根除治疗对糖尿病前期患者胰岛素抵抗的影响：一项初步研究及单盲随机对照临床试验。
Effect of eradication on insulin resistance among prediabetic patients: A pilot study and single-blind randomized controlled clinical trial.
作者信息
Kachuei Ali, Amini Masoud, Sebghatollahi Vahid, Feizi Awat, Hamedani Pooria, Iraj Bijan
机构信息
Department of Endocrinology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Gastroenterology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
出版信息
J Res Med Sci. 2016 Feb 23;21:8. doi: 10.4103/1735-1995.177355. eCollection 2016.
BACKGROUND
Type II diabetes mellitus (T2DM) is the prevalent type of diabetes in the world. Prediabetic patients are the most probable group to get diabetes. Several studies have mentioned the role of inflammation in the incidence of diabetes. The origin of inflammation can be infection such as (HP) infection. This study was designed to explore the effect of eradication on insulin resistance.
MATERIALS AND METHODS
This single-blind randomized controlled clinical trial was conducted in 2014-2015. The sample size consisted of 49 individuals who were in prediabetes stage with HP infection. Patients with positive stool antigen were allocated randomly into two groups. The treatment group took medication to eradicate HP infection by the routine method of four-drug eradication. However, placebo capsules and tablets were given to the patients in the placebo group. Then fasting plasma glucose (FPG), fasting plasma insulin (FPI), and quantitative C-reactive protein (CRP) levels were measured and homeostatic model assessment of insulin resistance (HOMA-IR), homeostatic model assessment of beta-cell function (HOMA-B), Matsuda index, insulinogenic index, and disposition index were calculated.
RESULTS
Results of this study showed that FPI and HOMA-IR increased significantly ( value of FPI = 0.023 and value of HOMA-IR = 0.019) after HP eradication in the treatment group. On the other hand, comparison of differences at the baseline and after 6 weeks in FPG ( value = 0.045), FPI ( value = 0.013), and HOMA-B ( value = 0.038) revealed significant differences between the placebo group and treatment group.
CONCLUSION
Results showed that HP eradication by a 2-week antibiotic medication did not decrease insulin resistance and even increased FPI and insulin resistance indices. So HP eradication among prediabetic patients is not recommended for the decrease of insulin resistance and postponement of the development of diabetes mellitus.
背景
2型糖尿病（T2DM）是全球最常见的糖尿病类型。糖尿病前期患者是最有可能患糖尿病的群体。多项研究提及炎症在糖尿病发病中的作用。炎症的起源可能是感染，如幽门螺杆菌（HP）感染。本研究旨在探讨根除HP对胰岛素抵抗的影响。
材料与方法
这项单盲随机对照临床试验于2014年至2015年进行。样本包括49例处于糖尿病前期且感染HP的个体。粪便抗原检测呈阳性的患者被随机分为两组。治疗组采用四联根除HP感染的常规方法服药。然而，安慰剂组患者服用的是安慰剂胶囊和片剂。随后测量空腹血糖（FPG）、空腹血浆胰岛素（FPI）和定量C反应蛋白（CRP）水平，并计算胰岛素抵抗稳态模型评估（HOMA-IR）、β细胞功能稳态模型评估（HOMA-B）、松田指数、胰岛素生成指数和处置指数。
结果
本研究结果显示，治疗组根除HP后FPI和HOMA-IR显著升高（FPI的P值 = 0.023，HOMA-IR的P值 = 0.019）。另一方面，安慰剂组和治疗组在基线和6周后FPG（P值 = 0.045）、FPI（P值 = 0.013）和HOMA-B（P值 = 0.038）差异的比较显示出显著差异。
结论
结果表明，为期2周的抗生素药物根除HP并未降低胰岛素抵抗，甚至增加了FPI和胰岛素抵抗指数。因此，不建议对糖尿病前期患者进行HP根除以降低胰岛素抵抗和延缓糖尿病的发展。
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