水飞蓟宾对代谢综合征患者葡萄糖代谢率与脂肪因子的影响

Effect of silibinin on insulin sensitivity and plasma adipokines levels in subjects with metabolic syndrome

目的探讨代谢综合征(MS)患者葡萄糖代谢率(M)与血浆抵抗素(resistin)、脂联素(adiponectin)、瘦素(leptin)水平变化及水飞蓟宾(Silibinin)的治疗作用。方法筛选15例MS病例和20例健康对照组。采用高胰岛素-正常血糖钳夹技术检测M,评估胰岛素抵抗(IR)程度;采用EILSA法检测血浆resistin、adiponectin与leptin浓度;检测空腹胰岛素(FINS)、血糖、血脂等生化指标;MS患者给予水飞蓟宾70mg口服,一日3次,治疗12 w,于治疗结束后重复检测M、血浆resistin、adiponectin与leptin浓度。结果①MS组腰围(WC)、体重指数(BMI)、空腹血糖(FPG)、2 h血糖(2 h PG)、FINS及甘油三酯(TG)等均显著高于对照组,高密度脂蛋白-胆固醇(HDL-C)明显低于对照组(P均<0.05)。高胰岛素正常血糖钳夹试验稳态时(120～150 min),MS组M显著低于对照组(P<0.01)。两组血浆resistin水平无显著差异(P>0.05);MS组血浆leptin水平显著高于对照组,adiponectin水平显著低于对照组(P均<0.05)。②与治疗前相比,治疗12 w后MS组TG、2 h PG及FINS明显降低(P均<0.05),BMI、WC有所降低,但与治疗前比较无显著差异(P>0.05),FPG、HDL-C、TC及LDL-C等与治疗前比较无显著差异(P>0.05)。③治疗前后M分别为(4.24±1.42)和(6.16±1.58)mg.kg-1.min-1,治疗12 w后,MS组M明显升高(P<0.05)。④治疗前后MS组血浆resistin,adiponectin,leptin水平等无显著变化(P均>0.05)。结论水飞蓟宾治疗后能减轻IR,MS患者IR改善不依赖于体重的减轻。水飞蓟宾治疗后IR改善未伴有血浆resistin、adiponectin、leptin水平的明显变化;提示水飞蓟宾治疗减轻MS患者IR的机制可能并非通过影响resistin、adiponectin、leptin等脂肪因子途径,而可能主要与其抗氧化应激机制及减轻脂毒性作用有关。

Objective To investigate effects of silibinin on glucose metabolic rate（M） and plasma resistin,adiponectin and leptin levels in subjects with metabolic syndrome（MS）.Methods 15 MS patients were selected as MS group.20 normal adults were selected as control group.M was evaluated by hyperinsulinemic euglycemia clamp technique.Plasma resistin,adiponectin and leptin concentrations were detected by ELISA.Blood pressure,waist circumference（WC）,body mass index（BMI） were measured.MS group received metformin 500 mg every time,three times every day for 12 weeks.After treatment,M and plasma resistin,adiponectin and leptin levels were evaluated repeatedly.Results ①WC,BMI,FPG,2 h PG,FINS and TG in MS group were significantly higher than those in control group（P0.05 for all）.During the steady state（120～150 min） in the hyperinsulinemic euglycemia clamp,M in MS group was significantly lower than that in controls（P0.01）.Plasma resistin levels in MS group had no significant difference from that in controls（P0.05）.Plasma adiponectin levels in MS group was significantly lower than that in controls（P0.01）.Plasma leptin levels in MS group was significantly higher than that in controls（P0.01）.②After 12 weeks treatment,TG,2 h PG and FINS were decreased significantly（P0.05） while BMI,WC,FPG,HDL-C,TC and LDL-C did not significantly change（P0.05）.③After 12 weeks of treatment,M was significantly increased（（6.16±1.58） vs（4.24±1.42）mg·kg-1· min-1,P0.05）.④After 12 weeks of treatment,plasma resistin,adiponectin and leptin levels did not significantly change（P0.05 for all）.Conclusions Silibinin treatment alleviated IR without weight loss in the MS subjects.The alleviated IR without significant changes of plasma resistin,adiponectin and leptin levels suggests that the mechanism of silibinin′s effect on IR should be not by way of affecting adipokines and may be related to its effects of anti-oxidative stress and lipotoxicity relieving.