二甲双胍对2型糖尿病患者动脉粥样硬化的一级预防作用

Primary preventive effect of metfromin upon atherosclerosis in patients with type 2 diabetes mellitus

目的探讨二甲双胍是否可以预防2型糖尿病（T2DM）患者发生动脉粥样硬化（AS）。方法140例T2DM患者分为二甲双胍组（75例）和非二甲双胍组（65例），进行强化血糖、血压、血脂控制100周，记录强化治疗前后随访指标，进行统计学分析。以颈总动脉内中膜厚度（CC—IMT）为AS观测指标。结果经过100周强化代谢控制后，两组舒张压（DBP）、空腹血糖、餐后2h血糖、糖化血红蛋白、甘油三酯（TG）、总胆固醇（TC）（P〈0．05）均明显下降；二甲双胍组的体重指数（BMI）、胰岛素抵抗指数（HOMA-IR）和CC—IMT降低（P〈0．05），高密度脂蛋白胆固醇（HDL-C）水平有所升高（P〈0．05）；100周时二甲双胍组的BMI[（23．1±0．98）kg／m^2、HOMA．IR（1．68±0．20）及CC—IMT（0．55±0．13）him]均较非二甲双胍组低[（24．1±0．05）kg／mm^2，（2．03±1．38），（0．70±0．15）mm，P〈0．05]。CC-IMT与BMI（r=0．489，P〈0．05）、TC（r=0．429，P〈0．05）、LDL．C（r=0．426，P〈0．05）、HOMA—IR（r=0．428，P〈0．05）呈正相关。结论二甲双胍可以降低T2DM患者的CC-IMT，对T2DM患者发生AS具有一级预防作用。

Objective To investigate the preventive action of mefformin for atherosclerosis （AS） in patients with type 2 diabetes mellitus （T2DM）. Methods A total of 140 cases with T2DM were assigned to 2 groups taking metformin （ n = 75 ） or not （ n = 65 ）. All cases received intensive control of blood glucose, blood pressure and blood lipids for 100 weeks. The data before and after intensive control were recorded and statistically analyzed. Common carotid intima-media thickness （CC-IMT） was the efficacy endpoint of AS. Results Diastolic blood pressure （DBP）, fasting blood glucose, post 2-hour blood glucose, glycated hemoglobin Alc, triglyceride （TG） and total cholesterol （TC） decreased in both groups after intensive metabolic control for 100 weeks （ P 〈 0. 05 ）. Body mass index （ BMI）, HOMA insulin resistance index （HOMA-IR） and CC-IMT decreased in metformin group （P 〈 0. 05 ） while high-density lipoprotein cholesterol （HDL-C） increased （ P 〈 0. 05 ）. BMI （23.1 ± 0. 98 ） kg/m^2, HOMA-IR （ 1.68 ± 0. 20） and CC-IMT（0.55 ± 0. 13 ）mm in meffonnin group were lower than those in non-mefformin group [ （24. 1 ± 0. 05） kg/m^2, 2. 03 ± 1.38, （ 0. 70 ± 0. 15 ） mm） ] at 100 week （ P 〈 0. 05 ）. CC-IMT was positively correlated with BMI （ r = 0. 489, P 〈 0. 05 ）, TC （ r = 0. 429, P 〈 0. 05 ）, low-density lipoprotein cholesterol （LDL-C） （r =0.426, P 〈0.05） and HOMA-IR （r =0.428, P 〈0.05）. Conclusion Mefformin attenuates CC-IMT of patients with T2DM and it has the primary preventive effect upon AS in patients with T2DM.