抗氧化治疗对2型糖尿病合并急性脑梗死患者RBP4及糖脂代谢的影响

Effect of Antioxidant Therapy on the Levels of Retinol Binding Protein 4 and Glucose-lipid Metabolism in Patients with Type 2 Diabetic Complicated with Acute Cerebral Infarction

目的:探讨抗氧化治疗对2型糖尿病合并急性脑梗死患者血清视黄醇结合蛋白4(RBP4)及糖脂代谢的影响。方法:选取2013年6月-2015年6月在本院住院的2型糖尿病合并急性脑梗死患者110例,随机将其分为治疗组56例和对照组54例。所有患者均行生活方式干预,给予降糖、调脂、降压、抗血小板凝聚、改善循环药物治疗。治疗组在此基础上将α-硫辛酸注射液600mg加入250 mL 0.9%氯化钠溶液中静脉滴注,1次/d,连用3周。对照组采用维生素C治疗,连用3周。观察两组患者治疗前后的RBP4、胱抑素C(Cys-C)、半胱氨酸(Hcy)、高敏C反应蛋白(hs-CRP)、血糖(FPG、2 h PG、HbA1c)、血脂(TG、TC、LDL-C、FFA)、β细胞功能(HOMA-IR、HOMA-β)、血压、体重指数、心电图、肝肾功能、电解质以及NIHSS评分等方面的变化,并记录药物不良反应。结果:经1个疗程的治疗后,两组患者治疗后的RBP4、Cys-C、Hcy、hs-CRP水平均明显下降,但治疗组下降幅度明显大于对照组,差异均有统计学意义(P<0.05或P<0.01)。两组FPG、2 h PG、HbA1c、HOMA-IR、TG、TC、LDL-C、FFA均明显下降,HOMA-β明显升高,但治疗组变化更明显,差异均有统计学意义(P<0.05或P<0.01);两组治疗后患者的NIHSS评分均明显下降(P<0.01),但治疗组下降更显著(P<0.05)。两组均未发现明显不良反应。结论:抗氧化剂α-硫辛酸治疗2型糖尿病合并急性脑梗死,可明显降低患者RBP4和血糖、血脂水平及NIHSS评分,并可改善胰岛β细胞功能。

Objective：To investigate the efficacy of antioxidant therapy on the levels of retinol binding protein 4 and glucose-lipid metabolism in patients with type 2 diabetic（T2DM） complicated with acute cerebral infarction（ACI）.Method：From June 2013 to June 2015,110 patients with T2DM complicated with acute cerebral infarction admitted to our hospital were randomly divided into the treatment group for 56 cases and the control group for 54 cases.All patients were given lifestyle intervention,treated with hypoglycemic,lipidlowering,antihypertensive,anti platelet aggregation,improve circulation drugs.The treatment group was given Alpha-lipoic Acid 600 mg add into 250 mL of 0.9% Sodium Chloride Solution for intravenous infusion,once every day,for three weeks.The control group was treated with vitamin C for 3 weeks.The levels of RBP4,Cys-C,Hcy,hs-CRP,blood glucose（FPG,2 h PG,HbA1c）,blood lipid（TG,TC,LDL-C,FFA）,β cell function（HOMA-IR,HOMA-β）,blood pressure,body mass index,electrocardiogram,liver and kidney function,electrolyte were observed and the score of NIHSS was evaluated between the two groups before and after the treatment.The adverse reaction of drugs was recorded.Result：After one course of treatment,the levels of RBP4,Cys-C,Hcy,hs-CRP in the two groups after treatment were decreased significantly,those of treatment group were decreased significantly than the control group,the differences were statistically significant（P〈0.05 or P〈0.01）.The levels of FPG,2h PG,HbAlc,HOMA-IR,TG,TC,LDL-C and FFA of the two groups after treatment were significantly decreased,and the level of HOMA-β was significantly increased,but the treatment group changed obviously greater,the differences were statistically significant（P〈0.05 or P〈0.01）.The NIHSS score of the two groups after treatment were significantly decreased（P〈0.01）,that of the treatment group was significantly lower than the control group（P〈0.05）.There was no obvious adverse reaction in the two groups.Conclusion：Alpha-lipoic Acid in the treatment of T2DM with ACI patients can reduce the levels of RBP4,blood glucose,blood lipid and NIHSS scores,improve islet β-cell function.