二甲双胍治疗儿童单纯性肥胖相关胰岛素抵抗的疗效观察

发布时间：2018-05-21 07:16

本文选题：单纯性肥胖 + 胰岛素抵抗　；参考：《大连医科大学》2017年硕士论文

【摘要】：背景随着全球经济化的发展,肥胖症已经成为严重的公共卫生问题,儿童肥胖症发病率逐年上升,采取有效措施控制肥胖刻不容缓。目前肥胖的治疗方案主要包含调整膳食结构、体育锻炼、药物治疗、认知治疗和手术治疗,而药物治疗是重要环节。二甲双胍可以用于治疗儿童糖尿病,它除降糖外有控制体重的作用。目的本课题主要探讨二甲双胍是否可以降低肥胖儿童的体重及体重指数(BMI),改善胰岛素抵抗及糖脂代谢紊乱。并观察1例单独应用二甲双胍治疗儿童2型糖尿病(T2DM)的疗效。材料及方法本课题主要收集2010年6月到2016年10月于大连医科大学附属第二医院儿科病房住院的9-14周岁,诊断为单纯性肥胖及胰岛素抵抗的全部儿童作为治疗组,共41例,口服二甲双胍治疗12周,监测治疗前后的体重、身高、BMI、空腹血糖、空腹胰岛素、C肽、糖化血红蛋白、胰岛素抵抗指数(HOMA-IR)、甘油三酯、低密度脂蛋白、高密度脂蛋白、总胆固醇等指标变化。另外选择同时期于大连医科大学附属第二医院儿科门诊常规体检的9-14周岁正常身高体重的儿童20例作为对照组,比较该组儿童与治疗组儿童用药前BMI、空腹血糖、空腹胰岛素、HOMA-IR值的差别。统计学上,对于计量资料,符合正态分布的资料以均值±标准差((?)±S)表示,采用t检验比较,不符合正态分布的资料以中位数(P25 P75)表示,采用非参数检验比较。计数资料采用卡方检验进行比较。各自计算其P值,P0.05提示差异有统计学意义。同时报道1例大连医科大学附属第二医院儿科住院的诊断为T2DM及单纯性肥胖的女童,年龄为10.58岁,单独口服二甲双胍治疗,动态监测空腹血糖、糖化血红蛋白、HOMA-IR等指标8个月。结果1.治疗组儿童与对照组儿童的平均年龄、性别构成及空腹血糖的差异无统计学意义(P0.05)。治疗组儿童用药前BMI、空腹胰岛素及Ln(HOMA-IR)显著高于对照组,差异有统计学意义(P0.001)。2.治疗组儿童予以口服二甲双胍治疗l2周后,体重由用药前的(74.66±15.02)kg降到用药后的(71.91±14.19)kg,差异有统计学意义(P=0.004),BMI由治疗前的(29.36±4.42)kg/m~2降到治疗后的(27.40±3.99)kg/m~2,差异有统计学意义(P0.001),身高较前增长,差异有统计学意义(P=0.002)。3.治疗组儿童予以口服二甲双胍治疗l2周后,空腹血糖较前下降,差异有统计学意义(P=0.002),Ln(HOMA-IR)、空腹胰岛素、C肽、糖化血红蛋白均明显下降,差异有统计学意义(P0.001)。4.治疗组儿童予以口服二甲双胍12周后27名(65.85%)儿童HOMA-IR值降到3.5以下,其中24名(58.54%)儿童的HOMA-IR值降到3.16以下。5.治疗组儿童予以口服二甲双胍l2周后,甘油三酯较前下降,差异有统计学意义(P=0.002),低密度脂蛋白、总胆固醇明显下降,差异有统计学意义(P0.001),而高密度脂蛋白的前后变化无统计学意义(P=0.635)。6.报道1例诊断为2型糖尿病及单纯性肥胖女童,单独应用二甲双胍治疗,动态监测其空腹血糖于3天后降至正常,糖化血红蛋白于2月后降至正常,HOMA-IR亦呈明显下降趋势。7.用药儿童口服二甲双胍过程中4例(9.52%)出现不良反应,均为消化道反应,腹泻1例,恶心、腹胀3例,发生在用药前2周,未予处置,自行恢复正常。结论1.二甲双胍能够降低单纯性肥胖儿童的体重及BMI。2.二甲双胍能够调节单纯性肥胖儿童的糖代谢紊乱,改善胰岛素抵抗。3.二甲双胍能够降低单纯性肥胖儿童的甘油三酯、低密度脂蛋白及总胆固醇。4.二甲双胍能够治疗青少年T2DM。
[Abstract]:Background with the development of global economy, obesity has become a serious public health problem. The incidence of obesity in children is increasing year by year. It is urgent to take effective measures to control obesity. At present, the treatment scheme of obesity mainly includes adjustment of dietary structure, physical exercise, drug treatment, cognitive therapy and surgical treatment, and drug treatment is heavy. Metformin, which can be used to treat children with diabetes, has the effect of controlling weight in addition to hypoglycemic control. The subject is to investigate whether metformin can reduce the weight and body mass index (BMI) of obese children, improve insulin resistance and metabolic disorder of glucose and lipid, and observe 1 cases of children with type 2 diabetes treated by metformin alone. The effect of disease (T2DM). Materials and methods mainly collected from June 2010 to October 2016 in the second hospital of the Second Affiliated Hospital of Dalian Medical University, 9-14 years of hospitalization in the pediatric ward, diagnosed as simple obesity and insulin resistance in all children as the treatment group, a total of 41 cases, oral two a guanidine treatment for 12 weeks, monitoring the weight, height, before and after treatment. BMI, fasting blood glucose, fasting insulin, C peptide, glycosylated hemoglobin, insulin resistance index (HOMA-IR), triglyceride, low density lipoprotein, high density lipoprotein, total cholesterol, etc., 20 children with normal height and body weight at 9-14 years old in outpatient department of Pediatrics, Second Affiliated Hospital of Dalian Medical University, were selected at the same time. For the control group, the difference between the BMI, fasting blood glucose, fasting insulin and the HOMA-IR value before the medication in the children and the treatment group was compared. Statistically, for the data, the data conforming to the normal distribution were expressed as mean standard deviation ((?) + S), and compared with the t test, the data which did not conform to the normal distribution were expressed in the median (P25 P75), and the non parameters were used. The count data were compared with chi square test. The P values were calculated respectively. The difference was statistically significant by P0.05. At the same time, 1 cases of pediatric hospitalization in the second hospital affiliated to Dalian Medical University were diagnosed as T2DM and simple obese girls. The age was 10.58 years old. Hemoglobin, HOMA-IR and other indicators for 8 months. Results the average age, sex composition and fasting blood glucose of children in the 1. treatment group were not statistically significant (P0.05). The pre medication BMI, fasting insulin and Ln (HOMA-IR) in the treatment group were significantly higher than those in the control group. The difference was statistically significant (P0.001) the children of the.2. treatment group were given the mouth. After L2 weeks, the body weight was reduced from (74.66 + 15.02) kg to (71.91 + 14.19) kg after medication, and the difference was statistically significant (P=0.004). BMI was reduced from (29.36 + 4.42) kg/m~2 to (27.40 + 3.99) kg/m~2 before treatment. The difference was statistically significant (P0.001) and the difference was statistically significant (P=0.002).3. (P=0.002).3.. After L2 weeks of oral metformin treatment in the treatment group, the fasting blood glucose decreased significantly (P=0.002), Ln (HOMA-IR), fasting insulin, C peptide and glycosylated hemoglobin decreased significantly (P0.001) the difference was statistically significant (P0.001) in the.4. treatment group, 27 (65.85%) children (65.85%) were reduced to 3. after 12 weeks of oral metformin. Under 5, 24 (58.54%) children (58.54%) of children were reduced to less than 3.16 for L2 weeks after oral metformin for L2 weeks. The triglyceride decreased significantly (P=0.002), low density lipoprotein (P=0.002), low density lipoprotein (LDL) and total cholesterol (P0.001), but there was no statistical difference between HDL and HDL. Significance (P=0.635).6. reported 1 cases of type 2 diabetes and simple obesity girls, using metformin alone, the dynamic monitoring of fasting blood glucose decreased to normal in 3 days, glycated hemoglobin dropped to normal after February, and the HOMA-IR also decreased significantly in 4 cases (9.52%) in the process of oral metformin (9.52%). 1 cases of digestive tract reaction, 1 cases of diarrhea, nausea and abdominal distention in 3 cases, which occurred at 2 weeks before the medication, and were not disposed of and recovered spontaneously. Conclusion 1. metformin can reduce the weight of simple obese children and BMI.2. metformin can regulate the disorder of glucose metabolism in simple obese children, and the improvement of insulin resistance.3. metformin can reduce simplicity. Obese children's triglycerides, low density lipoprotein and total cholesterol.4. metformin can treat adolescent T2DM.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R723.14

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