臺灣博碩士論文加值系統

胰島素阻抗 (insulin resistance) 會造成糖尿病、血中脂質上升、高血壓等疾病，隨著年紀的增長，其發生率會逐漸增加。醫原性造成胰島素阻抗的原因，皮質類固醇之使用為常見之一，如何減輕病理性或醫原性的胰島素阻抗，以促進人類健康，為本研究之主要目的。
本研究以大白鼠為實驗對象，使用胰島素挑戰試驗 (insulin challenge test) 的方法，觀察實驗組與對照組是否有降血糖的差異，另外再以股靜脈注射streptozotocin的方法，製造出糖尿病大白鼠的模型為對象，以相同的方法來評估。先於正常之大白鼠，比較電針兩側足三里是否可以有降血糖之差異，同時檢測游離脂肪酸 (free fatty acid) 的差異程度，同樣實驗也於糖尿病大白鼠中再做一次。另外觀察正常之大白鼠對靜脈注射葡萄糖耐受試驗 (intravenous glucose tolerance test) 的反應為何。進一步於正常大白鼠注射類固醇，發現的確會造成胰島素阻抗。接著對於腹膜腔內注射類固醇之大白鼠或糖尿病大白鼠，同樣以胰島素挑戰試驗檢測，電針是否增加胰島素降血糖作用與游離脂肪酸下降有關。最後，以類固醇處置過之大白鼠為對象，施予naloxone靜脈注射以觀察是否會阻斷電針增加胰島素降血糖之效果。
結果顯示：不管有無給予類固醇處置，電針足三里都可以提升正常大白鼠的胰島素挑戰試驗之血糖下降程度，且與游離脂肪酸減少有正相關；對於糖尿病大白鼠，不管有無給予類固醇處置，電針足三里也可以提升胰島素挑戰試驗之血糖下降程度，但必須遲至60分鐘才出現效果，與游離脂肪酸減少有正相關。電針足三里可以提升正常大白鼠之靜脈注射葡萄糖耐受試驗的血糖下降程度，而naloxone對於類固醇處置過之正常大白鼠而言，卻無法阻斷電針增強胰島素降血糖之療效。
結論：電針足三里改善胰島素的敏感度的原因，可能是透過降低血中游離脂肪酸的效果，而內生性嗎啡 (endogenous opioid peptides)並非主要的角色。

Insulin resistance (IR) induces diabetes mellitus, hyperlipidemia and hypertension. The incidence of IR elevates with age. Corticosteroid is one of the reasons that cause iatrogenic IR. The aim of this study is trying to find the way to improve the pathologic or iatrogenic IR, in order to improve peoples’ health. Wistar rats were chose to be the experimental animal in this study and insulin challenge test (ICT) was used to evaluate whether there was significant difference between experimental and control groups or not. In this study, the diabetic rat model was produced via intravenous injecting with streptozotocin (STZ). Electroacupuncture (EA) to Zusanli acupoint was performed in the normal rats and assayed plasma glucose and free fatty acid levels. The intravenous glucose tolerance test (ivGTT) was also performed to the rats. The same protocol was done in the STZ-induced diabetic rats. Then, the normal rats were injected prednisolone to ensure the insulin resistance will be induced. The rats with prednisolone management were tested by EA as those without prednisolone management. Finally, rats with prednisolone management were given naloxone intravenously and tested whether EA had effect in insulin resistance no not.
The results showed whether there had prednisolone management or not, EA at Zusanli acupoint had hypoglycemic effect under ICT, and it was in parallel response to free fatty acid. The same results were found in those diabetic rats but the responses did not happen until 60 minutes, it also was in parallel response to free fatty acid. EA at Zusanli acupoint also significantly lowered blood glucose in intravenous glucose tolerance test (ivGTT). But naloxone did not block the hypoglycemic effect of EA in rats with prednisolone management.
In conclusion, EA can improve insulin resistance in parallel the lowering of plasma free fatty acid level, and endogenous opioid peptide seems not involve in this action of EA at Zusanli acupoint.

摘要 1
前言 3
第一章 文獻探討 5
第一節 葡萄糖的代謝 5
第二節 胰島素的生理特性與功能5 6
第三節 胰島素阻抗 8
第四節 類固醇對胰島素作用的影響 12
第五節 游離脂肪酸之形成與代謝 13
第六節 神經傳導物質對血糖的影響 15
第七節 中醫對糖尿病的看法 16
第八節 足三里 20
第二章 材料與方法 21
第一節 實驗步驟 21
第二節 檢驗方法 27
第三節 統計方法 28
第三章 結果 29
第四章 討論 44
第五章 結論 48
參考文獻 49
英文摘要 56

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