肥胖患者血清瘦素和胰岛素抵抗的关系及西布曲明对其的影响

目的 :观察肥胖患者血清瘦素和胰岛素抵抗的关系及西布曲明治疗单纯性肥胖的疗效及对瘦素和胰岛素抵抗的影响。方法 :单纯性肥胖患者 体重指数 (BMI)≥ 2 5kg/m2 ]70例 ,随机分为B组 (口服盐酸西布曲明片10mg/d)和C组 (口服安慰剂 1片 /d) ,共治疗 12周 ;另选 30例年龄匹配的健康正常人作为对照组 (A组 ) :BMI<2 3kg/m2 ,均检测身高、体重、腰围、臀围 ,观察空腹血糖 (FPG)、血清空腹胰岛素 (FINS)、血清瘦素 (leptin)的变化 ,计算胰岛素敏感指数 ISI=1/ (FPG×FINS) ],对瘦素与上述指标和ISI的相关性用多元逐步回归分析和偏相关分析。结果 :治疗 12周后 ,B组体重、BMI ,腰围、臀围显著下降 (P <0 .0 0 1) ,但C组上述指标无明显变化。两组肥胖受试者在治疗前血清瘦素、胰岛素水平明显高于A组 (P <0 .0 1) ,ISI明显低于A组 (P <0 .0 1) ;但B组用西部曲明治疗后血清瘦素、胰岛素水平明显下降 (P <0 .0 1) ,ISI水平显著升高 (P <0 .0 5 ) ;而C组用安慰剂治疗后上述指标无变化。在肥胖受试者中 ,影响瘦素最主要的因素依次为性别、BMI,胰岛素、ISI(R2 =0 .6 6 1,F =12 .6 6 2 ,P <0 .0 1) ,去除性别、BMI的影响后 ,瘦素与胰岛素呈著显正相关 (r=0 .5 97,P <0 .0 1) ,与ISI明显负相关 (r= 0 .4 6 8,P <0 .0

Serum leptin and insulin resistance in obesity and effects of sibutramine on them

Objective To assess the relationship between serum leptin and insulin resistance (IR) in obesity, and to investigate the effects of sibutramine on obesity, serum leptin and IR. Methods Seventy obese subjects body mass index(BMI)≥25 kg/m 2] were randomly divided into 2 groups: group B (sibutramine 10 mg/day) and group C (a placebo tablet /day). Both had been treated for 12 weeks. Another 30 healthy adults served as the normal control (group A: BMI<23 kg/ m 2). Their height, body weight, waist and hip circumference, fasting plasms glucose (FPG), fasting plasma insulin (FINS), and serum leptin were examined at the baseline and 12 weeks after the therapy. Insulin senstivity index (ISI) was calculated ISI=1/(FPG×FINS)]. Multiple linear regression analysis and partial correlation were performed on serum leptin. Results The body weight,BMI,waist and hip circumference decreased significantly after the 12 week-treatment with sibutramine in group B (P<0.01), but those indexes did not change after the treatment with placebo in group C (P>0.05). The levels of leptin and FINS were higher (P<0.01) , but ISI was lower (P<0.01) both in group B and C compared with those in group A at the baseline. The levels of serum leptin and FINS decreased (P<0.01), and ISI increased significantly (P<0.05) after the treatment with sibutramine in group B,while those indexes did not change after the treatment with placebo in group C.The most important factors to influence serum leptin level were listed as follows: sex>BMI>FINS>ISI (R 2=0.661, F=12.662, P<0.01). The leptin was positively correlated with FINS (r=0.597, P<0.01), but negatively correlated with ISI (r= -0.468,P<0.01) after eliminating the effects of sex and BMI.Conclusion Leptin resistance and insulin resistance exist in obesity,and serum leptin is associated with IR.Treatment with sibutramine significantly reduces the body weight and leptin,increases insulin senstivity, and improves IR.