罗格列酮对2型糖尿病患者血清脂肪细胞因子的影响

目的观察罗格列酮（RSG）对2型糖尿病（T2DM）患者血清脂肪细胞因子的影响，探讨血清脂肪细胞因子和胰岛素抵抗（IR）的关系及其在T2DM发病机制中的作用。方法38例新诊断T2DM患者（DM组），以RSG每日4mg口服治疗12周；24例年龄和性别匹配的糖耐量正常者为正常对照（NC）组。检测NC组及DM组患者治疗前后的身高、体重、血压、FPG、2hPG、免疫反应胰岛素（IRI）、真胰岛素（TI）、胰岛素原（PI）、血清脂肪细胞因子瘦素（LEP）、抵抗素（RST）、脂联素（APN）、视黄醇结合蛋白4（RBP-4）、尿白蛋白（UAlb）和血脂谱。计算BMI、胰岛素敏感性指数（QUICKI）、胰岛素抵抗指数（HOMA-IR）和FPI／FTI。结果DM组RSG治疗前PG、IRI、FPI、LEP、RST、RBP-4、HOMA-IR和FPI／FTI均较NC组升高，而APN和QUICK下降（P〈0．05）；DM组RSG治疗后，BMI、UAlb、血脂谱和RBP-4无显著变化，其余指标均向正常转化，APN则升高达2倍多（P〈0．01）。LEP与性别、BMI、FIRI、FTI、FPI、HOMA-IR和QUICKI相关；RST与FPI／FTI和TI相关；APN与年龄、BMI、RBP-4、FPI、2hPI、FTI、HOMA-IR和QuICKI相关；RBP-4与BMI、APN、HOMA-IR相关。多元逐步回归分析提示，LEP和APN与IR独立相关。结论新诊断T2DM患者存在IR和血清LEP、RST、RBP-4升高；APN下降；RSG可能通过改善血清脂肪细胞因子谱而发挥降血糖、改善IR和口细胞功能的疗效。

Effects of rosiglitazone on serum adipocytokines in type 2 diabetic patients

Objective To investigate the effects of rosiglitazone（RGT） on serum adipocytokines and insulin resistance （IR） in the newly diagnosed patients with type 2 diabetes（T2DM）. Methods Thirtyeight newly diagnosed T2DM patients were given RGT 4mg/d for 12 weeks. The changes of plasma glucose（FPG and 2hPG）, serum total immunoreactive insulin（IRI-0h and IRI-2h）, true insulin （TI-0h and TI-2h）, proinsulin（PI-0h and PI-2h）, serum levels of adiponectin, leptin, resistin, retinol binding protein 4（RBP-4）were examined in 24 sex-and age-matched normal subjects and patients at the baseline and 12 weeks after the therapy. HOMA-IR was calculated by the HOMA model. Insulin secretion was evaluated by the fasting PI/TI ratio. BMI and QUICKI were also calculated. Results FPG, 2hPG, IRI, PI-0h, leptin, resistin, RBP-4,HOMA-IR and fasting PI/TI ratio were increased, adiponectin and QUICKI were decreased and RBP-4 had no difference in T2DM patients before treatment as compared to normal controls. After rosiglitazone treatment,FPG, 2hPG, IRI,PI-0h, leptin, resistin, HOMA-IR and fasting PI/TI ratio were reduced （all .P〈0. 05）. and serum adiponectin was increased （27. 8 vs 12.6μg/ml, P〈0. 01）. Leptin was positively correlated with sex , BMI, IRI-0h,TI-0h, PI-0h and HOMA- IR, but negatively correlated with QUICKI （P〈0. 05）. Resistin was positively correlated with fasting PI/TI ratio, but.negatively correlated with TI-0h（P〈0.05）. Adiponectin was correlated with age, BMI, RBP-4, PI, TI-0h, HOMA-IR and QUICKI（P〈0. 05）. RBP-4 was correlated with BMI, adiponectin and HOMA-IR（P〈0.05）. The most important factors affecting HOMA-IR were leptin, adiponectin and BMI（R^2-0. 655, P〈0.01）. Conclusions Increased levels of serum leptin, resistin, RBP-4, and decreased adiponectin levels were correlated closely with IR in the newly diagnosed T2DM patients. RGT treatment can decrease plasma glucose level, and improve insulin sensitivity and β-cell function at least partly through impro