过氧化体增殖物激活型受体α/γ激动剂对代谢综合征患者高敏C反应蛋白和基质金属蛋白酶9的影响

The Effect of Peroxisome Proliferator Activated Receptor-α/γ Agonist Intervention on Serum Concentration of High Sensitive C-reactive Protein and Matrix Metalloproteinase-9 in Patients with Metabolic Syndrome

目的了解过氧化体增殖物型激活受体α/γ激动剂单用与联用对代谢综合征患者高敏C反应蛋白和基质金属蛋白酶9的影响。方法 256例代谢综合征患者随机分为基础治疗组、非诺贝特组、吡格列酮组、非诺贝特+吡格列酮组。所有患者进行生活方式干预及应用相应药物。在控制血压的基础上,基础治疗组加服安慰剂;非诺贝特组加服非诺贝特0.2 g,每日1次,睡前服;吡格列酮组加服吡格列酮15 mg,每日1次;非诺贝特+吡格列酮组按相同剂量加服上述2种药物。共干预24周。干预前后测定所有患者高敏C反应蛋白和基质金属蛋白酶9的浓度。结果干预前后各组的血清高敏C反应蛋白分别为:非诺贝特组6.32±1.65 mg/L和3.52±1.98 mg/L,吡格列酮组5.85±1.59 mg/L和3.33±1.16 mg/L,非诺贝特+吡格列酮组6.49±1.34 mg/L和2.47±0.91 mg/L;干预前后各组的基质金属蛋白酶9的浓度分别为:非诺贝特组179.3±54.9μg和L/144.9±30.8μg/L,吡格列酮组188.7±62.4μg/L和146.9±27.8μg/L,非诺贝特+吡格列酮组177.5±58.7μg/L和128.8±34.8μg/L。结论单用非诺贝特或吡格列酮干预均可降低代谢综合征患者高敏C反应蛋白和基质金属蛋白酶9浓度,联用较单用降低更明显。

Aim To explore the effect of peroxisome proliferator activated receptors-α/γ（PPAR-α/γ） agonist intervention alone or in combination on serum concentration of high sensitive C-reactive protein（hs-CRP） and matrix metalloproteinase-9（MMP-9） in patients with metabolic syndrome. Methods 256 patients with metabolic syndrom were randomly assigned into basic treatment group,fenofibrate group,pioglitazone group,and fenofibrate＋pioglitazone group.All patients received lifestyle interventions and medications to control blood pressure.Additionally,patients in the B group received placebo.Patients in the fenofibrate group received fenofibrate 0.2 g once a day at night.Patients in the pioglitazone group received pioglitazone 15 mg once a day.Patients in the fenofibrate＋pioglitazone group received both fenofibrate and pioglitazone as described above.The intervention lasted for 24 weeks.All patients＇ serum concentration of hs-CRP and MMP-9 were checked pre and post intervention. Results Patients＇ serum concentration of hs-CRP pre and post intervention in each group were 6.32±1.65 mg/L and 3.52±1.98 mg/L in the fenofibrate group,5.85±1.59 mg/L and 3.33±1.16 mg/L in the pioglitazone group,and 6.49±1.34 mg/L and 2.47±0.91 mg/L in the fenofibrate ＋pioglitazone group respectively.Patients＇ serum concentration of MMP-9 pre and post intervention in each group were 179.3±54.9 μg/L and 144.9±30.8 μg/L in the fenofibrate group,188.7±62.4 μg/L and 146.9±27.8 μg/L in the pioglitazone group,and 177.5±58.7 μg/L and 128.8±34.8 μg/L in the fenofibrate＋pioglitazone group respectively.Conclusions Fenofibrate or pioglitazone intervention alone can reduce serum concentration of hs-CRP and MMP-9 in patients with metabolic syndrome.A combined use of fenofibrate and pioglitazone was more effective than single intervention with fenofibrate or pioglitazone.