二甲双胍对肥胖症患者胰岛素敏感性及胰岛β细胞分泌功能的影响

Effects of metformin on insulin sensitivity and beta cell secretion in obese patients

目的:探讨肥胖症给予二甲双胍用药干预,患者胰岛素敏感性及胰岛β细胞分泌功能在给药后发生的变化,提供临床参考借鉴。方法:选取60例肥胖症伴胰岛素抵抗者,根据口服糖耐量试验(OGTT)分为糖耐量正常组25例与糖调节受损组35例,均予以二甲双胍治疗,对比治疗前、治疗3个月及治疗6个月体质指数(BMI)、空腹血糖(FPG)、空腹胰岛素(FINS)、胰岛素分泌指数(HOMA-β)及胰岛素抵抗指数(HOMA-IR)变化。结果:60例患者BMI均是治疗3个月与治疗6个月较治疗前降低;FPG治疗后3个月与6个月较治疗前降低,其中糖耐量正常组前后差异小,糖调节受损组治疗后降低;FINS治疗3个月较治疗前提高,而治疗6个月则表现为降低;在经3个月治疗后的HOMA-IR和治疗前的指标水平差异小,但经过6个月的治疗指标水平要明显较3个月以及治疗前更低;HOMA-β在治疗3个月最高,但治疗前糖调节受损组HOMA-β低于糖耐量正常组治疗前。结论:对肥胖合并胰岛素抵抗者,使用二甲双胍能提高胰岛素敏感性,而如果患者的糖耐量正常,尽早给予二甲双胍更有助于使胰岛β细胞分泌功能提升,达到显著降糖的效果。

Objective To investigate the changes of insulin sensitivity and secretion function of islet cells in patients with obesity treated with metformin,and to provide clinical reference.Method 60 patients of obesity with insulin resistance were selected,according to oral glucose tolerance test(OGTT),they were divided into normal glucose tolerance group of 25 cases and sugar regulation damaged group 35 examples,both metformin treatment,compared with before treatment,treatment for 3 months and 6 months of body mass index(BMI),fasting plasma glucose(FPG),fasting insulin(FINS),insulin secretion index(HOMA-beta)and insulin resistance index(HOMA IR).Results BMI of 60 patients was lower than that before treatment at 3 months and 6 months after treatment.FPG was decreased at 3 months and 6 months after treatment compared with that before treatment,with small difference before and after treatment in the normal glucose tolerance group and decreased after treatment in the impaired glucose regulation group.FINS treated for 3 months increased compared with that before treatment,while FINS treated for 6 months decreased.There was a small difference in the levels of HOMA-IR after 3 months of treatment and before treatment,but the levels of treatment indicators after 6 months were significantly lower than at 3 months and before treatment.HOMA-IR was highest at 3 months of treatment,but before treatment the impaired glucose regulation group HOMA-IR was lower than the normal glucose tolerance group before treatment.Conclusion In obese patients with insulin resistance,the use of metformin can improve insulin sensitivity,and if the patient's glucose tolerance is normal,early administration of metformin is more helpful to improve the secretion function of islet cells,achieving a significant hypoglycemic effect.