艾塞那肽对糖调节受损肥胖者血胰岛素及胰岛素抵抗的影响

目的探讨艾塞那肽对糖调节受损（IGR）肥胖者血胰岛素及血糖的影响。方法选取2011年5月至2012年11月在福建医科大学附属泉州第一医院就诊的75例糖调节受损（IGR）肥胖者为研究对象，其中62例受试者符合入选条件，按基线胰岛素水平分为高胰岛素血症（HIns，32例）与非高胰岛素血症（NHIns，30例）2组，HIns以空腹胰岛素≥15mU／L和（或）口服葡萄糖耐量试验（OGTr）2h胰岛素≥80mU儿作为切点。测定基线及应用艾塞那肽5d及14d时的空腹与OGTF2h血浆血糖、胰岛素、C肽、体重等指标。以稳态模型评估的胰岛素抵抗指数（HOMA-IR）及Gutt胰岛素敏感指数评估胰岛素抵抗及敏感性。同一组治疗前后比较采用配对t检验，组间均数比较采用单因素方差分析，率的比较采用x。检验。结果两组的空腹及OGTr2h血糖在用药5d时较基线下降（t=4．42、9．78、4．00、8．66，均P〈0．05），HIns组空腹胰岛素在用药5d时较基线下降（t=2．07，P〈0．05），OGTr2h胰岛素在用药5d较基线时下降，用药14d较5d时进一步下降（F=24．17，P〈0．05）。HIns组HOMA—IR在用药5d时较基线下降（t=3．27，只〈0．05）。NHIns组HOMA—IR在用药5d及14d时较基线均无下降（均P〉0．05），HIns组Gutt胰岛素敏感指数在用药5d时较基线升高（t=-9．84，P〈0．05），14d时较5d时进一步升高（F=55．96，P、遗0．05）。NHIns组Gutt胰岛素敏感指数在用药5d时较基线升高（t=-4．27，P〈0．05）。HIns组与NHIns组体重在5d时较基线无下降，14d时均较5d时明显下降（t=14．13、12．00，均P〈0．05）。结论IGR肥胖人群短期应用艾塞那肽即可获益调节血糖、改善胰岛素抵抗、控制体重。

Effect of exenatide on serum insulin level and insulin resistance in obese subjects with impaired glucose regulation

Objective To investigate the effect of exenatide on serum insulin and plasma glucose in obese subjects with impaired glucose regulation（IGR）. Methods A total of 75 obese subjects with IGR were enrolled from May 2011 to November 2012 in Quanzhou First Hospital Affiliated Fujian Medical University. A total of 62 eligible subjects were divided into the hyperinsulinemia group （ HIns, fasting serum insulin t〉 15 mU/L and （or）2-hour serum insulin 〉i 80 mU/L post glucose load, n = 32 ） and the non- hyperinsulinemia group （ NHIns, n = 30 ） by the serum insulin level Fasting and 2h plasma glucose in OG~, insulin , C-peptide and body weight were measured at the baseline, D5 and D14 of exenatide treatment. Insulin resistance was evaluated by the homeostasis model assessment （HOMA-IR） and the gutt insulin sensitivity index. Paired t test was used to test within group change. One-way ANOVA was applied to compare differences of continuous variables between subgroups. Rates were compared by using the X2 test. Results Compared with the baseline, fasting and 2 h glucose significantly improved at D5 in the two groups, but without further decrease at D14 in the two groups （ t = 4.42, 9.78, 4.00, 8.66 with all P 〈 0.05 ）. Compared with the baseline, the fasting insulin significantly decreased at D5 in the HIns group（ t =2.07,P 〈0.05）. The 2 h insulin level significantly decreased at D5 with further reduction at D14 in the HIns group（ F = 24.17,P 〈 0.05 ）. No significant decrease was observed with the fasting and 2 h insulin in the NHIns group at D5 and D14. HOMA-IR significantly decreased at D5 in the HIns groups（t = 3.27 ,P 〈 0.05）, while showed no change at D5 and D14 in the NHIns group（all P 〉0.05）. Gutt insulin sensitivity index increased at D5 in the HIns groups（ t = - 9.84, P 〈 0.05 ） with further increase at D14 （ F = 55.96, P 〈 0.05）. Compared with the baseline, the Gutt insulin sensitivity index significantly increased at D5 in the NHIns group（ t = -4.27, P 〈 0.05 ）. Body weight significantly decreased in the HIns group and the NHIns group at D14 （t = 14.13,12.00,all P 〈 0.05 ） , while showed no change at D5 in both groups. None of the subjects withdrew because of adverse event including hypoglycemia. Conclusions Exenatide short- term treatment in obese subjects with IGR can benefit glucose regulation, improve insulin resistance and control body weight.