胰岛素对新诊断2型糖尿病炎症脂肪因子的影响

Effect of insulin treatment on inflammatory adipokines serum amyloid A protein and visfatin levels in newly diagnosed type 2 diabetic patients

目的探讨胰岛素对新诊断2型糖尿病患者炎症脂肪因子血清淀粉样蛋白A(SAA)和内脂素的影响。方法将60例新诊断2型糖尿病患者随机分为胰岛素泵组和口服降糖药组,血糖达标后继续原治疗方案一周。观察SAA和内脂素水平的变化。结果胰岛素泵和口服降糖药明显降低了空腹血糖、糖化血红蛋白和三酰甘油水平(P<0.05);胰岛素分泌指数HOMA B改善(P<0.05),但早期相胰岛素分泌指数仅在胰岛素泵组改善(P<0.01);炎症脂肪因子SAA[分别为:(120.3±39.1)μg/L vs(78.3±23.0)μg/L;(117.5±45.0)μg/L vs(57.8±28.0)μg/L,P<0.01]和内脂素[分别为:(23.5±0.2)μg/L vs(15.1±4.4)μg/L;(22.7±6.1)μg/L vs(10.9±3.3)μg/L,P<0.01]降低,胰岛素泵组降低更明显(P<0.05)。结论胰岛素泵和口服降糖药达到类似的血糖和血脂水平降幅,但胰岛素泵抑制炎症脂肪因子更明显,可能提示胰岛素有降糖和抗炎双重作用。

[ Objective ] To investigate the effect of insulin treatment on inflammatory adipokines serum amyloid A protein （SAA） and visfatin levels in newly diagnosed type 2 diabetic patients. [Methods ] Sixty patients with new- ly diagnosed type 2 diabetes were randomly divided into continuous subcutaneous insulin infusion （CSII） group and oral hypoglycaemic agent （OHA） group for initial rapid correction of hyperglycaemia. Treatment was maintained for one week after target glycaemic control. Serum SAA and visfatin levels were measured at baseline and after treat- ment. [Results] Both CSII and OHA treatments significantly reduced the levels of fasting plasma glucose, HbAlc and triglyceride （P 〈 0.05）. HOMA B was increased after CSII and OHA treatments （P 〈 0.05）, while early-phase in- sulin secretion index AI30/AG30 was improved only in CSII group （P 〈 0.01）. CSII and OHA treatments inhibited SAA [（120.3±39.1） p,g/L vs （78.3±23.0） μg/L for OHA; （117.5±45.0） μg/L vs （57.8±28.0） μg/L for CSII,P 〈 0.01） ] and visfatin levels [（23.5±0.2 ） μg/L vs （15.1~4.4） txg/L for OHA; （22.7±6.1） μg/L vs （10.9±3.3） txg/L for CSII, P 〈 0.01）], and the decrease of SAA and visfatin levels in CSII group was markedly greater than that in OHA group. [Conclusions] In newly diagnosed type 2 diabetic patients, both CSII and OHA treatments have similar effect on improving glucose and lipid control. The increase of AI30/AG30 and decrease of serum SAA and visfatin levels in CSII group was markedly greater than that in OHA group.