吡格列酮对非糖尿病急性冠脉综合征患者炎症因子的影响

Effects of pioglitazone on high-sensitive C-reactive protein and soluble vascular cellular adhesion molecule-1 levels in non-diabetic patients with acute coronary syndrome

目的:探讨吡格列酮抑制非糖尿病急性冠脉综合征(ACS)患者动脉粥样硬化炎症的作用及可能机制。方法:将非糖尿病ACS患者随机分成吡格列酮组(40例,每日服吡格列酮15mg)和常规治疗组(42例);另选20例健康者作为对照。分别于用药前、用药30天后抽取静脉血,用免疫散射比浊法和酶联免疫吸附法分别测定血清高敏C反应蛋白(hsCRP)和可溶性血管细胞粘附分子1(sVCAM-1)的浓度,并计算胰岛素抵抗指数(HOMA-R)。结果:用药前ACS患者hsCRP和sVCAM-1水平均高于正常对照组(P<0.01)。用药30天后,ACS患者hsCRP和sVCAM-1水平明显下降(P<0.01);吡格列酮组hsCRP和sVCAM-1较常规治疗组下降更明显(P<0.01);吡格列酮组HOMA-R明显下降(P<0.01),且hsCRP和sVCAM-1的下降与HOMA-R下降成正相关(r=0.47和0.39,P均<0.01),血糖浓度略有下降,但差异无统计学意义。结论:吡格列酮可显著降低非糖尿病急性冠脉综合征患者血清炎症因子水平,抑制动脉硬化炎症反应;降低胰岛素抵抗是其可能机制之一。

Objective： To investigate whether pioglitazone can suppress inflammation by reducing the serum levels of inflammatory factors, such as high-sensitive C-reactive protein （hsCRP） and soluble vascular cellular adhesion molecule -1 （sVCAM-1） in non-diabetic patients with acute coronary syndrome （ACS）. Methods： Eighty and two non-diabetic patients with ACS were randomized into two groups： Pioglitazone treat group （n=40） and routine treat group （n =42）. Except for routine treatment, patients in former group took 15 mg pioglitazone every day. Using immunity scatter rate nephelometry and enzyme-linked immunosorbent assay, the serum levels of hsCRP and sVCAM-1 for all patients were measured before taking medicine, and 30 days after taking medicine separately and compared with results from healthy volunteers without any treatment （n=20）. In addition, the homeostasis model of insulin resistance index （HOMA R） of patients were calculated. Results： Before taking medicine, the levels of hsCRP and sVCAM 1 m ACS patients were significantly higher than those in healthy group （P〈0.01）, but there was no difference between pioglitazone group and routine group. While 30 days later, the levels of hsCRP and sVCAM-1 in ACS patients descended significantly （P〈0.01）. Compared with routine group, the levels of hsCRP and sVCAM-1 in pioglitazone group descended more significantly （P〈0.01）. In the pioglitazone treated group, HOMA R decreased significantly （P〈 0.01）, and the reduction in hsCRP and sVCAM-1 were significantly positive correlated with reduction of HOMA-R （r=0. 47 and 0. 39, both P〈0.01）. Conclusion： Pioglitazone can significantly reduce serum levels of inflammatory factors in ACS patients without diabetes, demonstrating that pioglitazone reduces the inflammation of arteries, and insulin sensitization is its one of potential underlying mechanisms.