二甲双胍干预肥胖儿童高胰岛素血症的临床疗效分析

The clinical analysis of metformin in the treatment of obese children with hyperinsulinemia

目的探讨二甲双胍结合生活方式干预肥胖儿童合并高胰岛素血症的临床效果。方法选取2015年1月—2016年12月在我院儿科内分泌门诊就诊的肥胖高胰岛素血症儿童82例。所有患儿均给予调整饮食结构、增强运动的生活方式指导,同时口服二甲双胍治疗1年。治疗前及治疗3、6、12个月时分别测量并计算各项临床指标,比较二甲双胍治疗前后各项指标的变化。结果 (1)二甲双胍治疗12个月后,体质量指数(BMI)、腰围(WC)、腰臀比(WHR)、腰身比(WHtR)均较治疗前下降。(2)与治疗前相比,6个月时各时间点空腹胰岛素(FINS)水平均有明显下降,至12个月时,FINS、1 h-INS、2 h-INS进一步降低(均P<0.05)。(3)二甲双胍治疗6个月后,胰岛素抵抗指数(HOMA-IR)下降、胰岛素分泌指数(HOMA-β)下降、胰岛素曲线下面积(AUCI)减小,总体胰岛素敏感指数(WBISI)升高(均P<0.05),治疗12个月时HOMA-IR继续降低,WBISI继续升高(均P<0.05);早期胰岛素分泌指数(ΔI30/ΔG30)治疗前后无明显变化。结论在调整饮食结构、加强运动的基础上,肥胖高胰岛素血症儿童每天服用二甲双胍为期1年,可减轻体质量,提高胰岛素敏感性,减轻胰岛素抵抗。

Objective To investigate the clinical effect of meffornlin combined with lifestyle intervention in obese children with hyperinsulinemia. Methods A total of 82 obese children treated in the Department of Pediatric endocrine of our hospital from January 2015 to December 2016 were selected in this study. All of them were diagnosed as hyperinsulinemia. All eases were treated with metformin in addition to lifestyle guide to adjust their dietary structure and enhance exercise for one year. Clinical anthropometrie indicators including height, weight, body mass index （BMI）, waist circumference （WC）, waist to hip ratio （WHR） and waist-height ratio （WHtR） were measured before treatment and 3 months, 6 months and 12 months after treatment. Blood biochemical indexes were compared before and after treatment with mefformin. Results （1） After 12 months of mefformin treatment, BMI, WC, WHtl and WHtR were all decreased compared with those before treatment. （2） The insulin levels were decreased significantly at all time points in 6 months compared with those before treatment. Levels of FINS, 1 h-INS and 2 h-INS were further reduced after 12-month treatment （P 〈 0.05）. （3） After 6 months of mefformin treatment, insulin resistance index （HOMA-IR）, function of pancreatic beta-cell （HOMA - 13） and area under curve of insulin were decreased whereas the whole body insulin sensitivity index （WBISI） increased （P 〈 0.05）. The value of HOMA-IR continued to decline and WBISI continued to rise after 12-month treatment （P 〈 0.05）. There was no significant difference in first-phase insulin secretion index （△I30/△G30） before and after treatment. Conclusion On the basis of adjusting the diet structure and strengthening the exercise, metformin can reduce BMI, improve insulin sensitivity and reduce insulin resistance in children with hyperinsulinemia.