二甲双胍对糖耐量受损合并代谢综合征患者血清视黄醇结合蛋白4和炎性因子的影响

目的 观察二甲双胍对糖耐量受损(IGT)合并代谢综合征(MS)患者临床血生化指标及血清视黄醇结合蛋白4(RBP-4)、高敏C反应蛋白(hs-CRP)和肿瘤坏死因子α(TNF-α)的影响。方法 将60例新诊断IGT合并MS患者按随机数字表法分为二甲双胍组和生活干预组，每组30例，比较两组治疗前和治疗16周后体质指数(BMI)、糖化血红蛋白(HbA1c)、HOMA模型胰岛素抵抗指数(HOMA-IR)、血脂、血清RBP-4、hs-CRP、TNF-α水平的变化。结果 治疗后二甲双胍组较生活干预组HbA1c、HOMA-IR、RBP-4、hs-CRP和TNF-α明显下降(5.09±0.26)％比(5.69±0.49)％，2.95±0.63比3.49±0.78,( 18.69±6.50) mg/L比(26.20±6.97) mg/L,( 2.37±0.53) mg/L比（2.99±0.57)mg/L，(9.49±2.37)μg/L比(14.33±2.62)μg/L]，差异有统计学意义(P＜0.01)。多元线性回归分析显示，RBP-4变化与BMI、HOMA-IR、hs-CRP、TNF-α有线性回归关系(β=0.284、0.506、0.274、0.230，P＜0.01)，其中HOMA-IR对RBP-4的影响最大。结论 二甲双胍可明显改善IGT合并MS患者的胰岛素抵抗，显著降低RBP-4、hs-CRP和TNF-α的水平，具有明显的抗炎作用。

Effects of metformin on the levels of serum retinol-binding protein 4 and inflammatory factors in patients with impaired glucose tolerance and metabolic syndrome

Objective To investigate the effects of mefformin on the levels of serum retinol-binding protein 4 (RBP-4),high sensitive C reactive protein (hs-CRP) and tumor necrosis factorα (TNF-α) in patients with impaired glucose tolerance(IGT) and metabolic syndrome(MS). Methods Sixty patients with IGT and MS were divided into mefformin treatment group (30 cases) and life-style intervention group (30 cases) by random digits table. Body mass index (BMI),the levels of HbAic, HOMA-IR, blood fat, RBP-4,hs-CRP, TNF- α were measured both before and 16 weeks after treatment in the two groups and compared.Results The levels of HbA1c, HOMA-IR, RBP-4, hs-CRP and TNF- α were significantly lower in mefformin treatment group than those in life-style intervention group (5.09 + 0.26 )％ vs. (5.69 ± 0.49 )％, 2.95 ± 0.63vs. 3.49 ± 0.78, ( 18.69 ± 6.50) mg/L vs.(26.20 ± 6.97) mg/L, (2.37 ± 0.53) mg/L vs.(2.99 ± 0.57) mg/L,(9.49 ± 2.37) μ g/L vs. ( 14.33 ± 2.62) μ g/L] (P ＜ 0.01 ). The results of multiple linear regression showed that correlations were found between the changes of RBP-4 and BMI,HOMA-IR,hs-CRP,TNF-α (β =0.284,0.506,0.274,0.230,P ＜0.01 ),and HOMA-IR was the most important limiting factor. Conclusions Mefformin can improve insulin sensitivity of the patients with IGT and MS, and depress the levels of RBP-4,hs-CRP and TNF- α. Meanwhile mefformin has anti-inflammatory effect.