托吡酯预防偏头痛发作的患者体重及相关代谢指标研究

Study of Body Weight and Associated Metabolic Indexes in Patients Receiving Topiramate Migraine Prophylaxis

目的探讨托吡酯预防治疗偏头痛,对患者体重、体重指数、血清瘦素、胰岛素、游离脂肪酸(FFA)和脂联素的影响及其相互关系。方法随机选取32例接受托吡酯预防治疗的偏头痛患者,于用药前和用药3个月后测定并计算体重、体重指数、血清甘油三酯、总胆固醇、血清脂联素、胰岛素敏感指数(SI)、血清瘦素、游离脂肪酸水平。结果使用托吡酯治疗3个月后,患者体重、体重指数、甘油三酯、胆固醇、游离脂肪酸分别为(59.36±9.39)kg,(19.02±2.36)kg/m2,(1.25±0.38)mmoL/L,(4.13±1.10)mmol/L,(289.2±89.1)mmol/L,均比治疗前显著降低(P<0.05或P<0.01);脂联素、胰岛素敏感指数分别为(22.14±10.72)mg/mL和(8.48±2.18)×10-4,则比治疗前显著升高(P<0.01);瘦素水平为(2.77±0.68)μg/L,比治疗前无明显变化(P>0.05)。Spearman相关性分析表明,治疗后体重、体重指数与脂联素水平呈明显负相关(P<0.001),与胰岛素敏感指数水平亦呈负相关(P<0.05),与游离脂肪酸水平呈明显正相关(P<0.05或P<0.01)。在以体重为应变量的多元回归方程中,脂联素、胰岛素敏感指数和游离脂肪酸进入方程(r2=0.27,P<0.001)。结论托吡酯预防治疗偏头痛会导致代谢改变,表现为体重和体重指数下降。在此过程中,脂联素、胰岛素敏感指数和游离脂肪酸的改变可能起到重要作用,而瘦素则可能与此无关。

Objective To explore the effects of topiramate on the body weight,body mass index（BMI）,serum leptin,insulin,free fatty acid（FFA）and adiponectin levels and to analyze the relationships among them in the patients receiving topiramate migraine prophylaxis.Methods 32 patients receiving topiramate migraine prophylaxis were randomly selected and detected the weight,BMI,lipid,adiponectin,insulin sensitivity index（SI）,leptin and FFA levels before medication and in 3 months after medication.Results After 3-month topiramate treatment,the weight,BMI,blood triglyceride,cholesterol and FFA were（59.36±9.39）kg,（19.02±2.36）kg/m2,（1.25±0.38）mmoL/L,（4.13±1.10）mmol/L and（289.2±89.1）mmol/L respectively and decreased significantly than before treatment（P 〈 0.05 or P 〈 0.01）.The adiponectin and SI were（22.14±10.72）mg/mL and（8.48±2.18）×10-4 and significantly increased than before treatment（P 〈 0.01）.The leptin was（2.77±0.68）μg/L,showing no obvious change compared with before treatment.The Spearman correlation analysis revealed that the body weight and BMI after treatment were negatively correlated with the adiponectin level（P 〈 0.001）,also negatively correlated with SI level（P 〈 0.05）and positively correlated with the FFA level（P 〈 0.05 or P 〈 0.01）.In the multiple regression equation with the body weight as the dependent variable,adiponectin,SI and FFA entered into the equation（r2=0.27,P 〈 0.001）.Conclusion Topiramate for preventing migraine could cause the metabolic change manifested by the decrease of the body weight and BMI.During this process,the changes of serum adiponectin,FFA and SI could play an important role,but leptin could be irrelevant.