论文部分内容阅读
目的探讨圣·约翰草提取物(路优泰)对老年2型糖尿病(T2DM)合并抑郁症(DPS)患者胰岛素抵抗(HOMA-IR)的关系及影响机制。方法入选120例T2DM患者,其中单纯T2DM 60例为对照组(Ⅰ组),T2DM合并抑郁症60例,年龄均>60岁,均采用人胰岛素类似物Aspart,进行个体化降糖治疗。60例T2DM合并DPS患者根据病情基本匹配分为两组,每组30例:治疗组(Ⅱ组)以路优泰300 mg,2次/d口服;非治疗组(Ⅲ组)不加用任何抗抑郁药物。分别跟踪监测三组治疗前后抑郁症程度和代表胰岛β-cell分泌功能的指标:空腹血糖(FG)及静脉血2 h血糖(PG 2 h)、C-P、内源性胰岛素(INS)、糖化血红蛋白(HbA1c)、HOMA-β细胞等以及代表IR的程度指标:身高、体重、体质量指数(BMI)、WHR、血压、HOMA-IR、TG、CHO等。结果与对照组及非治疗组相比,路优泰治疗组以汉米尔顿抑郁量表(HRSD)及自评抑郁量表(SDS)为标准判定DPS明显减轻,由Homa模型计算反应IR的指标Homa-IR由治疗前的4.68±1.32下降至治疗后的2.31±1.02(P<0.05)。在停止治疗后6、12 w,Homa-β分别增加至108.26±16.98和110.42±16.15(P<0.001),HOMA-IR分别下降至1.76±0.85和1.57±0.78(P<0.05)。结论联合路优泰治疗,不仅使T2DM合并DPS患者的抑郁症状明显改善,亦能有效减轻胰岛素抵抗状态,对疾病总体的治疗有积极的临床意义。
Objective To investigate the relationship between the effects of St. John’s wort extract (LUO You-tai) and insulin resistance (HOMA-IR) in elderly patients with type 2 diabetes mellitus (T2DM) and depression. Methods A total of 120 patients with T2DM were enrolled in this study. 60 cases of T2DM alone were treated as control group (group Ⅰ), 60 cases of T2DM complicated with depression (all 60 years old) were treated with human insulin analogue Aspart. Sixty patients with T2DM complicated with DPS were divided into two groups according to the basic condition of the disease: 30 cases in each group. The patients in the treatment group (group Ⅱ) were treated with Luyutai 300 mg twice daily, while those in the non-treatment group (Ⅲ) Antidepressants. The levels of depression and the function of pancreatic islet β-cell secretion were tracked and monitored before and after treatment respectively: fasting blood glucose (FG) and venous blood 2 h (PG 2 h), CP, endogenous insulin (INS), glycosylated hemoglobin (HbA1c), HOMA-β cells and so on, as well as the indicators of the degree of IR: height, weight, body mass index (BMI), WHR, blood pressure, HOMA-IR, TG, CHO and so on. Results Compared with the control group and the non-treatment group, Lu You-tai treatment group was significantly reduced by the Hamilton Depression Rating Scale (HRSD) and Self-Rating Depression Scale (SDS), and the index of response IR was calculated by Homa model Homa-IR decreased from 4.68 ± 1.32 before treatment to 2.31 ± 1.02 after treatment (P <0.05). Homa-β increased to 108.26 ± 16.98 and 110.42 ± 16.15 (P <0.001) at 6 and 12 weeks after treatment was stopped, respectively. HOMA-IR decreased to 1.76 ± 0.85 and 1.57 ± 0.78 respectively (P <0.05). Conclusion Union Road, Thai treatment, not only in patients with T2DM DPS significantly reduced symptoms of depression, but also effectively reduce the status of insulin resistance, the overall treatment of the disease has a positive clinical significance.