过氧化物酶体增殖物活化受体γ激动剂对冠心病患者介入治疗后血浆炎症因子水平的影响

Effect of PPARγ-Agonist on Plasma Levels of Inflammatory Cytokine in Diabetes Mellitus With CAD Patients After Percutaneous Coronary Intervention

目的 :探讨过氧化物酶体增殖物活化受体 (PPAR)γ激动剂对伴有糖尿病的冠心病患者在冠状动脉介入治疗后血浆炎症因子水平的影响。方法 :用随机方法将 40例伴有糖尿病的冠心病患者在冠状动脉介入治疗后分为口服PPARγ激动剂马来酸罗格列酮(RSG)试验组 (n =2 0 )和对照组 (n =2 0 ) ,随访 6个月 ,用酶联免疫吸附法测定患者介入治疗前和RSG治疗后 6个月的血浆C 反应蛋白、巨噬细胞炎症蛋白 1水平 ,并观察血糖、胰岛素水平、胰岛素抵抗指数、糖基化血红蛋白 A1c、血脂水平的改变。结果 :6个月时试验组血浆C 反应蛋白、巨噬细胞炎症蛋白 1水平均比治疗前和对照组低 ,试验组RSG治疗前后比较、与对照组比较均有显著性差异 ,相关分析提示C 反应蛋白、巨噬细胞炎症蛋白 1的降低幅度与血糖水平呈负相关 (C 反应蛋白r =-0 45 ,P <0 0 0 1;巨噬细胞炎症蛋白 1r =-0 42 ,P <0 0 1) ,与血脂水平无相关。试验组 6个月时血浆空腹血糖、胰岛素水平、胰岛素抵抗指数、糖基化血红蛋白 A1c分别降低到 ( 7 3± 0 2 )mmol/L、( 9 2± 0 5 )mIU/L、4 1± 0 3、( 6 8± 0 2 ) % ,治疗前、后自身对照及与对照组比较均有显著性差异。结论 :RSG在提高胰岛素的敏感性、改善糖代谢的同时 。

Objective:This study was designed to determine the effect of rosiglitazone treatment on plasma levels of inflammatory cytokine in coronary artery disease(CAD) patients with diabetes mellitus undertook angioplasty and implanted stents.Methods:Forty CAD patients who just have undertook angioplasty and stents implanted were randomized into two groups,rosiglitazone group ( n =20) and control group ( n =20).After treatment of rosiglitazone,patients were followed-up for 6 months,plasma sample was collected from each patient before percutaneous coronary intervention and after treatment of rosiglitazone,respectively.Then plasma levels of C-reactive protein (CRP),Monocyte chemoattractant protein-1 (MCP-1)were measured by Enzyme-Linked Immunoassay.At the same time,cholesterol、fasting plasma glucose (FPG)、insulin、hemoglobinA_ 1C (HbA_ 1C) and Homeostasis Model Assessment (HOMA)-Insulin Resistance were also investigated.Result:At the end 6 months,patients in the rosiglitazone group showed significantly reduction in plasma levels of CRP and MCP -1,the decline in each of them appear to be inversely correlated with FPG (CRP,r=-0.45,p <0.001;MCP-1, r= -0.42,p <0.01),but there was no correlation with change of lipid factors.At the end of 6 months,patients treated with combination of rosiglitazone produced significant improvement in FPG,insulin,HOMA-IR and HbA_ 1C compared to baseline and relative to control.The levels of FPG,insulin,HOMA-IR and HbA_ 1C were significantly reduction to 7.3±0.2 mmol/L,9.2±0.5 mIU/L,4.1±0.3,(6.8±0.2)%,respectively.Both rosiglitazone group and control group showed no change in total cholesterol、LDL cholesterol、HDL cholesterol and triglyceride.Conclusions:Rosiglitazone show a clinically meaningful reduction in the plasma levels of inflammatory marker CRP、MCP-1 and FPG.Then rosiglitazone is through the mechanism of impress inflammatory cytokines exert it′s benefit effect to CAD patients with diabetes mellitus who received percutaneous coronary intervention.