Velussi M, Cernigoi A M, De Monte A, Dapas F, Caffau C, Zilli M
Anti-Diabetes Centre, Monfalcone Hospital, Gorizia, Italy.
J Hepatol. 1997 Apr;26(4):871-9. doi: 10.1016/s0168-8278(97)80255-3.
BACKGROUND/AIMS: Several studies have demonstrated that diabetic patients with cirrhosis require insulin treatment because of insulin resistance. As chronic alcoholic liver damage is partly due to the lipoperoxidation of hepatic cell membranes, anti-oxidizing agents may be useful in treating or preventing damage due to free radicals. The aim of this study was to ascertain whether long-term treatment with silymarin is effective in reducing lipoperoxidation and insulin resistance in diabetic patients with cirrhosis.
A 12-month open, controlled study was conducted in two well-matched groups of insulin-treated diabetics with alcoholic cirrhosis. One group (n=30) received 600 mg silymarin per day plus standard therapy, while the control group (n=30) received standard therapy alone. The efficacy parameters, measured regularly during the study, included fasting blood glucose levels, mean daily blood glucose levels, daily glucosuria levels, glycosylated hemoglobin (HbA1c) and malondialdehyde levels.
There was a significant decrease (p<0.01) in fasting blood glucose levels, mean daily blood glucose levels, daily glucosuria and HbA1c levels already after 4 months of treatment in the silymarin group. In addition, there was a significant decrease (p<0.01) in fasting insulin levels and mean exogenous insulin requirements in the treated group, while the untreated group showed a significant increase (p<0.05) in fasting insulin levels and a stabilized insulin need. These findings are consistent with the significant decrease (p<0.01) in basal and glucagon-stimulated C-peptide levels in the treated group and the significant increase in both parameters in the control group. Another interesting finding was the significant decrease (p<0.01) in malondialdehyde/levels observed in the treated group.
These results show that treatment with silymarin may reduce the lipoperoxidation of cell membranes and insulin resistance, significantly decreasing endogenous insulin overproduction and the need for exogenous insulin administration.
背景/目的：多项研究表明，肝硬化糖尿病患者因胰岛素抵抗需要胰岛素治疗。由于慢性酒精性肝损伤部分归因于肝细胞膜的脂质过氧化，抗氧化剂可能有助于治疗或预防自由基造成的损伤。本研究的目的是确定水飞蓟宾长期治疗对降低肝硬化糖尿病患者脂质过氧化和胰岛素抵抗是否有效。
对两组匹配良好的酒精性肝硬化胰岛素治疗糖尿病患者进行为期12个月的开放对照研究。一组（n = 30）每天服用600毫克水飞蓟宾加标准治疗，而对照组（n = 30）仅接受标准治疗。研究期间定期测量的疗效参数包括空腹血糖水平、每日平均血糖水平、每日尿糖水平、糖化血红蛋白（HbA1c）和丙二醛水平。
水飞蓟宾组治疗4个月后，空腹血糖水平、每日平均血糖水平、每日尿糖和HbA1c水平显著降低（p < 0.01）。此外，治疗组空腹胰岛素水平和平均外源性胰岛素需求量显著降低（p < 0.01），而未治疗组空腹胰岛素水平显著升高（p < 0.05）且胰岛素需求量稳定。这些发现与治疗组基础和胰高血糖素刺激的C肽水平显著降低（p < 0.01）以及对照组这两个参数显著升高一致。另一个有趣的发现是治疗组丙二醛水平显著降低（p < 0.01）。
这些结果表明，水飞蓟宾治疗可能降低细胞膜的脂质过氧化和胰岛素抵抗，显著减少内源性胰岛素过度分泌以及外源性胰岛素给药需求。
