| 摘要: | 先前研究發現電針有促進胰島素分泌的降血糖作用，此一降糖作用可能有腦內啡 (β-endorphin) 參與其中。在胰島素挑戰試驗 (Insulin Challenge Test，ICT) ，以及電針人體試驗中發現電針有增加胰島素敏感性的作用；胰島素增敏劑 (Rosiglitazone，TZD) 為目前臨床常用的糖尿病藥物，本研究主要目的為探討 15 Hz 電針足三里與TZD結合治療，觀察此一中西結合的療法對血糖調控之功效並探討其可能的機轉。
本研究先將正常大鼠隨機分為四組，分別為：0.1 mg/kg TZD組 (0.1TZD)、0.1 mg/kg TZD+EA組 (0.1TZD+EA)、電針組 (EA) 及空白對照組 (Saline)，探討電針藥物結合的效應。進一步運用幼年 Streptozotocin (STZ) 誘發的第2型糖尿病大鼠 (T2DM) 隨機分為三組，分別為：0.1TZD組、0.1TZD+EA及EA組，比較電針藥物結合的作用。最後，運用於臨床研究，選取年齡為20~65歲，新診斷為第2型糖尿病者，同樣隨機分為TZD組和TZD+EA組來觀察。最後並選取兩位年輕，BMI相近的男性患者，比較試驗前後血清中細胞激素 (Cytokine) 的變化。
結果顯示在正常大鼠部分，無論是EA，0.1TZD及0.1TZD+EA組皆有顯著的降糖作用，且0.1TZD+EA組顯著優於0.1TZD組。在T2DM方面，0.1TZD+EA及EA組降血糖之功效亦顯著優於0.1TZD組。無論是在正常或是T2DM大鼠針藥結合組皆發現有促進胰島素分泌之作用，但0.1TZD組則無促進胰島素分泌的作用。而在臨床試驗部分，僅TZD+EA組前後有明顯降糖；兩組胰島素阻抗程度及血清游離脂肪酸含量都有明顯減少，但兩組間比較並無顯著差異。
結論：經由動物研究初步證實兩者合併使用，較單獨電針或口服Rosiglitazone都有較好的降糖效果；在臨床試驗中，則可見到，Rosiglitazone或合併電針都有明顯改善胰島素敏感度的作用，而且，此胰島素阻抗的改善可能與調降游離脂肪酸有關。因此，電針並用藥物可以透過調節游離脂肪酸改善第2型糖尿病人胰島素的阻抗程度，但是否能比單獨用藥有更好的作用，仍須長期試驗結果才能證實。同時，針藥並用亦調節了多種Cytokines，這些Cytokines是否參與了胰島素阻抗的改善，仍需進一步探討。
Hypoglycemic effect was noted by electroacupuncture in previous study. The effect maybe due to electroacupuncture promot insulin secretion, and related to β-endorphin. In this study, electroacupuncture on Zusanli combined with Rosiglitazone (TZD) is applied to evaluate the influence of plasma glucose level to find its possible machenisms.
The normal Wistar rats are divided to 4 groups randomly as: 0.1 mg/kg TZD group (0.1TZD) , 0.1 mg/kg TZD+EA group (0.1TZD+EA) , electroacupuncture group (EA) and blank control group (Saline) . Then Streptozotocin (STZ) -induced type 2 Diabetes Mellitus (T2DM) rats are divided to 3 groups ramdomly as: 0.1TZD group, 0.1TZD+EA group and EA group. Hypoglycmic effect and the plasma insulin level are evaluated. Further, a randomized, single blind and placebo group controlled study to evluated the effect of EA with a frequency in 15 Hz on Human Zusanli acupoint. A total 30 newly diagnostic type 2 diabetic patients are enrolled. They are divided to TZD and TZD+EA group ramdomly. Hypoglycemic effect and plasma insulin level are evaluated. Finally, we select two young patients with similar baseline, one is treated TZD, and the other is treated TZD+EA. The change of Cytokines between before and after the intervention is compared.
As the results showed, there are significant hypoglycemic effects in all of the 3 groups, 0.1TZD, 0.1TZD+EA and EA group of normal Wistar rats. And better hypoglycemic effect is observed in 0.1TZD+EA group than 0.1TZD group. In the T2DM groups, better hypoglycemic effect in 0.1TZD+EA and EA groups is achieved than that of 0.1 TZD group. No matter normal or the T2DM rats, insulin secretion is enhanced in EA and TZD+EA groups, but not in 0.1TZD group. In the clinical trial, significant hypoglycemic effect is only observed in TZD group. But insulin resistance and plasma free fatty acid has been significant decreased in both group, there is no significant statistic difference between two groups in the level of insulin sensitivity.
In conclusion, significant hypoglycemic effect is observed in this EA and TZD combined groups than in the drug-only group, due to EA and combined therapy enhance the secretion of insulin. In the clinical trial, there is no significant hypoglycemic effect in combined group, which maybe due to much interference during the study. EA and combined therapy used in type 2 DM patients improve insulin sensitivity and the mechanisms maybe relate to the regulation of free fatty acid. Whether the combined therapy has a better effect to the plasma glucose regulation, long-term study is needed. EA adjust many kinds of cytokines, whether these cytokines did participate in the insulin resistance improvement need further explore. |
