二甲双胍对2型糖尿病患者糖脂代谢、Socs3及炎性因子的影响

Metformin in effects of glucose and lipid metabolism,Socs3 and inflammatory factors in patients with type 2 diabetes mellitus

目的探讨二甲双胍对糖尿病患者糖脂代谢、Socs3及炎性因子的影响。方法筛选初发2型糖尿病(T2DM)110例,随机分为2型糖尿病单纯饮食控制+运动组55例(T2DM组),和在注意饮食运动基础上口服盐酸二甲双胍治疗组55例(T2DM+MET组)。另选同期体检正常者57例作为对照组,观察2型糖尿病组FBG、HbA1c、BMI、TG、TC、HDL-C、LDL-C、TNF-α、IL-6、CRP、MCP-1及SOCS3水平,明确Socs3及炎性因子与胰岛素抵抗相关性及Logistic回归分析明确胰岛素抵抗独立危险因素,并观察二甲双胍干预后上述糖脂代谢、Socs3及炎性因子指标变化。结果对照组和T2DM组之间年龄、性别差异无统计学意义(P>0.05),T2DM组比NC组BMI、TC、TG、LDL-C、HbA1c、FBG、HOMA-IR、Socs3、CRP、IL-6、TNF-α、MCP-1明显升高,且差异有统计学意义(P<0.05),但2组间HDL-C差异无统计学意义(P>0.05)。Socs3及炎性因子CRP、IL-6、TNF-α、MCP-1与胰岛素抵抗指数均呈正相关(P<0.01)。二元Logistic回归分析结果表明,矫正性别、年龄等混杂因素后,Socs3、TNF-α、TG、LDL-C是胰岛素抵抗的独立危险因素(P<0.05)。二甲双胍治疗前2组年龄、HbA1c、BMI、病程、TC、TG、Socs3差异均无统计学意义(P>0.05),二甲双胍治疗3个月后,与T2DM饮食运动组比较,T2DM饮食运动+MET组BMI、HbA1c、TC、TG、Socs3水平明显下降,差异均有统计学意义(P<0.05)。二甲双胍治疗前2组2型糖尿病受试者CRP、IL-6、TNF-α、MCP-1水平比较,差异无统计学意义(P>0.05)。二甲双胍治疗后,与T2DM饮食运动组比较,T2DM饮食运动+MET组IL-6、TNF-α、MCP-1水平显著下降,且差异有统计学意义(P<0.05),CRP水平无明显变化(P>0.05)。结论二甲双胍可降低血炎性因子水平,改善胰岛素抵抗。

Objective To explore the effects of metformin on glucose and lipid metabolism,suppressor of cytokine signaling 3(SOCS3)and inflammatory factors in patients with type 2 diabetes mellitus(T2DM).Methods In a concurrent physical examination,the normal patients(n=57)were as the control group,and 110 incipient diabetic patients were randomly assigned to recevie simple diet control+exercise(T2DM group,n=55),or the oral metformin hydrochloride+diet control and exercise(T2DM+MET group,n=55).The levels of FBG,HbA1c,BMI,TG,TC,HDL-C,LDL-C,TNF-α,IL-6,CRP,MCP-1 and SOCS3 in type 2 diabetes group were recorded.The correlation between Socs3 and inflammatory factors and insulin resistance was evaluated.Logistic regression analysis was conducted to identify independent risk factors for insulin resistance,the changes of glucose and lipid metabolism,Socs3 and inflammatory factors of post intervention were observed.Results The difference was not statistically significant in the age and gender between control group and T2DM group;BMI,TC,TG,LDL-C,HbA1c,FBG,HOMA-IR,Socs3,CRP,IL-6,TNF-α,MCP-1 in T2DM group were significantly increased compared with control group(P<0.05);none of the HDL-C differed significantly between groups.The positive correlations between Socs3,CRP,IL-6,TNF-α,MCP-1 and insulin resistance index were found(P<0.01).Binary Logistic regression analysis showed that the independent risk factors for insulin resistance were Socs3,TNF-α,TG and LDL-C after gender and age were corrected(P<0.05).Before treatment,there was no significant difference in age,HbA1c,BMI,course of disease,TC,TG,Socs3 between the two groups(P>0.05);BMI,HbA1c,TC,TG,Socs3 on month 3 in T2DM+MET group were notably decreased than those in T2DM group(P<0.05).The difference was not statistically significant in the CRP,IL-6,TNF-α,MCP-1 between groups before the two treatmen(P>0.05).After treatment,IL-6,TNF-α,MCP-1 in T2DM+MET group were obviously decreased in comparison with T2DM group(P<0.05),and no significant change in CRP levels was found(P>0.05).Conclusion Metformin can reduce the inflammatory factor levels in blood and improved insulin resistance.