葛根素干预冠心病患者胰岛素抵抗的研究

Study on Interventing Effect of Puerarin on Insulin Resistance in Patie nts with Coronary Heart Disease

目的 :探讨葛根素对冠心病 (CHD)患者胰岛素抵抗 (IR)及与其存在密切相关性的血脂、纤溶活性异常的影响。方法 :76例CHD患者随机分为常规治疗组 (36例 )和葛根素治疗组 (40例 )。葛根素治疗组于常规治疗基础上加用葛根素 5 0 0mg静脉滴注 ,每日 1次 ,3周为 1个疗程。均于治疗前及治疗结束时检测血糖、血脂、胰岛素、纤溶指标 ,计算胰岛素敏感性指数 (ISI) ,并行静脉闭塞试验 (VOT)。选择 30名健康人作为对照组。结果 :(1)与对照组比较 ,CHD患者血浆胰岛素 (FINS)浓度增高 ,ISI降低 ,总胆固醇(TC)、甘油三酯 (TG)、低密度脂蛋白胆固醇 (LDL C)增高 ,高密度脂蛋白胆固醇 (HDL C)降低 ,VOT前及VOT时组织型纤溶酶原激活物 (tPA)活性降低 ,纤溶酶原激活物抑制物 - 1(PAI 1)活性升高。FINS、ISI与血脂、纤溶指标存在高度线性相关意义。 (2 )葛根素治疗组治疗后FINS、TC、TG、LDL C、PAI 1明显下降(P <0 0 5 ,P <0 0 1) ,ISI、HDL C、VOT前及VOT时tPA明显增高 (P <0 0 5 ,P <0 0 1)。葛根素治疗组治疗后FINS与TC、TG、LDL C、PAI 1呈显著正相关 ,而与HDL C、VOT前及VOT时tPA呈显著负相关 ;ISI与TC、TG、LDL C、PAI 1呈显著负相关 ,与HDL C、VOT时tPA呈显著正相关。结论

To explore the effect of puerarin in improvin g the insulin resistance (IR) and its closely related abnormal lipid and fibrinoly tic activity in patients with coronary heart disease (CHD). Methods: Seventy six patients with CHD were randomly divided into two groups, 40 in the puerarin group and 36 in the routine treated group. P uerarin 500 mg was given to the former in addition to routine therapy by adding to 250 ml of normal saline for intravenous dripping once a day with a therapeuti c course of 3 weeks. The changes of fasting blood glucose (FBG), fasting plasma insulin (FINS), plasma total cholesterol (TC), triglyceride (TG), low and high d ensity lipoprotein cholesterol (LDL C & HDL C) and plasminogen activator inhib itor 1 (PAI 1) activity were measured before and after treatment, and the insu lin sensitivity index (ISI) calculated. At the same time, tissue plasminogen act ivator (tPA) activity before and during venous occlusion test (VOT) was tested. Besides, 30 healthy subjects were taken as control. Results: In CHD patients, FINS, TC, TG, LDL C and PAI 1 leve ls were higher and ISI, HDL C and tPA before and during VOT were lower than tho se in the healthy controls. FINS and ISI correlated well with lipids and fibrino lyti c abnormality. After puerarin treatment, FINS level lowered and ISI increased si gnificantly (P<0 01), while comparing with the routine group, TC, TG, LDL C and PAI 1 were lower but HDL C and tPA activity before and duri ng VOT were higher in the puerarin group (P<0 05,P<0 01). Correlation analysis showed that FINS was positively correlated w ith TC, TG, LDL C and PAI 1 and negatively correlated with HDL C, tPA before and during VOT; ISI was negatively correlated with TC, TG, LDL C and PAI 1 and positively correlated with HDL C and tPA before and during VOT in the puerarin group. Conclusion: Puerarin could improve the IR, IR related lipid an d fibrinolytic activity abnormality in CHD patients.