作者单位：321000 金华，金华市人民医院内分泌科

α-硫辛酸联合胰岛素强化治疗对初诊2型糖尿病患者脂肪因子和胰岛素抵抗的影响

郑伟英楼时先包慧兰应卫婵

【摘要】目的观察α-硫辛酸联合胰岛素强化治疗对初诊2型糖尿病患者脂肪因子和胰岛素抵抗的影响，分析相关因素间存在的关系。方法将88例初诊2型糖尿病患者随机分为单纯胰岛素组和联合硫辛酸组，2组均接受胰岛素强化治疗，后者同时接受静脉滴注α-硫辛酸600 mg、每日2次，2组总疗程均为14 d。比较2组治疗前、后的血糖、血脂、血浆胰岛素、脂联素、瘦素、胰岛素敏感性和胰岛细胞分泌功能。结果包括：①治疗后，2组GHbA1c、血糖、甘油三酯、总胆固醇较治疗前显著下降(P均<0.05)；BMI、HDL-C、LDL-C与治疗前比较差异无统计学意义(P均>0.05)。②除稳态模型评估的胰岛素敏感性指标(HOMA-IS)，联合硫辛酸组的其它指标治疗后均较治疗前有改善(P均<0.05)；治疗后联合硫辛酸组超氧化物歧化酶(SOD)、还原型谷胱甘肽(GSH)、脂肪细胞因子脂联素及HOMA-IS均高于单纯胰岛素组，瘦素、空腹胰岛素、稳态模型评估的胰岛素抵抗指数(HOMA-IR)则低于单纯胰岛素组(P均<0.05)。③SOD、GSH与脂联素呈正相关，SOD、GSH与瘦素呈负相关，脂联素与HOMA-IR、HOMA-IS呈正相关，瘦素与HOMA-IR、稳态模型评估的胰岛细胞分泌指数(HOMA-β)和HOMA-IS呈负相关(P均<0.05)。结论与单纯使用胰岛素强化治疗相比，α-硫辛酸联合胰岛素强化治疗2型糖尿病更能减轻机体氧化应激程度并提高胰岛素的敏感性。氧化应激指标、脂肪细胞因子及胰岛素相关指标间可能有一定关联。

【关键词】α-硫辛酸；胰岛素抵抗； 氧化应激； 脂肪因子

DOI:10.3969/g.issn.0253-9802.2015.02.005

基金项目：金华市科技计划项目(2011A33494)

收稿日期:(2014-10-01)

Influence of α-lipoic acid in combination with intensive insulin therapy on adipokines and insulin resistance in newly diagnosed type 2 diabetes mellitusZhengWeiying,LouShixian,BaoHuilan,YingWeichan.JinhuaPeople’sHospital,Jinhua321000,China

Abstract【】ObjectiveTo observe the effect of α-lipoic acid in combination with intensive insulin therapy upon adipokines and insulin resistance in patients newly-diagnosed with type 2 diabetes mellitus and analyze the relationship among correlated factors. MethodsEighty-eight patients newly-diagnosed with type 2 diabetes mellitus were randomly divided into insulin alone and insulin combined with lipoic acid groups. All participants received intensive insulin therapy. The subjects in the combination group were administered with intravenous drip of α-lipoic acid (600 mg, twice daily). The overall course of treatment endured for 14 d in both groups. Parameters including blood glucose, blood lipid, plasma insulin, adiponectin, leptin, insulin sensitivity and secretion function of islet cells before and after treatment were statistically compared between two groups. Results ①GHbA1c, blood glucose, triglyceride and total cholesterol were significantly decreased after corresponding treatment in two groups (all P<0.05). BMI, HDL-C and LDL-C did not significantly differ before and after treatment (all P>0.05). ②Except for homeostasis model assessment of insulin sensitivity (HOMA-IS), all parameters were significantly improved after combined therapy in insulin combined with lipoic acid group(all P>0.05). Superoxide dismutase (SOD), glutathione (GSH), adiponectin and HOMA-IS in the insulin combined with lipoic acid group were all significantly higher compared with those in the insulin alone group, whereas leptin, fasting insulin and HOMA-IR in the combination group were significantly lower than those in the insulin alone group (all P<0.05). ③SOD and GSH were positively correlated with adiponectin, whereas negatively associated with leptin. adiponectin was positively correlated with HOMA-IR and HOMA-IS, but negatively correlated with HOMA-IR, HOMA-β and HOMA-IS (all P<0.05). ConclusionsCompared with intensive insulin therapy alone, combined therapy of α-lipoic acid and intensive insulin is able to alleviate the severity of oxidative stress and enhance the insulin sensitivity. There may be correlation among oxidative stress indexes, adipocytokines and insulin-related parameters.

【Key words】α-lipoic acid; Insulin resistance; Oxidative stress; Adipokines

2型糖尿病发病的核心因素是胰岛素抵抗和胰岛β细胞功能受损。研究表明，脂肪组织具有重要的内分泌功能，由其分泌的多种细胞因子以及炎性因子通过内分泌、旁分泌和自分泌的途径广泛影响着机体的物质和能量代谢，与肥胖、2型糖尿病及其他与胰岛素抵抗关联的疾病密切相关[1-2]。研究表明，在炎症-胰岛素抵抗-2型糖尿病的病理生理过程中，脂肪组织分泌功能紊乱起了重要作用[3-4]。越来越多的证据表明脂肪因子和糖尿病发病及并发症之间密切相关。