Tong Peter C Y, Lee Zoe S K, Sea Man-Mei, Chow Chun-Chung, Ko Gary T C, Chan Wing-Bun, So Wing-Yee, Ma Ronald C W, Ozaki Risa, Woo Jean, Cockram Clive S, Chan Juliana C N
Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
Arch Intern Med. 2002 Nov 25;162(21):2428-35. doi: 10.1001/archinte.162.21.2428.
We examined the weight-losing effect of orlistat treatment on insulin sensitivity and cardiovascular risk factors in a group of severely obese young Chinese patients with or without type 2 diabetes mellitus.
Obese patients with diabetes (n = 33) and obese nondiabetic patients (n = 27) were given orlistat, 120 mg 3 times daily, without a concomitant hypocaloric diet for 6 months (body mass index [calculated as weight in kilograms divided by the square of height in meter; kg/m2] range, 27.8-47.4). The efficacy measures were (1) insulin sensitivity indices derived from the homeostasis model assessment and a composite measure of whole-body insulin sensitivity index; (2) glycemic control; (3) cardiovascular risk factors, including anthropometry, blood pressure, lipid profiles, and albuminuria; and (4) body composition determined by dual-energy x-ray absorptiometry.
At baseline, patients with diabetes had lower body mass index and percentage of body fat but higher waist-hip ratios and were more insulin resistant. Orlistat therapy reduced body weight, waist and hip circumferences, percentage of total body fat, blood pressure, fasting plasma glucose and lipid levels, albuminuria, and insulin sensitivity indices in both groups (all, P<.05). Despite less weight reduction, we found a greater percentage of reduction from baseline in glycosylated hemoglobin level (-11.6% vs -3.6%; P<.001), fasting plasma glucose level (-18.2% vs -5.0%; P<.001), and systolic blood pressure (-7.1% vs -3.1%; P =.02) in patients with diabetes. Obese subjects without diabetes had greater improvements in triglyceride levels, albuminuria, and the homeostasis model assessment (all, P<.01).
Short-term orlistat treatment without the use of a hypocaloric diet significantly improved insulin sensitivity and cardiovascular risk profiles in severely obese Chinese patients with or without type 2 diabetes.
我们研究了奥利司他治疗对一组患有或未患有2型糖尿病的重度肥胖中国年轻患者胰岛素敏感性和心血管危险因素的减肥效果。
糖尿病肥胖患者（n = 33）和非糖尿病肥胖患者（n = 27）接受奥利司他治疗，每日3次，每次120 mg，不伴有低热量饮食，持续6个月（体重指数[以千克为单位的体重除以身高米数的平方计算；kg/m²]范围为27.8 - 47.4）。疗效指标包括：（1）基于稳态模型评估得出的胰岛素敏感性指数和全身胰岛素敏感性指数的综合指标；（2）血糖控制；（3）心血管危险因素，包括人体测量学指标、血压、血脂谱和蛋白尿；（4）通过双能X线吸收法测定的身体成分。
在基线时，糖尿病患者的体重指数和体脂百分比较低，但腰臀比更高且胰岛素抵抗更强。奥利司他治疗使两组患者的体重、腰围和臀围、全身脂肪百分比、血压、空腹血糖和血脂水平、蛋白尿以及胰岛素敏感性指数均降低（所有P <.05）。尽管体重减轻较少，但我们发现糖尿病患者糖化血红蛋白水平从基线降低的百分比更大（-11.6%对-3.6%；P <.001），空腹血糖水平（-18.2%对-5.0%；P <.001），以及收缩压（-7.1%对-3.1%；P =.02）。无糖尿病的肥胖受试者在甘油三酯水平、蛋白尿和稳态模型评估方面有更大改善（所有P <.01）。
在不采用低热量饮食的情况下，短期使用奥利司他治疗可显著改善患有或未患有2型糖尿病的重度肥胖中国患者的胰岛素敏感性和心血管风险状况。
