二甲双胍干预肥胖儿童高胰岛素血症的临床疗效分析
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JIANG Li-hong1, ZHU Kai-kai2, ZHENG Rong-xiu1, YANG Qing-yan1, LIU Ge-li1△ 1 Department of Pediatrics, Tianjin Medical University General Hospital, Tianjin 300052, China;
2 Tianjin Second Children's Hospital △Corresponding Author E-mail: liugeli2001@ Abstract: Objective To investigate the clinical effect of metformin combined with lifestyle intervention in obese children with hyperinsulinemia. Methods A total of 82 obese children treated in the Department of Pediatric endocrine of our hospital from January 2015 to December 2016 were selected in this study. All of them were diagnosed as hyperinsulinemia. All cases were treated with metformin in addition to lifestyle guide to adjust their dietary structure and enhance exercise for one year. Clinical anthropometric indicators including height, weight, body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR) and waist-height ratio (WHtR) were measured before treatment and 3 months, 6 months and 12 months after treatment. Blood biochemical indexes were compared before and after treatment with metformin. Results (1) After 12 months of metformin treatment, BMI, WC, WHR and WHtR were all decreased compared with those before treatment. (2) The insulin levels were decreased significantly at all time points in 6 months compared with those before treatment. Levels of FINS, 1 h-INS and 2 h-INS were further reduced after 12-month treatment (P＜0.05). (3) After 6 months of metformin treatment, insulin resistance index (HOMA-IR), function of pancreatic beta-cell (HOMA - β) and area under curve of insulin were decreased whereas the whole body insulin sensitivity index (WBISI) increased (P＜ 0.05). The value of HOMA-IR continued to decline and WBISI continued to rise after 12-month treatment (P＜0.05). There was no significant difference in first-phase insulin secretion index (ΔI30/ΔG30) before and after treatment. Conclusion On the basis of adjusting the diet structure and strengthening the exercise, metformin can reduce BMI, improve insulin sensitivity and reduce insulin resistance in children with hyperinsulinemia. Key words: metformin; hyperinsulinism; obesity; child; insulin resistance
天津医药 2018 年 11 月第 46 卷双胍干预肥胖儿童高胰岛素血症的临床疗效分析
姜丽红 1，朱凯凯 2，郑荣秀 1，杨箐岩 1，刘戈力 1△
摘要：目的 探讨二甲双胍结合生活方式干预肥胖儿童合并高胰岛素血症的临床效果。方法 选取 2015 年 1 月—2016 年 12 月在我院儿科内分泌门诊就诊的肥胖高胰岛素血症儿童 82 例。所有患儿均给予调整饮食结构、增强 运动的生活方式指导，同时口服二甲双胍治疗 1 年。治疗前及治疗 3、6、12 个月时分别测量并计算各项临床指标，比 较二甲双胍治疗前后各项指标的变化。结果 （1）二甲双胍治疗 12 个月后，体质量指数（BMI）、腰围（WC）、腰臀比 （WHR）、腰身比（WHtR）均较治疗前下降。（2）与治疗前相比，6 个月时各时间点空腹胰岛素（FINS）水平均有明显下 降，至 12 个月时，FINS、1 h-INS、2 h-INS 进一步降低（均 P＜0.05）。（3）二甲双胍治疗 6 个月后，胰岛素抵抗指数 （HOMA-IR）下降、胰岛素分泌指数（HOMA-β）下降、胰岛素曲线下面积（AUCI）减小，总体胰岛素敏感指数（WBISI） 升高（均 P＜0.05），治疗 12 个月时 HOMA-IR 继续降低，WBISI 继续升高（均 P＜0.05）；早期胰岛素分泌指数（ΔI30/ ΔG30）治疗前后无明显变化。结论 在调整饮食结构、加强运动的基础上，肥胖高胰岛素血症儿童每天服用二甲双 胍为期 1 年，可减轻体质量，提高胰岛素敏感性，减轻胰岛素抵抗。
a与治疗前比较b与3个月比较c与6个月比较p0051214天津医药2018年11月第46卷第11期22治疗前后空腹及糖负荷后各时间点fins水平的变化与治疗前相比6个月时各时间点fins水平均有明显下降至12个月时fins1hins2hins进一步降低均p005而05hins3hins与6个月时水平差异无统计学意义p005见表223治疗前后空腹及糖负荷后各时间点血糖水平的变化治疗6个月时2hpg较初始时无降低12个月时较治疗前和治疗6个月均降低均p005
关键词：二甲双胍；高胰岛素血症；肥胖症；儿童；胰岛素抵抗 中图分类号：R725.899 文献标志码：A DOI：10.11958/20180400
The clinical analysis of metformin in the treatment of obese children with hyperinsulinemia
2 Tianjin Second Children's Hospital △Corresponding Author E-mail: liugeli2001@ Abstract: Objective To investigate the clinical effect of metformin combined with lifestyle intervention in obese children with hyperinsulinemia. Methods A total of 82 obese children treated in the Department of Pediatric endocrine of our hospital from January 2015 to December 2016 were selected in this study. All of them were diagnosed as hyperinsulinemia. All cases were treated with metformin in addition to lifestyle guide to adjust their dietary structure and enhance exercise for one year. Clinical anthropometric indicators including height, weight, body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR) and waist-height ratio (WHtR) were measured before treatment and 3 months, 6 months and 12 months after treatment. Blood biochemical indexes were compared before and after treatment with metformin. Results (1) After 12 months of metformin treatment, BMI, WC, WHR and WHtR were all decreased compared with those before treatment. (2) The insulin levels were decreased significantly at all time points in 6 months compared with those before treatment. Levels of FINS, 1 h-INS and 2 h-INS were further reduced after 12-month treatment (P＜0.05). (3) After 6 months of metformin treatment, insulin resistance index (HOMA-IR), function of pancreatic beta-cell (HOMA - β) and area under curve of insulin were decreased whereas the whole body insulin sensitivity index (WBISI) increased (P＜ 0.05). The value of HOMA-IR continued to decline and WBISI continued to rise after 12-month treatment (P＜0.05). There was no significant difference in first-phase insulin secretion index (ΔI30/ΔG30) before and after treatment. Conclusion On the basis of adjusting the diet structure and strengthening the exercise, metformin can reduce BMI, improve insulin sensitivity and reduce insulin resistance in children with hyperinsulinemia. Key words: metformin; hyperinsulinism; obesity; child; insulin resistance
天津医药 2018 年 11 月第 46 卷双胍干预肥胖儿童高胰岛素血症的临床疗效分析
姜丽红 1，朱凯凯 2，郑荣秀 1，杨箐岩 1，刘戈力 1△
摘要：目的 探讨二甲双胍结合生活方式干预肥胖儿童合并高胰岛素血症的临床效果。方法 选取 2015 年 1 月—2016 年 12 月在我院儿科内分泌门诊就诊的肥胖高胰岛素血症儿童 82 例。所有患儿均给予调整饮食结构、增强 运动的生活方式指导，同时口服二甲双胍治疗 1 年。治疗前及治疗 3、6、12 个月时分别测量并计算各项临床指标，比 较二甲双胍治疗前后各项指标的变化。结果 （1）二甲双胍治疗 12 个月后，体质量指数（BMI）、腰围（WC）、腰臀比 （WHR）、腰身比（WHtR）均较治疗前下降。（2）与治疗前相比，6 个月时各时间点空腹胰岛素（FINS）水平均有明显下 降，至 12 个月时，FINS、1 h-INS、2 h-INS 进一步降低（均 P＜0.05）。（3）二甲双胍治疗 6 个月后，胰岛素抵抗指数 （HOMA-IR）下降、胰岛素分泌指数（HOMA-β）下降、胰岛素曲线下面积（AUCI）减小，总体胰岛素敏感指数（WBISI） 升高（均 P＜0.05），治疗 12 个月时 HOMA-IR 继续降低，WBISI 继续升高（均 P＜0.05）；早期胰岛素分泌指数（ΔI30/ ΔG30）治疗前后无明显变化。结论 在调整饮食结构、加强运动的基础上，肥胖高胰岛素血症儿童每天服用二甲双 胍为期 1 年，可减轻体质量，提高胰岛素敏感性，减轻胰岛素抵抗。
a与治疗前比较b与3个月比较c与6个月比较p0051214天津医药2018年11月第46卷第11期22治疗前后空腹及糖负荷后各时间点fins水平的变化与治疗前相比6个月时各时间点fins水平均有明显下降至12个月时fins1hins2hins进一步降低均p005而05hins3hins与6个月时水平差异无统计学意义p005见表223治疗前后空腹及糖负荷后各时间点血糖水平的变化治疗6个月时2hpg较初始时无降低12个月时较治疗前和治疗6个月均降低均p005
关键词：二甲双胍；高胰岛素血症；肥胖症；儿童；胰岛素抵抗 中图分类号：R725.899 文献标志码：A DOI：10.11958/20180400
The clinical analysis of metformin in the treatment of obese children with hyperinsulinemia