吡格列酮对老年糖耐量低减患者内皮功能的影响

Effect of pioglitazone on endothelial function in elderly patients with impaired glucose tolerance

目的:探讨吡格列酮对老年糖耐量低减患者(IGT)内皮功能的影响。方法:选取56例老年糖耐量正常者(NGT)及60例老年糖耐量低减患者(IGT),将IGT患者随机分两组进行治疗,每组30例,疗程为6月。非药物干预组,仅改变生活模式;综合治疗组,生活模式改变基础上服吡格列酮(每天30mg),观察内皮依赖舒张功能(EDD)变化。结果:EDD在IGT患者明显低于NGT个体;在非药物干预组和综合治疗组EDD治疗前无明显差别,6月后EDD在非药物干预组无明显改变,在综合治疗组明显升高(P<0.05),EDD变化值与糖化血红蛋白(HbA1C)变化值、胰岛素抵抗指数(HOMA-IR)变化值、高敏感C反应蛋白(HsCRP)变化值呈负相关。结论:在改变生活模式基础上,吡格列酮可进一步改善老年IGT患者内皮功能,其机制可能是通过降低血糖、改善胰岛素抵抗,抑制炎症反应等。

Objective：To investigate the effects of pioglitazone on endothelial function in elderly patients with impaired glucose tolerance （IGT）. Methods：According to 75g OGTT test, 56 elderly subjects with normal glucose tolerance （NGT） and 60 IGT patients were selected and compared. IGT patients were randomly enrolled in two groups with different treatment for 6 months. Non-medication therapy group underwent an individually designed diet and exercise program;while patients in combination therapy group were treated with pioglitazone （30 mg·d^-1 ） in addition to non-medication therapy. Endothelium-dependent dilation （EDD） , blood lipid profile, blood glucose, and high-sensitive C reaction protein （HsCRP） were determined. Results： EDD in IGT patients were significantly lower than that in NGT elderly. EDD before treatment were similar between non-medication therapy group and combination therapy group. After 6 month treatment,EDD significantly increased in combination therapy group as compared with pre-treatment （P 〈 0.05） , but did not show statistically significant changes in non-medication therapy group. There were also significant differences in EDD between two groups after treatment （P 〈 0.05 ）. Moreover, the change in EDD was negatively correlated with the change of hemoglobin A1C （ HbA1 c） , homeostasis model assessment insulin resistance index （HOMA-IR） , and HsCRP. Conclusion：On the basis of improvement of life style, pioglitazone can improve endothelial function in elderly IGT patients. Its mechanism is probably associated with the change of blood glucose, insulin resistance and inflammation.