运动处方联合二甲双胍对初治肥胖2型糖尿病患者visfatin、vaspin、RBP4水平及HOMA-IR指数的影响-现代医学

运动处方联合二甲双胍对初治肥胖2型糖尿病患者visfatin、vaspin、RBP4水平及HOMA-IR指数的影响

单位：1. 北京市第六医院内分泌科, 北京 100007;
2. 北京市垂杨柳医院急救医学中心, 北京 100022

分类号：R587.1

出版年·卷·期（页码）：2018·46·第五期（518-523）

摘要：

目的：探讨运动处方联合二甲双胍对初治肥胖2型糖尿病患者内脂素（visfatin）、腹内脂肪源性丝氨酸蛋白酶抑制物（vaspin）、视黄醇结合蛋白4（RBP4）水平及HOMA-IR指数的影响。方法：选取2015年8月至2017年8月北京市第六医院内分泌科收治的126例肥胖2型糖尿病患者，采用随机数字表法将患者分为对照组和观察组，每组63例。对照组患者采用二甲双胍口服降糖治疗，观察组在此基础上联合运动处方。治疗12周后比较两组患者胰岛功能、糖脂代谢、visfatin、vaspin及RBP4的水平。结果：经过12周的运动处方联合二甲双胍口服治疗，观察组患者体质量指数（BMI）和腰臀比分别为（27.16±2.68） kg·m^-2、0.92±0.08，均小于对照组的（28.03±2.79） kg·m^-2、0.98±0.09，差异有统计学意义（t=1.847，P=0.034；t=3.955，P=0.000）；观察组患者空腹血糖（FPG）、餐后2 h血糖（2hPG）及糖化血红蛋白（HbAlC）水平分别为（5.89±0.78） mmol·L^-1、（7.84±0.76） mmol·L^-1、（6.44±1.04）%，均低于对照组的（7.26±0.97） mmol·L^-1、（9.76±0.98） mmol·L^-1、（7.93±1.19）%，差异有统计学意义（t=8.736，P=0.000；t=12.288，P=0.000；t=7.483，P=0.000）；观察组患者TC、TG及LDL-C水平分别为（3.65±0.45）、（1.89±0.22）、（2.51±0.29） mmol·L^-1，均低于对照组的（4.32±0.47）、（2.31±0.29）、（2.69±0.35） mmol·L^-1，差异有统计学意义（t=8.295，P=0.000；t=9.158，P=0.000；t=3.143，P=0.001）；观察组HDL-C水平为（1.39±0.31） mmol·L^-1，高于对照组的（1.26±0.27） mmol·L^-1，差异有统计学意义（t=2.510，P=0.007）；观察组患者FINS、HOMA-IR指数分别为（13.12±1.45） mIU·L^-1、4.27±0.53，均低于对照组的（16.44±1.87） mIU·L^-1、5.32±0.68，差异有统计学意义（t=11.136，P=0.000；t=9.667，P=0.000）；观察组患者ISI指数为0.103±0.012，高于对照组为0.089±0.009，差异具有统计学意义（t=7.408，P=0.000）；此外，经过12周的综合治疗，观察组患者visfatin、vaspin及RBP4水平分别为（23.58±2.67）μg·L^-1、（1.26±0.25）μg·L^-1、（32.18±3.21） mg·L^-1，均低于对照组的（27.45±2.94）μg·L^-1、（1.47±0.33）μg·L^-1、（36.27±3.63） mg·L^-1，差异有统计学意义（t=7.734，P=0.000；t=4.026，P=0.000；t=6.699，P=0.000）。结论：运动处方联合二甲双胍可以有效调节初治肥胖2型糖尿病患者的胰岛应答效应，协调脂肪因子，优化糖脂代谢。

Objective: To investigate the effect of exercise prescription combined with metformin on visfatin, vaspin, RBP4 and HOMA-IR index in patients with type 2 diabetes.Methods: A total of 126 obese patients with type 2 diabetes mellitus were enrolled in our hospital from August 2015 to August 2017.They were divided into control group and observation group according to the random number table, 63 cases in each group. The patients in the control group were treated with metformin and the observation group was given a sports prescription on top of it. After 12 weeks of treatment, the changes of islet function, glucose and lipid metabolism, the level of visfatin, vaspin and RBP4 were compared between the two groups.Results: After 12 weeks of exercise prescription combined with metformin oral treatment, the BMI and waist-to-hip ratio of the observation group were less than those of the control group, the difference was statistically significant(t=1.847,P=0.034;t=3.955,P=0.000);FPG, 2hPG and HbAlC of the observation group was lower than that of the control group, the difference was statistically significant(t=8.736,P=0.000;t=12.288,P=0.000;t=7.483,P=0.000); The levels of TC, TG and LDL-C in the observation group were lower than those in the control group, the difference was significant(t=8.295,P=0.000;t=9.158,P=0.000;t=3.143,P=0.001);The level of HDL-C in the observation group was higher than that in the control group, and the difference was significant(t=2.510,P=0.007);The FINS and HOMA-IR index in the observation group were lower than those in the control group, the difference was significant(t=11.136,P=0.000;t=9.667,P=0.000); The ISI index in the observation group was higher than that in the control group, the difference was statistically significant (t=7.408,P=0.000);In addition, after 12 weeks of comprehensive treatment, the levels of visfatin, vaspin and RBP4 in the observation group were lower than those in the control group, and the difference was statistically significant(t=7.734,P=0.000;t=4.026,P=0.000;t=6.699,P=0.000).Conclusion: Exercise prescription combined with metformin can effectively regulate the islet response in patients with newly diagnosed obese type 2 diabetes, coordinate the adipokines, and optimize the metabolism of glucose and lipids.

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