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[针刺治疗可能通过下调胰岛素和瘦素抵抗以及上调糖尿病前期患者可溶性瘦素受体水平来减轻体重]

[Acupuncture Treatment Reduces Body Weight Possibly by Down-regulating Insulin and Leptin Resistance, and Up-regulating Soluble Leptin Receptor Level in Prediabetic Patients].

作者信息

Zhao Zhi-Ming, Liu Chun-Li, Zhang Qun-Yan, Zhang Bei-Bei, Guo Jun-Hao, Yuan Ai-Hong, Cai Hui

机构信息

The First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing 210023, China; Department of Integrated Traditional Chinese and Western Medicine, Nanjing General Hospital of People's Liberation Army, Nanjing 210002.

Department of Integrated Traditional Chinese and Western Medicine, Nanjing General Hospital of People's Liberation Army, Nanjing 210002.

出版信息

Zhen Ci Yan Jiu. 2018 Aug 25;43(8):506-11. doi: 10.13702/j.1000-0607.180184.

Abstract

OBJECTIVE

To observe the effect of acupuncture of Feishu (BL 13), Pishu (BL 20), etc. on body weight, blood lipid, leptin (LP) and soluble leptin receptor (sOB-R) levels in prediabetic patients, so as to explore its mechanisms underlying treatment and prevention of prediabetes.

METHODS

A total of 100 prediabetic patients were randomly assigned to medication (Metformin) group (=35), acupuncture group (=35) and simple lifestyle intervention group (=30) with random number table method. All the patients of the 3 groups were treated with lifestyle intervention (reasonable diet and moderate physical exercise) and ordered to stop administration of any hypoglycemic drugs during the treatment period. Bilateral Feishu (BL 13), Pishu (BL 20), Weishu (BL 21), Shenshu (BL 23), Zusanli (ST 36) and Sanyinjiao (SP 6) were punctured with filiform needles which were manipulated by lifting, thrusting and twirling repeatedly for about 2 min every 5 min during 30 minutes' needle retaining. The acupuncture treatment was conducted once every other day for 12 weeks. Patients of the medication group were ordered to orally take Metformin tablets (0.5 g/time, twice a day) for continuous 12 weeks. Body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), 2 h-postprandial blood glucose (2 h-PBG), fasting blood glucose (FBG), glycosyla-ted hemoglobin (HbA), total cholesterol (TC), triglyceride (TG), fasting insulin (FINS), serum LP and sOB-R levels were measured before and after the treatment.

RESULTS

After the treatment, the BMI in the acupuncture group, and BMI, WC and WHR in the medication group were significantly decreased relevant to their own pre-treatment in each group (<0.05, <0.01). Following the treatment, the levels of FBG, 2 h-PBG, HbA TC, TG, FINS, HOMA-IR and LP in both acupuncture and medication groups, and FBG in the simple lifestyle intervention group were significantly decreased in comparison with their own pre-treatment in each group (<0.01, <0.05), and the levels of FBG, 2 h-PBG, HbA, TC and TG, HOMA-IR and LP in both acupuncture and medication groups were all considerably lower than those of the simple lifestyle intervention group (<0.01,<0.05). The level of FINS in the medication group was significantly lower than that of the simple lifestyle intervention group (<0.05). Additionally, following the treatment, serum sOB-R contents in both acupuncture and medication groups were obviously increased compared with their own pre-treatment in each group and also relevant to the simple lifestyle intervention group (<0.01). No significant changes were found in the simple lifestyle intervention group in all the above-mentioned blood indexes except FBG (>0.05).

CONCLUSION

Acupuncture can induce body weight loss, down-regulate FINS, insulin resistance and LP resistance, and up-regulate sOB-R content in prediabetic patients, displaying a positive role in the treatment of prediabetes.

摘要

目的

观察针刺肺俞(BL 13)、脾俞(BL 20)等穴位对糖尿病前期患者体重、血脂、瘦素(LP)及可溶性瘦素受体(sOB-R)水平的影响,以探讨其防治糖尿病前期的作用机制。

方法

将100例糖尿病前期患者采用随机数字表法随机分为药物(二甲双胍)组(n =35)、针刺组(n =35)和单纯生活方式干预组(n =30)。3组患者均给予生活方式干预(合理饮食及适度体育锻炼),且治疗期间均停用任何降糖药物。采用毫针针刺双侧肺俞(BL 13)、脾俞(BL 20)、胃俞(BL 21)、肾俞(BL 23)、足三里(ST 36)和三阴交(SP 6),留针30分钟期间每5分钟行提插捻转手法1次,持续约2分钟。针刺治疗隔日1次,共12周。药物组患者口服二甲双胍片(0.5 g/次,每日2次),连续服用12周。于治疗前后分别测量体质指数(BMI)、腰围(WC)、腰臀比(WHR)、餐后2小时血糖(2 h-PBG)、空腹血糖(FBG)、糖化血红蛋白(HbA)、总胆固醇(TC)、甘油三酯(TG)、空腹胰岛素(FINS)、血清LP及sOB-R水平。

结果

治疗后,针刺组的BMI以及药物组的BMI、WC和WHR与各组自身治疗前相比均显著降低(P<0.05,P<0.01)。治疗后,针刺组和药物组的FBG、2 h-PBG、HbA、TC、TG、FINS、HOMA-IR及LP水平,以及单纯生活方式干预组的FBG水平与各组自身治疗前相比均显著降低(P<0.01,P<0.05),且针刺组和药物组的FBG、2 h-PBG、HbA、TC、TG、HOMA-IR及LP水平均显著低于单纯生活方式干预组(P<0.01,P<0.05)。药物组的FINS水平显著低于单纯生活方式干预组(P<0.05)。此外,治疗后,针刺组和药物组的血清sOB-R含量与各组自身治疗前相比均明显升高,且与单纯生活方式干预组相比也升高(P<0.01)。单纯生活方式干预组除FBG外,上述各项血液指标均无明显变化(P>0.05)。

结论

针刺可使糖尿病前期患者体重减轻,下调FINS、胰岛素抵抗及LP抵抗,上调sOB-R含量,对糖尿病前期的治疗具有积极作用。

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