罗格列酮对非糖尿病代谢综合征患者代谢指标及大动脉硬化程度的影响

Effects of Rosiglitazone on Metabolic Parameters and Large Artery Sclerosis in Nondiabetic Patients with Metabolic Sydrome

目的观察罗格列酮对非糖尿病代谢综合征(MS)患者代谢指标以及颈动脉内膜中层厚度(IMT)、臂踝脉搏波速度(baPWV)、踝臂指数(ABI)的影响。方法非糖尿病MS患者79例随机分为两组:治疗组(41例)在生活方式干预的基础上加用罗格列酮4mg/d;对照组(38例)仅给予生活方式干预。每3个月随访1次,共随访9个月。所有患者随访前后均进行体质量指数(BMI)、腰围(WC)、收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白-胆固醇(HDL-C)、低密度脂蛋白-胆固醇(LDL-C)、高敏C反应蛋白(hsCRP)、糖化血红蛋白(HbA1c)、空腹胰岛素(FIns)、胰岛素抵抗指数(HOMA-IR)、IMT、baPWV及ABI的测定。结果 (1)治疗6个月后,治疗组FPG、TG、HDL-C、hsCRP、HbA1c、FIns和HOMA-IR明显改善(P<0.01),并且随治疗时间的延长,FPG、HDL-C、hsCRP、HbA1c、FIns和HOMA-IR进一步改善(P<0.01);9个月后,治疗组FPG、HDL-C、hsCRP、HbA1c、FIns和HOMA-IR与对照组相比,差异有高度统计学意义(P<0.01)。(2)治疗6个月后,治疗组baPWV和ABI明显改善(P<0.01),IMT无变化;9个月后,IMT得到改善(P<0.01),治疗组IMT、baPWV和ABI与对照组相比,差异有高度统计学意义(P<0.01)。(3)多因素分析显示,ABI的改善主要与HbA1c和HOMA-IR水平的下降相关(P<0.01)。结论罗格列酮能明显改善非糖尿病MS患者的胰岛素抵抗,调节糖脂代谢,减轻炎症反应,并在一定程度上延缓动脉粥样硬化的进程。

Objective To observe the effects of rosiglitazone on metabolic parameters,carotid intimamedia thickness（ IMT） ,brachial-ankle pulse wave velocity（ baPWV） and ankle-brachial index（ ABI） in nondiabetic patients with metabolic syndrome. Methods Seventy-nine nondiabetic patients with metabolic syndrome were randomly divided into treatment group （ n = 41） and control group （ n = 38） . The patients in treatment group were treated with rosiglitazone on the basis of life-style intervention,those in control group were treated with life-style intervention for 9 months. All patients were followed up every 3 months. Body mass index （ BMI） ,waist circumference（ WC） ,systolic blood pressure（ SBP） ,diastolic blood pressure（ DBP） ,fasting blood glucose （ FBG） ,triglyceride（ TG） ,total cholesterol（ TC） ,highdendity lipoprotein （ HDL-C） ,Low-density lipoprotein （ LDL） ,high sensitivity C-reactive protein （ hsCRP） ,HbA1C,fasting insulin（ FIns） ,HOMA-IR,IMT,baPWV and ABI were measured in both groups before treatment and at the 6th,9th month after treatment. Results （ 1） After treatment with rosiglitazone for 6 months,FPG,TG,HDL-C,hsC RP,HbA1C,Fins and HOMA-IR in treatment group were improved （ P 0. 01） . FPG,HDL-C,hsC RP,HbA1C,Fins and HOMA-IR got further improvement at the 9th month after treatment（ P 0. 01） . After 9 months,FPG,HDL-C,hsC-RP,HbA1C,Fins and HOMA-IR were changed significantly in treatment group compared to those in control group（ P 0. 01） . （ 2） After treatment with rosiglitazone for 6 months,baPWV and ABI in treatment group were improved （ P 0. 01） . IMT was not changed until the 9th month after treatment. IMT,baPWV,ABI were changed significantly in treatment group compared to those in control group after 9 months （ P 0. 01） . （ 3） The reduction of HbA1C and HOMA-IR was independently related to the improvement of ABI by multivarient analysis. Conclusion In nondiabetic patients with metabolic syndrome,rosiglitazone can significantly improve insulin resistance,correct metabolic disorders,has anti-inflammatory effect and retard atherosclerosis at some extent.