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目的观察二甲双胍治疗对高胰岛素血症肥胖患儿血清脂源性激素脂联素、抵抗素、瘦素水平的影响。方法2004-01—2005-02将武汉市儿童医院和同济医院54例高胰岛素血症肥胖患儿分为轻、中度肥胖组及重度肥胖组,均以二甲双胍治疗12周,测量治疗前后体重、空腹血糖、空腹胰岛素及脂源性激素脂联素、瘦素、抵抗素的变化。结果治疗前轻、中度肥胖组和重度肥胖组高胰岛素血症患儿空腹血糖水平与健康对照组比较差异无显著性(P>0.05),血清胰岛素、瘦素、抵抗素及胰岛素抵抗指数(HOMA-IR)均高于健康对照组(P<0.01),脂联素水平明显低于健康对照组(P<0.01)。二甲双胍治疗12周后与治疗前相比,血清胰岛素水平、胰岛素抵抗指数明显降低(P<0.01),轻、中度肥胖组及重度肥胖组血清瘦素水平分别由治疗前的(24.3±1.8)μg/L、(30.2±5.1)μg/L降低为治疗后的(19.6±6.3)μg/L、(24.7±5.3)μg/L,差异有统计学意义;抵抗素水平分别由治疗前的(16.5±6.0)μg/L、(22.3±5.2)μg/L升高为(22.0±5.1)μg/L、(30.6±11.7)μg/L,差异有统计学意义;轻、中度肥胖组和重度肥胖组血清脂联素水平治疗前分别为(8.4±3.2)mg/L、(6.5±1.2)mg/L,治疗后分别为(8.9±2.3)mg/L、(7.03±3.0)mg/L,治疗前后相比,P>0.05。体重指数(BMI)下降,但差异无显著性。结论二甲双胍能显著改善肥胖患儿胰岛素抵抗。降低血清瘦素水平可能是其改善胰岛素抵抗机制之一,但在对脂源性激素脂联素、抵抗素水平的改善上,有其局限性。
Objective To observe the effects of metformin on serum adiponectin, resistin and leptin levels in obese hyperlipidemia children. Methods From January 2004 to February 2005, 54 children with hyperinsulinemia and obesity in Wuhan Children’s Hospital and Tongji Hospital were divided into mild and moderate obesity group and severe obesity group. All patients were treated with metformin for 12 weeks. Body weight, Fasting blood glucose, fasting insulin and adipogenic hormone adiponectin, leptin, resistin changes. Results There was no significant difference in fasting blood glucose between hyperinsulinemia and mild obesity group before treatment (P> 0.05), serum insulin, leptin, resistin and insulin resistance index HOMA-IR) were higher than those in healthy controls (P <0.01), and adiponectin levels were significantly lower than those in healthy controls (P <0.01). After 12 weeks of metformin treatment, the levels of serum insulin and insulin resistance were significantly lower than those before treatment (P <0.01). The levels of serum leptin in patients with mild to moderate obesity and severe obesity were (24.3 ± 1.8) μg / L and (30.2 ± 5.1) μg / L respectively after treatment were (19.6 ± 6.3) μg / L and (24.7 ± 5.3) μg / L after treatment.The levels of resistin were (22.5 ± 6.0) μg / L, (22.3 ± 5.2) μg / L and (22.0 ± 5.1) μg / L respectively, and the difference was statistically significant Serum levels of adiponectin in severe obesity group were (8.4 ± 3.2) mg / L and (6.5 ± 1.2) mg / L respectively before treatment, and were 8.9 ± 2.3 mg / L and 7.03 ± 3.0 mg / L, before and after treatment, P> 0.05. Body mass index (BMI) decreased, but no significant difference. Conclusion Metformin can significantly improve insulin resistance in obese children. Lowering the level of serum leptin may be one of its mechanisms to improve insulin resistance, but there are limitations in the improvement of adiponectin and resistin levels.