非诺贝特和吡格列酮联合应用对代谢综合征患者动脉粥样硬化的影响

目的：探讨非诺贝特和吡格列酮联合应用对于代谢综合征患者动脉粥样硬化的影响。方法242例代谢综合症患者分层随机编入基础治疗组（n=64），非诺贝特组（n=65），吡格列酮组（n=63），非诺贝特＋吡格列酮组（联合应用组，n=64）。双盲方法对所有患者均进行生活方式干预及应用相应药物控制血压的基础上，基础治疗组加服安慰剂，非诺贝特组加服非诺贝特0.2 g/次，每日一次，睡前服；吡格列酮组加服吡格列酮15 mg/次，每日一次；联合应用组按上述用药加服上述两种药物，共干预24周。干预前后采用颈动脉超声观察其颈总动脉内膜中层厚度（IMT）和斑块阳性率，采用酶联免疫吸附法（ELISA）测定血清MMP-9浓度。结果干预后联合应用组与非诺贝特组比较，颈动脉IMT及斑块阳性率均降低，差异有统计学意义，P0.05。联合应用组与非诺贝特组和比格列酮组相比，MMP-9浓度下降有显著性差异， P〈0.01。结论非诺贝特和吡格列酮联合应用比单用对于代谢综合征患者动脉粥样硬化有更好的改善作用。

The effect of combination of Fenofibrate and Pioglitazone to atherosclerosis of metabolic syndrome

Objective To explore the effect of Fenofibrate and pioglitazone combination intervention for atherosclerosis of metabolic syndrome （MS） patients. Methods 242 MS patients were randomly divided into basic treatment group （n=64）, fenofibrate group （n=65）, pioglitazone group （n=63）, and Fenofibrate and Pioglitazone combination group （n=64）. All patients went through lifestyle intervention and appropriate medication to control blood pressure. Fenofibrate group took fenofibrate 0.2g once a day while Pioglitazone group took pioglitazone 15mg once a day;the combination group took both of the above drugs as described. The intervention lasted for 24 weeks. The carotid intima-media thickness and the positive rate of atheromatous plaque were detected by type-B ultrasonic, and the serum concentration of MMP-9 was detected by ELISA before and after intervene. Results Comparing with Fenofibrate group, both of the carotid intima-media thickness and the positive rate of atheromatous plaque of combination group declined; comparing with Pioglitazone group, carotid intima-media thickness of combination group declined, but it reflected on significant difference on the positive rate of atheromatous plaque;the serum concentration of MMP-9 in combination group declined more than Fenofibrate group and Pioglitazone group, respectively. Conclusion Combination of Fenofibrate and Pioglitazone intervene is considered being more effective than either Fenofibrate or Pioglitazone application.