗后FPG均较治疗前显著下降(P<0.01),PQS组FPG下降(25.80±12.72)%,降低程度较常规组[(20.89±12.17)%]稍高,但无统计学意义。组内比较,两组治疗前后FINS、ISI、Homa-IR差异无统计学意义。治疗组治疗后Homa-β值为4.19±0.79,较治疗前(3.48±0.76)有显著增加(P<0.01),并显著高于常规组治疗后(3.82±0.77)的水平,差异有统计学意义(P<0.05);而常规组治疗前后Homa-β值无显著变化,且治疗前两组Homa-β水平比较差异无统计学意义。PQS组治疗后TC、LDL-C水平均较治疗前显著降低,差异有统计学意义(P<0.05),且治疗后TC水平为(1.17±0.54)mmol/L,显著低于常规组(1.42±0.49) mmol/L,差异有统计学意义(P<0.05)。结论在常规西药治疗的基础上加用PQS,有进一步降低冠心病血糖异常患者血糖的作用趋势,显著降低冠心病血糖异常患者血TC、LDL-C水平,并可能改善冠心病血糖异常患者β细胞功能。但两组患者的胰岛素敏感性均无明显变化。

Objective To investigate the effect of panax quinquefolius saponin （PQS） on blood glucose, blood lipid and insulin sensitivity in patients of coronary heart disease （CHD） with blood glucose abnormality （BGA）. Methods Eighty-four patients of CHD with BGA, namely CHD patients with impaired fasting glucose （IFG）, or impaired glucose tolerance （IGT）, or type 2 diabetes mellitus （T2DM）, were randomly assigned to the PQS group （43 cases） and the control group （41 cases）, all were treated with routine Western medicine, but to patients in the PQS group PQS was given orally for 4 successive weeks in addition. Levels of fasting plasma glucose （FPG）, fasting insulin （FINS）, total cholesterol （TC）, triglyceride （TG）, high-density lipoprotein cholesterol （HDL-C）, low-density lipoprotein cholesterol （LDL-C） were detected both before and after treatment, and insulin sensitive index （ISI） as well as the insulin resistance index and function of cells of homostasis model （Homa-IR and Homa-β） were calculated accordingly. Results After treatment, FPG decreased predominantly in both groups （P 〈 0.01）, and the decrement in the PQS group showed a greater trend （25.80±12.72） % vs （20.89 ± 12.17） %, but with no statistical significance; no obvious change in levels of FINS, ISI and Homa-IR was found in two groups （P 〉 0.05）. Homa-βvalue, which showed insignificantly difference before treatment, increased markedly in the PQS group after treatment from 3.48 ±0.76 to 4.19 ± 0.79 （P 〈 0.01）, which was higher obviously than the unchanged value of Homa-β in the control group （3.82 ± 0.77, P 〈0.05）. There was also decreasing of TC and LDL-C levels after treatment in the PQS group （P〈0.05）, and the TC level in the PQS group （1.17±0.54） mmol/L was significantly lower than that in the control group [（1.42±0.49） mmol/L, P 〈 0.05] after treatment. Conelusion Compared with using it alone, routine Western medicine treatment, by combining with PQS showed superiority in lowering FPG, could significantly decrease the levels of TC and LDL-C, and might improve the β-cell function in patients of CHD with BGA. It showed no effect on insulin sensitivity of patients, in spite of in combining or not with PQS.