多囊卵巢综合征患者二甲双胍治疗前后血清脂联素水平的变化

目的:检测多囊卵巢综合征(PCOS)患者血清脂联素水平,探讨脂联素在PCOS胰岛素抵抗中的作用。方法:PCOS患者30例,对其进行二甲双胍治疗3个月,治疗前后检测其空腹静脉血脂联素、胰岛素、血糖、黄体生成激素(LH)、卵泡刺激素(FSH)、雄激素(T)水平,分析脂联素与其他各项指标的关系,和治疗前后指标的变化。30例健康妇女做为正常对照。结果:PCOS患者空腹血清脂联素水平为6.8±2.2 mg/L,明显低于正常对照组(P<0.01)。PCOS患者脂联素水平与空腹胰岛素、体重指数、LH、T呈负相关(P<0.05或P<0.01),而与空腹血糖、FSH、LH/FSH无相关性(P>0.05)。二甲双胍治疗后,PCOS患者血清脂联素水平显著上升(P<0.01),空腹胰岛素、LH、LH/FSH、T显著下降(P<0.05或P<0.01),而空腹血糖、体重指数及FSH无明显变化(P>0.05)。结论:PCOS患者空腹血清脂联素水平明显降低,与血清胰岛素水平呈负相关,脂联素在PCOS胰岛素抵抗中具有一定作用。     

二甲双胍对肥胖及非肥胖PCOS妇女内分泌的影响

目的:分析肥胖及非肥胖多囊卵巢综合征(PCOS)患者的内分泌特征,探讨应用二甲双胍治疗对两类患者临床症状及内分泌指标的影响。方法:按体重指数(BMI)将43例PCOS患者分为肥胖组23例,非PCOS肥胖组20例,比较BMI、FPG、FINS及FSH、LH及T;两组均服用二甲双胍3个月,观察治疗前后临床症状及内分泌指标的改善情况。结果:肥胖组BMI、FINS及HOMA-IR明显高于非肥胖组(P<0.01),而非肥胖组LH高于肥胖组(P<0.05)。二甲双胍治疗后肥胖组BMI降低(P<0.01),FSH升高(P<0.05),LH、FPG、FINS和HOMA-IR均明显降低(P<0.01)。而非肥胖组BMI及FPG无改变。结论:肥胖与非肥胖PCOS患者内分泌特征不同,二甲双胍可明显改善肥胖及非肥胖PCOS患者的临床症状和内分泌指标,尤其适用于肥胖PCOS患者。     

二甲双胍对高血压病患者高胰岛素血症的治疗观察

目的观察二甲双胍对高血压病患者血胰岛素水平的影响。方法２３例高血压病患者，在降压治疗的基础上，加服二甲双胍。在年龄、性别、体重指数相匹配的１８例高血压病，单纯应用同样降压药物。分析两组治疗前后血胰岛素的变化，并与正常人３８例对照。结果二甲双胍组较单纯降压组空腹及餐后２小时血胰岛素分别明显下降（Ｐ＜０．０５，Ｐ＜０．０２）。结论二甲双胍较好地缓解高血压病的高胰岛素血症，并可能改善胰岛素抵抗及由此所致的代谢紊乱。     

格列美脲与二甲双胍联合治疗2型糖尿病的临床观察

目的：评价新一代磺酰脲类药物(格列美脲)与二甲双肌(格华止)联合治疗2型糖尿病(DM)的疗效。方法：新诊断的2型DM患者86例，脲用格列美脲1—6mg／d，治疗6周，空腹及餐后2h血糖仍未达标者为38例，加用二甲双肌1500mg／d，治疗6周。结果：格列美脲降低血糖的达标(理想控制水平)率为55．8％；格列美脲联合二甲双肌，达标率提高至89.47％。结论：格列美脲与二甲双肌联合治疗2型糖尿病能有效地控制血糖，并有降低血脂的作用，且不增加体重。     

Metformin for obese,insulin-treated diabetic patients: improvement in glycaemic control and reduction of metabolic risk factors

Summary The efficacy and safety of metformin in the treatment of obese, non-insulin-dependent, diabetic subjects poorly controlled by insulin after secondary failure to respond to sulphonylureas has been investigated. Fifty insulin-treated, obese diabetics participated in this prospective, randomised double-blind six-month trial. After a four-week run-in period, during which all patients were given placebo (single-blind), patients were randomly assigned to continue to receive placebo or to active treatment with metformin.At six months, there was a relevant and significant improvement in glycaemic control in diabetics receiving the combined insulin-metformin treatment (decrease in glucose –4.1 mmol·l^–1; glycosylated haemoglobin A₁ decrease –1.84%). No significant changes were seen in diabetics receiving insulin and placebo. There was a significant decrease in blood lipids (trygliceride and cholesterol), an increase in HDL-cholesterol and a reduction in blood pressure in diabetics taking metformin. These postive findings were most marked in the 14 diabetics who experienced a good response to metformin (glucose profile <10 mmol·l^–1), and were less marked but still significant in the remaining 13 diabetics, whose response to therapy was not so good (glucose profile >10 mmol·l^–1). The fasting insulin level was significantly lower after six months of combined insulin-metformin treatment as shown by a 25% reduction in the daily dose of insulin (–21.6 U/day).Metformin was well tolerated by all diabetics. Combining metforming with insulin in obese, insulin-treated and poorly controlled diabetics may represent a safe strategy to achieve better glycaemic control with a reduction in certain metabolic risk factors associated with the increased incidence of cardiovascular disease in diabetes mellitus.     

二甲双胍治疗对肥胖2型糖尿病患者血清中抵抗素、胰岛素样生长因子Ⅰ水平的影响

目的：检测新诊断的肥胖2型糖尿病人群经单用二甲双胍治疗前后抵抗素、胰岛素样生长因子Ⅰ（ IGF-Ⅰ）及炎症因子的变化,探讨二甲双胍改善胰岛素抵抗及预防肿瘤发生的分子机制。方法选取新诊断的肥胖2型糖尿病人56例及健康对照50例,经饮食及运动治疗1周后给予二甲双胍1500 mg/d,治疗3个月,给药前后分别抽取空腹静脉血,测定空腹血糖、空腹胰岛素、糖化血红蛋白、抵抗素、IGF-Ⅰ、白细胞介素-6（IL-6）和超敏的C反应蛋白（sCRP）,应用稳态模型评估法评价胰岛素抵抗指数（HOMA-IR）。治疗前后的比较及组间的比较采用t检验及单因素方差分析。多因素的分析采用多元回归分析。结果二甲双胍治疗前后空腹血糖、空腹胰岛素、HOMA-IR、糖化血红蛋白、抵抗素、IGF-Ⅰ、IL-6和sCRP 明显下降（ P＜0.05）,但仍高于正常对照组（ P＜0.05）。抵抗素、IL-6和sCRP与胰岛素抵抗指数呈正相关（ r＝0.95,0.89,0.78,P＜0.01）,是后者的独立影响因素（β＝1．91,0.148,1．6,P＝0.000）;空腹胰岛素与IGF-Ⅰ呈正相关（r＝0.91,P＜0.01）,是IGF-Ⅰ的独立影响因素（β＝4．30,P＝0.000）。结论新诊断的肥胖2型糖尿病给予二甲双胍治疗后可能通过降低抵抗素及炎症因子的水平,改善胰岛素抵抗,从而降低了血清胰岛素和IGF-Ⅰ的水平。     

二甲双胍与糖尿病心血管并发症

糖尿病心血管疾病是2型糖尿病(T2DM)的首要致死原因.近年的一些实验及临床观察表明,二甲双胍可降低T2DM合并心血管并发症患者的病死率,相关机制可能包括改善内皮和血小板功能,调节炎性反应和前血栓状态,改善脂质及细胞能量代谢,抑制晚期糖基化终末产物的产生等,因此二甲双胍对T2DM心血管并发症有独特的保护作用.     

二甲双胍对高盐高脂摄入致大鼠主动脉重构的干预研究

目的探讨二甲双胍对高盐高脂摄入致大鼠主动脉重构的干预作用。方法选取36只成年雄性SD大鼠,随机分为3组(n=12):对照组(C组)、高盐高脂组(SF组)和二甲双胍治疗组(T组),C组予标准饲料,SF组及T组高盐高脂饲料喂养,T组加用二甲双胍灌胃。16周后,测量大鼠动脉压、血清甘油三酯(TG)、总胆固醇(TC)及可溶性CD40L(sCD40L)浓度;免疫组化法检测升主动脉根部血管壁组织CD40L的表达;HE染色测量升主动脉起始段中膜层厚度和动脉内腔面积与血管腔横断面积比值。结果 (1)SF组收缩压与C组相比明显增高(P<0.01),而T组较SF组明显降低(P<0.05),但未达到C组水平;(2)SF组TC、TG水平较C组明显升高(P<0.01),而T组TC、TG水平较SF组明显下降(P<0.01);(3)SF组中膜厚度(IMT)较C组显著增厚(P<0.01),血管内腔面积明显缩小(P<0.01)而血管横断面积增加(P<0.01)。T组中膜厚度较SF组变薄(P<0.01)但未达到C组水平;(4)SF组血清sCD40L浓度高于C组和T组(P<0.01)。C组T组之间差异无统计学意义(P>0.05);(5)SF组动脉组织CD40L表达强度明显高于C组和T组(P<0.05),T组与C组差异无统计学意义(P>0.05)。结论二甲双胍可以通过降低血压,调节血脂代谢,抑制CD40系统,起到血管保护作用。     

Chronic Pretreatment of Metformin is Associated with the Reduction of the No‐Reflow Phenomenon in Patients with Diabetes Mellitus After Primary Angioplasty for Acute Myocardial Infarction

Introduction: Metformin is one of the most commonly prescribed antihyperglycemic agents for the treatment of type 2 diabetes. However, little is known about the effect of metformin on no‐reflow in diabetic patients. Aim: In this study, we investigated retrospectively whether chronic pretreatment with metformin was associated with no‐reflow in diabetic patients who underwent primary coronary intervention for acute myocardial infarction (AMI). Results: A total of 154 consecutive diabetic patients who underwent primary angioplasty for a first ST‐segment elevation myocardial infarction were studied. No‐reflow was defined as a final TIMI flow of ≤2 or final TIMI flow of 3 with a myocardial blush grade of <2. The no‐reflow phenomenon was found in 53 of 154 patients. There were no significant differences in clinical characteristics between the patients with and without metformin pretreatment. However, the 65 patients receiving chronic metformin treatment before admission had lower incidence of the no‐reflow than those without it (4.2 and 14.6%, P < 0.05). Multivariable logistic regression analysis revealed that absence of metformin pretreatment was a significant predictor of the no‐reflow along with high‐burden thrombus, ejection fraction on admission and anterior AMI. Conclusion: These results suggested that chronic pretreatment with metformin may be associated with the reduction of the no‐reflow phenomenon in patients with diabetes mellitus after primary angioplasty for AMI.     

Efficacy and safety of pioglitazone/metformin fixed-dose combination therapy compared with pioglitazone and metformin monotherapy in treating patients with T2DM

Abstract

Background:

Studies have shown that many patients with type 2 diabetes do not achieve optimal glycemic control, and progression of diabetes over time requires more than one pharmacotherapy to achieve glycemic goal.