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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。

Effects of metformin on glucose metabolism and serum lipogenic hormones in obese hyperinsulinemic children

??AbstractObjectiveTo observe effects of metformin on plasma adiponectin,leptin and resistin of hyperinsulinemic children and adolescents.MethodsFifty??four obese hyperinsulinemic children aged 6~17 years were enrolled in this trial and were divided into two groups:mild??moderate obesity and severe obesity group;forty??five healthy non??obese children aged 6.5~17 years were as control.The obese hyperinsulinemic children received metformin (175~250 mg twice or thrice daily) for 12 weeks.The plasma concentrations of plasma adiponectin,leptin and resistin were measured at baseline and after 12 weeks of metformin treatment for obesity groups.The fasting plasma glucose and fasting plasma insulin were also measured.ResultsBefore metformin treatment,the HOMA??IR and the serum concentrations of insulin,leptin and resistin of the two obese hyperinsulinemic groups were significantly higher,while adiponectin was significantly lower compared with the contral group;there was no significant difference(P>0.05) in serum fasting glucose between obese hyperinsulinemic children and the controls.After 12 weeks of treatment,serum insulin concentrations and insulin resistance index(HOMA??IR) decreased(P<0.01);leptin levels decreased (mild and moderate obesity group 24.3??1.8??g/L vs 19.6??6.3??g/L,P<0.05;severe obesity group 30.2??5.1??g/L vs 24.7??5.3??g/L,P<0.01).The plasma resistin levels increased(mild and moderate obesity group 16.5??6.0 ??g/L vs 22.0??5.1??g/L,P<0.05;severe obesity group 22.3??5.2??g/L vs 30.6??11.7??g/L,P<0.01).The plasma adiponectin didn't change greatly compared to the before(mild obesity and moderate obesity group 8.9??2.3 mg/L vs 8.4??3.2 mg/L??P>0.05;severe obesity group 7.0??3.0 mg/L vs 6.5??1.2 mg/L,P>0.05).ConclusionThese data collectively suggest that metformin induces attenuation of hyperinsulinemia and insulin resistance in obese hyperinsulinemic children.The decrease of serum leptin levels may contribute to the insulin??sensitizing and antihyperglycemia function of metformin.On adipocytokines level,the effect of metformin is limited.