二甲双胍和吡格列酮对2型糖尿病患者的疗效及抗氧化作用研究

Effect and antioxidation of metformin and pioglitazone in patients with type 2 diabetes

目的探讨二甲双胍或吡格列酮对2型糖尿病患者的疗效及其对超氧化物歧化酶(SOD)、丙二醛(MDA)的影响。方法纳入北京市昌平区中西医结合医院收治的2型糖尿病患者160例,按随机数字表法平均分为二甲双胍组和吡格列酮组,分别给予盐酸二甲双胍肠溶片(1 g/次,每日2次)和盐酸吡格列酮片(30 mg/次,每日1次),两组疗程均为4周。比较两组患者治疗前后空腹血糖(FPG)、餐后2 h血糖(PPPG)、糖化血红蛋白(Hb A1c),血脂以及两组患者SOD、MDA水平。结果给予降糖药4周后,两组患者FPG、PPPG、Hb A1c均显著下降,同组治疗前后比较差异有统计学意义(P<0.05)。治疗后,二甲双胍组患者三酰甘油(TG)、低密度脂蛋白(LDL)水平显著降低,同组治疗前后比较差异有统计学意义(P<0.05),而吡格列酮患者则无显著性变化。吡格列酮组患者血清MDA水平下降,同组治疗前后比较差异有统计学意义(P<0.05);二甲双胍组患者血清SOD水平显著上升(P<0.05),且显著高于吡格列酮组(P<0.05);吡格列酮组患者血清MDA水平显著下降(P<0.05),且显著低于二甲双胍组(P<0.05)。结论二甲双胍或吡格列酮均能改善胰岛素抵抗和糖尿病并发症;吡格列酮降低MDA水平效果优于二甲双胍,但增加SOD水平仅见于二甲双胍。两种药物对氧化应激的作用机制不同,有利于联合用药。

Objective To investigate the effect of Metformin or Pioglitazone on patients with type 2 diabetes and its effect on superoxide dismutase（SOD）, malondialdehyde（MDA）. Methods A total of 160 patients diagnosed as T2 DM were randomly selected, they were randomly divided into Metformin group and Pioglitazone groupHe treatment course was 4 weeks. We compared fasting blood glucose（FPG）, postprandial blood glucose（PPPG）, glycosylated hemoglobin（Hb A1 c） and serum level of superoxide dismutase（SOD）, malondialdehyde（MDA） before and after treatment between two groups. Results After giving the hypoglycemic drugs for 4 weeks, the levels of FPG, PPPG and Hb A1 c in the two groups were significantly decreased（P〈0.05）. The SOD in the two groups were increased, and the MDA were decreased. The serum level of SOD in Metformingroup was significantly higher than in Pioglitazone group（P〈0.05）. The serum MDA level in Pioglitazone group was significantly lower than in Metformingroup（P〈0.05）. Conclusions Both Metforminand Pioglitazone can improve insulin resistance and diabetes complications. Pioglitazone was superior to Metforminto improve oxidative stress as reflected by reduction in MDA but the antioxidant effect i.e. increases in SOD was seen with Metforminonly. The differing mechanism of actions of the two drugs on oxidative stress favors co prescription.