参苓白术散联合二甲双胍对2型糖尿病肥胖者miR-146a、GLP-1及血脂的影响

The influence of shenling baizhu powder and metformin on miR-146a,GLP-1 and blood lipid in type 2 diabetes mellitus obesity

目的探讨参苓白术散联合二甲双胍对2型糖尿病(T2DM)肥胖患者的miR-146a、胰高血糖素样肽-1(GLP-1)及血脂的影响。方法将86例T2DM肥胖者按照随机数字表法分为试验组(参苓白术散+二甲双胍治疗)和对照组(二甲双胍治疗);2组均持续治疗6个月,并分别采集患者用药前、用药1周、用药3个月和用药6个月的静脉血,荧光定量聚合链式反应检测miR-146a表达,生化法检测血脂水平,酶联免疫吸附测定法检测血GLP-1和白细胞介素(IL)-12水平。结果与对照组比较,试验组在用药3个月后miR-146a、GLP-1水平升高,IL-12水平降低,用药6个月血清总胆固醇(TC)和三酰甘油(TG)明显降低(P<0.05)。随着治疗时间的延长,试验组和对照组miR-146a和GLP-1均呈升高趋势,IL-12呈下降趋势(P<0.05),试验组TG、TC、低密度脂蛋白胆固醇(LDL-C)水平及体质量指数用药3个月时均下降(P<0.05)。T2DM的miR-146a表达水平与血清GLP-1水平呈正相关(r=0.874,P<0.01),与IL-12、TC、TG、LDL-C水平呈负相关(r分别为-0.744、-0.456、-0.397及-0.629,P<0.01)。血清GLP-1水平与IL-12、TC、TG和LDL-C水平呈负相关(r分别为-0.807、-0.482、-0.452及-0.693,P<0.01)。结论参苓白术散联合二甲双胍能更有效改善T2DM肥胖患者的TC和TG水平,作用机制可能与提高miR-146a和GLP-1水平、降低炎性因子IL-12的水平有关。

ObjectiveTo study the influence of shenling baizhu powder and metformin on the miR-146a,glucagon like peptide-1(GLP-1),interleukin-12(IL-12)and serum total cholesterol(TC),triglyceride(TG)and low density lipoprotein cholesterol(LDL-C)in type 2 diabetic mellitus(T2DM)obesity.MethodsA total of 86 patients with T2DM obesity were divided into experimental group(patients treated with shenling baizhu powder and metformin)and control group(patients treated with metformin)by randomly method.The treatment lasted for 6 months.The venous blood samples of patients were collected on the day before treatment,1 week,3 months and 6 months after treatment.miR-146a was detected by q PCR,and the level of blood lipid was detected by biochemical colorimetry,the serum levels of GLP-1 and IL-12 were detected by enzyme linked immunosorbent assay(ELISA).ResultsCompared with the control group,the levels of miR-146a and GLP-1 were increased,serum IL-12 was decreased three months after treatment in experimental group,while the serum levels of TC and TG were also decreasedsixmonthsafter treatment(P<0.05).With the prolongation of treatment time,the serum levels of miR-146a and GLP-1 showed an increasing trend in experimental group and control group(P<0.05),while the level of IL-12 showed a decreasing trend in experimental group and control group(P<0.05).The serum levels of TC,TG,LDL-C and body mass index(BMI)were started decreasing 3 months after treatment in experimental group(P<0.05).The expression level of miR-146a was positively correlated with serumGLP-1 levels in T2DM(r=0.874,P<0.01),and negatively correlated with IL-12,TC,TG and LDL-C levels(r=-0.744,-0.456,-0.397 and-0.629,P<0.01).The serum level of GLP-1 was negatively correlated with IL-12,TC,TG and LDL-C levels(r=-0.807,-0.482,-0.452 and-0.693,P<0.01).ConclusionThe shenling baizhu powder combined with metformin can effectively improve serum levels of TG and TC in T2DM obesity.The mechanism may be related with increasing the levels of miR-146a and GLP-1,decreasing the inflammatory factors and IL-12 level.