吡格列酮对老年冠心病合并胰岛素抵抗患者血浆纤溶酶原激活物抑制物1及短期预后的影响

Effects of Pioglitazone on Plasminogen Activator Inhibitor 1 and Short-term Prognosis in Elderly Patients with Coronary Heart Disease with Insulin Resistance

目的观察吡格列酮对老年冠心病合并胰岛素抵抗患者血浆纤溶活性及短期预后的影响。方法将76例老年冠心病合并胰岛素抵抗患者随机分为两组:吡格列酮组(38例)接受吡格列酮(15 mg/d)和基础治疗,对照组(38例)只接受基础治疗。两组均随访6个月,用ELISA法分别检测两组治疗前后血浆纤溶酶原激活物抑制物1(PAI-1)活性,并记录主要心脏不良事件(MACE)发生率。结果吡格列酮治疗6个月后PAI-1和胰岛素抵抗指数(HOMA-IR)均有显著性下降[(0.59±0.07)和(0.71±0.11)U/m l;(2.27±1.13)和(3.41±1.34)],吡格列酮组MACE发生率较对照组有显著降低(两组急性冠脉综合征发生率分别为10.52%和31.58%;靶血管重建发生率为5.26%和21.05%),差异均有统计学意义(P<0.05)。结论吡格列酮能有效降低老年冠心病合并胰岛素抵抗患者血浆PAI-1活性,减少近期MACE的发生。

Objective To observe the effects of pioglitazone on plasminogen activator Inhibitor 1（PAI-1） and short-term prognosis in elderly patients with coronary heart disease（CHD） complicated by insulin resistance.Methods Totally 76 elderly patients with CHD complicated by insulin resistance were randomly divided as pioglitazone group（n=38） receiving conventional therapy plus pioglitazone（15 mg/day）,and control group（n=38） merely receiving conventional therapy,The patients were followed up for six months.The plasma level of PAI-1 was detected at baseline and after treatment for 6 months with the method of ELISA,and major adverse cardiac events（MACE） were recorded.Results Pioglitazone therapy for 6 months was associated with a significant decrease of PAI-1[（0.59±0.07） vs（0.71±0.11） U/ml,P0.05 ]and HOMA-IR[（2.27±1.13） vs（3.41±1.34）,P0.05],MACE was significantly lower in the pioglitazone group than in the control group[acute coronary syndrome（ACS）： 10.52% vs 31.58%;target vessel revascularization（TVR）： 5.26%和21.05%;P0.05].Conclusion Pioglitazone can effectively reduce the plasma level of PAI-1 and the occurrence of MACE for the elderly patients with coronary heart disease complicated by insulin resistance.