吡格列酮对2型糖尿病患者早期动脉硬化和黏附分子水平的影响

Effects of Pioglitazone on the Carotid Intima-media Thickness and Serum Adhesion Molecules Levels of Type 2 Diabetic Patients

目的研究2型糖尿病患者血清可溶性血管细胞黏附分子-1(sVCAM-1)、可溶性细胞间黏附分子-1(sICAM-1)水平和颈动脉内膜中层厚度(carotid intima-media thickness,CIMT)的关系以及吡格列酮治疗对其的影响。方法将150例2型糖尿病患者随机分为治疗组和对照组。治疗组在原治疗基础上给予吡格列酮15mg/d,治疗6个月,观察吡格列酮治疗前后血糖、血脂、sVCAM-1、sICAM-1和CIMT水平变化及与对照组之间的差别。结果与治疗前比较,两组治疗后血糖均下降,差异有统计学意义(P<0.05),治疗组治疗后sVCAM-1、sICAM-1和CIMT较治疗前显著降低,差异有统计学意义(P<0.05)。对照组治疗前后sVCAM-1、sICAM-1和CIMT差异无统计学意义(P<0.05)。多元线性逐步回归分析显示,CIMT变化与体质指数(BMI)餐后2h血糖(2hPG)、糖化血红蛋白(HbA1C)、甘油三酯(TG)、sVCAM-1和sICAM-1有关,相关系数分别为0.298、0.358、0.381、0.368、0.580、0.572(均P<0.05)。结论血清sVCAM-1和sICAM-1水平与2型糖尿病早期大血管病变关系密切,吡格列酮能显著降低2型糖尿病患者血清sVCAM-1和sICAM-1水平,这可能是吡格列酮血管保护的作用机制之一。

Objective To observe the changes of carotid intima-media thickness （CIMT） ,serum soluble vascular cell adhesion molecule-1 （sVCAM-1）, soluble intercelluar adhesion molecule （sICAM-1） levels in type 2 diabetic patients, and to study the effect of pioglitazone on CIMT and sVCAM-1, sICAM-1 levels. Methods One hundred and five type 2 diabetic patients were randomly divided into a treatment group and a control group.The control group （n=75） received routine therapy alone. The treatment group was treated with pioglitazone 15 mg/d on the basis routine therapy for six months. Levels of sVCAM-1, sICAM-1, plasma glucose, plasma lipids and CIMT were detected before and after treatment. Results The mean level of plasma glucose of two groups was lower than that before treatment （P〈0.05）. After treatment, levels of pioglitazone, sVCAM- 1, sICAM- 1 and CIMT decreased significantly in the treatment group （P〈0.05）, but there was no significant difference in the control group. Multile linear stepwise regression analysis showed that the correlations between CIMT and BMI（r=0.298 ）, 2hPG（r=0.358 ）, HbA^c r=-0.381 ）, TG（r=0.368）, sVCAM-l（r=-0.580） and sICAM-I（r= 0.572） were significant （P〈0.05）. Conclusion There is closely relationship between serume sVCAM-1, slCAM-1 levels and type 2 diabetic macrovascular disease. Serum sVCAM-1 level can be reduced by pioglitazone, which may be one of the protective mechanisms of vascular vessels.