路优泰对2型糖尿病合并抑郁症胰岛素抵抗的影响

Effect of Neurostan in Insulin resistance of Diabetes millitus type 2 combin with Depression

目的:评价路优泰对2型糖尿病合并抑郁症患者胰岛素抵抗的关系,并探讨发生影响的相关机制。方法:本研究入选90例T2DM,其中单纯T2DM 30例、T2DM合并抑郁症患者60例,所有病例均采用人胰岛素类似物Aspart(诺和锐,丹麦产),进行个体化降糖治疗。以单纯T2DM 30例为对照组(Ⅰ组);60例T2DM合并抑郁症患者根据病情,基本匹配分为两组,每组30例:治疗组(Ⅱ组)以路优泰300 mg,2次/d口服;非治疗组(Ⅲ组)不加用任何抗抑郁药物。分别跟踪监测三组治疗前后抑郁症程度和代表胰岛β-cell分泌功能的指标:FG及PG2h、C-P、INS、GHbA1C、HOMA-β-cell等,以及代表IR的程度指标:身高、体重、BMI、WHR、血压、HOMA-IR、TG、CHO等。结果:与对照组及非治疗组相比,路优泰治疗组以汉米尔顿抑郁量表(HRSD)及自评抑郁量表(SDS)为标准判定抑郁症明显减轻,由Homa模型计算的反应IR的指标Homa-IR由治疗前的4.87±1.47下降至治疗后的2.27±0.92(P<0.05)。在停止治疗后6周、12周,Homa-β分别增加至107.43±17.31和109.37±15.32(P<0.001),Homa-IR分别下降至1.85±0.83和1.68±0.72(P<0.05)。讨论:联合路优泰治疗,不仅使2型糖尿病合并抑郁症患者的抑郁症状明显改善,亦能有效减轻胰岛素抵抗状态,对疾病总体的治疗有积极的临床意义。

Objective To evaluate the relationship between Neurostan and Insulin resistance of Diabetes millitus type 2 combin with Depression, and to investigate the relative mechanism of the effection. Method The study enrolled 90 cases of T2 DM, which simple T2 DM have 30 eases,60 patients with T2DM with depression, all patients were treated with human insulin analogueAspart （Novo sharp, Danish production） ,individual hypoglyeemie therapy. There are 30 cases of simple T2DbI in the control group （ group [ ） ;60 cases of patients with T2DM with depression according to the disease,the basic match is divided into two groups,30 cases：in each treatment group （group II） to the road excellent Thai300mg twice a day oral; non - treatment group （III group） without anyanfidepressants. Track the monitoring group before and after treatment the degree of depression and indicators of islet beta - cell secretory function： FG andPG2h, the CP, the INS, GH- bA 1C and HOMA - beta - cell, and represent the level of IR indicators ： height, weight, BMI, WHR, blood pressure and I-IOMA - IR, TG and CHO,et al. Results Compared with the control group and the non -treatment group,treatment group took Neurostan Hamilton Rating Scale for Depression （HRSD） and self-rating depression scale （SDS） as a standard to determine depression significantly reduced,the Homa model calculation of the reaction IR index Homa - IR decreased after treatment from 4. 87 ~ 1.47 to 2. 27 ~ 0. 92 （ P 〈 0. 05 ）. After cessa- tion of therapy,Homa - beta was increased to 107.43 ＋ 17.31 and 109.37 ~ 15.32 （ P 〈 0. 001 ）, Homa - IR was reduced to 1.85 ~ 0. 83 in the sixth week and 1.68 ~ 0. 72 in the twelfth week （ P 〈 0. 05 ）. Conclusion Conclusioa United Neurostan treatment can not only iprove symptom of patients with type 2 diabetes and depression,but also reduce insulin resistance effectively. There is a positive clilical sig- nificance for the overall treatment of disease.