摘要
目的:血浆游离脂肪酸的升高导致机体的脂毒性,脂毒性是肥胖并发糖尿病的核心环节,探讨针刺减肥是否有抑制脂毒性的作用及其可能机制。方法:选择南京中医药大学针灸减肥门诊2002-06/2004-05收治的单纯性肥胖病患者34例,应用毫针结合王不留行籽耳压的方法治疗,每周一、三、五针刺(主穴为天府、曲池、合谷,中脘、天枢、气海、血海、足三里、内庭。耳压主穴为神门、外鼻、三焦、内分泌),三餐前半小时按压耳穴,治疗3个月。治疗前后测量体质量指数、脂肪百分率,酶联免疫法测定血清胰岛素、瘦素和可溶性瘦素受体,生化比色法测定血脂、血糖,高效液相色谱法测定主要的8种游离脂肪酸,各指标间进行相关性检验,并与20例体质量正常的正常人对照。结果:按意向处理分析,54例均进入结果分析。①血清瘦素水平:单纯性肥胖组针刺后低于治疗前,与正常组无差异犤(16.33±1.06),(18.83±1.06),(14.55±1.17)μg/L犦。②瘦素受体水平:单纯性肥胖组针刺后高于治疗前(P=0.028),与正常组无差异(P=0.352)。③胰岛素敏感指数:单纯性肥胖组针刺后高于治疗前(-3.78±0.09,-4.06±0.09,P=0.000),与正常组无差异。④单纯性肥胖组针刺后脂肪百分率和体质量指数均较治疗前降低,但体质量指数仍高于正常组(P<0.01)。⑤游离脂肪酸水平:单纯性肥胖组针刺后低于治疗前,与正常组无差异(P<0.05)。⑥相关性分析结果:脂肪百分率的降低与不饱和脂肪酸的升高相关(r=0.402),与不饱和脂肪酸与饱和脂肪酸的比值的升高相关(r=0.348);高密度脂蛋白升高与二十碳五烯酸的升高相关(r=0.352),体质量指数的降低与高密度脂蛋白的升高的相关(r=0.357);治疗后瘦素的降低与豆寇酸的降低相关(r=0.443)。结论:针刺可以降低患者的游离脂肪酸水平、提高其胰岛素敏感性,从而表现出抑制脂毒性的效应。针刺抑制脂毒性的作用与降低瘦素水平有一定的关系。
AIM： The increase of free fatty acid in plasma leads to the organic lipotoxicity, which is the key link of obesity combined with diabetes mellitus. This paper was to investigate whether acupuncture can repress lipetoxicity, and the possible mechanism in repressing lipotoxicity.
METHODS： Thirty-four patients with simple obesity, who were treated in the outpatient department of Nanjing University of Traditional Chinese Medicine between June 2002 and May 2004, were treated for 3 months with acupuncture and auricular sticking cowherb seed. Acupuncture was given on each Monday, Wednesday and Friday, the main acupeints were Tianfu, Quchi, Hegu, Zhongwan, Tianshu, Qihai, Xuehai, Zuscatli and Neiting, and the main acupeints of auricular pressing were Shenmen, external nose, Sanjiao and endocrine. Auricular pressing was given at 30 minutes before the three meals. Before and after treatment, the indexes of body mass index and fat percentage were measured, serum levels of insulin, leptin and soluble leptin receptor were measured with enzyme- linked immunoadsordent assay （ELISA）, blood. lipids and blood glucose were detected with biochemical chromatometry, and the 8 main free fatty acids were determined with high performance liquid chromatograpy （HPLC）. The correlations among the indexes were analysis, and the results were compared with those of 50 normal subjects with normal body mass.
RESULTS： According to intention-to-treat analysis, all the 54 cases were involved in the analysis of results. （1） Serum level of leptin： The serum level of leptin in the simple obesity group after acupuncture was lower than that before treatment, and had no difference from that in the normal group [（16.33±1.06）, （18.83±1.06）, （14.55±1.17） μg/L]. （2） Level of leptin receptor. The level of leptin receptor in the simple obesity group after acupuncture was lower than that before treatment （P=0.028）, and had no difference from that in the normal group （P=0.352）. （3） Insulin sensitivity index： The insulin sensitivity index in the simple obesity group after acupuncture was lower than that before treatment （-3.78±0.09, -4.06±0.09, P=0.000）, and had no difference from that in the normal group. （4） The fat percentage and body mass index in the simple obesity group after acupuncture were lower than those before treatment, but the body mass index was still higher than that in the normal group （P 〈 0.01）. （5） Levels of free fatty acids： The levels of free fatty acids in the simple obesity group after acupuncture were lower than those before treatment, and had no difference from that in the normal group （P 〈 0.05）. （6） The results of correlation analysis： The decrease of fat percentage was correlated with the increase of unsaturated fatty acid （r=0.402）, also correlated with the increase of the ratio of unsaturated fatty acid to saturated fatty acid （r =0.348）. The increase of high density lipoprotein had correlation with the increase of eicosapentaenoic acid （r=0.352）, the decrease of body mass index was associated with the increase of high density lipoprotein （r =0.357）. After treatment, the decrease of leptin had correlation with the decrease of myristic acid r=0.443）.
CONCLUSION： Acupuncture can decrease the levels of free fatty acids of the patients, increase their insulin sensitivity index, and then shows it effect in repressing lipotoxicity, which has certain correlation with the decrease of leptin level.
出处
《中国临床康复》
CSCD
北大核心
2005年第43期122-125,共4页
Chinese Journal of Clinical Rehabilitation
基金
江苏省中医管理局2003年度资助项目
江苏省科技厅社会发展项目(BS2004032)
南京市2005年科技发展计划项目(200504023-3)~~
