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

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。

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

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),HbA1C(r=0.381),TG(r=0.368),sVCAM-1(r=0.580)and sICAM-1(r= 0.572)were significant(P<0.05).Conclusion There is closely relationship between serume sVCAM-1,sICAM-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.