基于促代谢因子探讨卡格列净对2型糖尿病胰岛素抵抗的影响

Effect of canagliflozin on insulin resistance in type 2 diabetes mellitus based on betatrophin

目的分析卡格列净治疗后2型糖尿病(T2DM)患者促代谢因子、血清尿酸(SUA)和胰岛素抵抗指数(HOMA-IR)的变化,探讨卡格列净改善胰岛素抵抗(IR)的机制。方法将82例T2DM患者分为A组和B组;其中A组40例接受二甲双胍治疗,B组42例接受二甲双胍联合卡格列净治疗,另选取同期健康体检者78例作为对照组。A组和B组治疗3个月,检测两组促代谢因子、SUA、HOMA-IR、空腹血糖(FPG)、空腹胰岛素(Fins)、血脂、血压等指标。结果B组促代谢因子、SUA及HOMA-IR水平比A组下降明显。经Pearson相关性分析发现,促代谢因子与体重指数(BMI)、甘油三酯(TG)、胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、FPG、Fins、HOMA-IR呈正相关(r=0.802、0.472、0.351、0.456、0.484、0.747和0.674,P<0.05);SUA与BMI、Fins、HOMA-IR呈正相关(r=0.786、0.745和0.669,P<0.05);促代谢因子与SUA呈正相关(r=0.674,P=0.000)。结论卡格列净能改善IR,可能与促代谢因子、SUA密切相关。

Objective To observe the changes of betatrophin,serum uric acid(SUA)and insulin resistance index(HOMA-IR)after canagliflozin treatment in the patients with type 2 diabetes mellitus(T2DM),and to explore the mechanism of canagliflozin in improving insulin resistance(IR).Methods Eighty-two patients with T2DM were randomly divided into the group A(n=40)and group B(n=42).Other 78 subjects undergoing the physical examination in the same period were selected as the control group.The group A received the metformin treatment for 3 months,and the group B received the combined treatment of metformin and canagliflozin.The observation group was treated for 3 months.The indexes of betatrophin,SUA,HOMA-IR,fasting blood glucose(FPG),fasting insulin(Fins),blood lipid and blood pressure were measured in the two groups.Results The levels of betatrophin,SUA and HOMA-IR in the group B were significantly decreased compared with those in the group A.The Pearson correlation analysis showed that betatrophin was positively correlated with BMI,TG,TC,LDL-C,FPG,Fins and HOMA-IR(r=0.802,0.472,0.351,0.456,0.484,0.747 and 0.674),SUA was positively correlated with BMI,Fins and HOMA-IR(r=0.786,0.745 and 0.669),and betatrophin was positively correlated with SUA(r=0.674,P=0.000).Conclusion Canagliflozin can improve IR,which may be closely related to betatrophin and SUA.