吡格列酮降低非糖尿病患者冠状动脉药物洗脱支架再狭窄的研究

Study of pioglitazone reducing in-stent restenosis on non-diabetic patients with drug-eluting stents

目的:探讨吡格列酮对非糖尿病患者冠状动脉(冠脉)支架内再狭窄的影响及其可能机制。方法:选择置入雷帕霉素洗脱支架的非糖尿病患者128例,并排除糖耐量异常者,随机分成吡格列酮组(71例)和对照组(57例),吡格列酮组在对照组常规治疗的基础上加用吡格列酮(30mg,qd);冠脉支架置入术后6～8个月行选择性冠脉造影术,于治疗前及随访6～8个月复查时先后分别测定血脂、空腹血糖、空腹胰岛素、血清瘦素及血清脂联素,并计算胰岛素抵抗指数(HOMA-IR)。结果:吡格列酮组支架内再狭窄的发生率显著低于对照组(2.82%∶12.28%,P=0.037);冠脉支架术后6～8个月,2组血脂指标、空腹血糖差异无统计学意义,但HOMA-IR、脂联素及脂联素/瘦素比值均差异有统计学意义(均P<0.05)。结论:吡格列酮能够降低非糖尿病患者药物洗脱支架的再狭窄,这种作用独立于调整血糖、血脂之外,改善胰岛素抵抗和血管内皮功能可能是吡格列酮阻止支架内再狭窄的重要机制。

Objective：To investigate the effects and mechanisms of pioglitazone on in-stent restenosis after coronary stenting in nondiabetic patients with coronary artery disease. Method：One hundred and twenty-eight nondiabetic patients after rapamycin eluting stent implantation were randomly assigned to pioglitazone（pioglitazone group,n=71,30 mg/d） or placebo（control group,n=57） treatment in addition to standard therapy.Selective coronary angiography was performed at 6-8 months follow-up.Fasting blood glucose,fasting insulin,leptin,adiponectin as well as lipid parameters were measured at study entry and 6-8 months follow-up.In addition,the homeostasis model assessment of insulin resistance index（HOMA-IR） of patients were calculated. Result：The incidence of in-stent restenosis in pioglitazone group was significantly lower than the control group（2.82% vs 12.28%,P=0.037）.After 6-8 months follow-up,there was no significant difference of serum lipids and fasting blood glucose in 2 group.However,HOMA-IR,adiponectin and A/L in pioglitazone group were significantly different from the control group. Conclusion：Pioglitazone can reduce the restenosis of non-diabetic patients with drug-eluting stents.Improving insulin resistance and endothelial dysfunction is probably the important mechanisms of pioglitazone preventing in-stent restenosis.