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目的观察二甲双胍对谷氨酸脱羧酶抗体(GADA)阳性及阴性糖耐量受损(IGT)患者血清白介素6(IL-6)、C反应蛋白(CRP)及胰岛β细胞功能的影响。方法选取GADA阳性IGT患者20例、GADA阴性IGT患者40例及正常对照30例,两组IGT患者予二甲双胍治疗8周,观察治疗前后血压、血脂、血糖、IL-6、CRP和胰岛素抵抗指数(HOMA-IR)、胰岛素分泌指数(HOMA-IS)的变化,并与对照组比较。结果GADA阳性和阴性组治疗前空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1C)、CRP、HOMA-IR均高于对照组,HOMA-IS低于对照组。二甲双胍治疗8周后两组血压、血脂、BMI、IL-6较治疗前均无明显变化,而CRP[(0.89±0.22)、(0.91±0.25);(0.54±0.23)、(0.49±0.21)mg/L]、HOMA-IR(6.42±2.3,6.02±1.9;4.90±2.0,4.86±2.1)、FPG([5.9±1.4)、(5.7±1.3);(5.2±0.7)、(4.6±0.6)mmol/L]、2hPG([9.1±1.8)、(10.2±2.3);(7.2±1.6)、(7.3±1.8)mmol/L]均较治疗前降低(P<0.05或P<0.01),HOMA-IS(2.04±0.12、2.03±0.17;2.53±0.14、2.73±0.18)升高(均P<0.05),HbA1C亦较治疗前降低,但无统计学意义;两组HOMA-IR均与CRP呈正相关(r1=0.338,r2=0.364,P<0.05)。结论部分GADA阳性IGT患者亦存在不同程度的胰岛素抵抗和胰岛β细胞功能障碍。二甲双胍可显著降低CRP水平,改善胰岛β细胞功能。
Objective To observe the effects of metformin on serum interleukin 6 (IL 6), C reactive protein (CRP) and islet β cell function in patients with GADA positive or negative impaired glucose tolerance (IGT). Methods Twenty patients with GADA positive IGT, 40 GADA negative patients with IGT and 30 normal controls were enrolled. Two groups of patients with IGT were treated with metformin for 8 weeks. Blood pressure, blood lipid, blood glucose, IL-6, CRP and insulin resistance index HOMA-IR), insulin secretion index (HOMA-IS) changes, and compared with the control group. Results The levels of fasting plasma glucose (FPG), postprandial 2h glucose, HbA1C, CRP and HOMA-IR in GADA positive and negative groups were significantly higher than those in control group, and HOMA-IS was lower than that in control group. After 8 weeks of metformin treatment, blood pressure, blood lipids, BMI and IL-6 in the two groups had no significant changes before treatment, while CRP [(0.89 ± 0.22), (0.91 ± 0.25), (0.54 ± 0.23) and (0.49 ± 0.21) (5.9 ± 1.4), (5.7 ± 1.3); (5.2 ± 0.7), (4.6 ± 0.6), and (4.6 ± 0.6) ) were significantly lower than those before treatment (P <0.05 or P <0.01), 2hPG (9.1 ± 1.8, 10.2 ± 2.3, 7.2 ± 1.6, 7.3 ± 1.8 mmol / L, HOMA-IS (2.04 ± 0.12, 2.03 ± 0.17; 2.53 ± 0.14, 2.73 ± 0.18) (all P <0.05), HbA1C was also lower than before treatment, but no statistical significance; (R1 = 0.338, r2 = 0.364, P <0.05). Conclusions Some patients with GADA-positive IGT also have some degree of insulin resistance and pancreatic β-cell dysfunction. Metformin can significantly reduce CRP levels, improve pancreatic β-cell function.