罗格列酮对2型糖尿病内皮依赖性血管舒张功能的影响

目的：观察罗格列酮对2型糖尿病患者内皮依赖性血管舒张功能的影响。方法：83例新诊断的2型糖尿病患者，分成3个治疗组，即二甲双胍组（二甲双胍750mg／d）、联合治疗组（二甲双胍750mg／d＋罗格列酮4mg／d）和罗格列酮组（罗格列酮4mg／d），连续治疗12周；另选年龄性别匹配的正常人25例为正常对照组。治疗前后均检测身高、体质量、血压、空腹血糖（FPG）、血浆胰岛素（FINS）、糖化血红蛋白（HbA1C）、甘油三脂（TG）、胆固醇（TC）、低密度脂蛋白（LDL-C）、高密度脂蛋白（HDL-C）、血清一氧化氮（nitric oxide，NO），同时计算体质量指数（bodymass index，BMI）和胰岛素抵抗指数（homeostasis model assessment-insulin resistant index，HOMA-IR），并用高分辨超声技术检测肱动脉血流介导的内皮依赖性舒张（flow-medimed dilatation，FMD）和硝酸甘油介导的非内皮依赖性舒张（endothelium independent dilatation，EID）。结果：治疗前糖尿病各组BMI，TG，TC，LDL-C，FPG，HbAlC，HOMA-IR较正常对照组升高（P〈0．01）；HDL-C，NO，FMD和EID较正常对照组下降（P〈0．01）。治疗后糖尿病各组TG，FPG，HbAlC，HOMA-IR较治疗前显著下降（P〈0．05）。联合治疗组和罗格列酮组FINS较治疗前下降（P〈0．05）；HDL，NO，FMD和EID较治疗前显著升高（P〈0．05）。但二甲双胍组HDL，FINS，NO和FMD较治疗前无变化。结论：2型糖尿病患者存在内皮依赖性血管舒张功能受损，用罗格列酮治疗可显著升高血NO水平，改善糖尿病患者的内皮依赖性血管舒张功能，而二甲双胍对上述指标无明显影响。

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OBJECTIVE: To investigate the effects of rosiglitazone on endothelium-dependent vasodilation in patients with Type 2 diabetes. METHODS: Eighty-three newly diagnosed patients with Type 2 diabetes were divided into metformin group (metformin 750 mg/d), therapeutic alliance group (rosiglitazone 4 mg/d and metformin 750 mg/d), and rosiglitazone group (rosiglitazone 4 mg/d), and 25 normal subjects were as the control group. All patients were treated for 12 weeks. The height, weight, blood pressure, fasting plasma glucose (FPG), fasting serum insulin (FINS), glycosylated hemoglobin (HbA1c), triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), and serum nitric oxide (NO) were measured before and after the therapy. The body mass index (BMI) and homeostasis model assessment-insulin resistant index (HOMA-IR) were calculated. The flow-mediated dilatation (FMD) and endothelium independent dilatation (EID) were measured by high-resolution ultrasound. RESULTS: The BMI, TG, TC, LDL-C, FPG, HBA1c, HOMA-IR were higher (P<0.01), but HDL-C, NO, FMD were lower (P<0.01) in all diabetic groups than those in the control group before the treatment. After the 12-week treatment, TG, FPG, HBA1c, HOMA-IR decreased significantly in all the diabetic groups (P<0.01); FINS decreased, but HDL-C, NO, FMD and EID increased (P<0.01) in therapeutic alliance group and rosiglitazone groups, while HDL-C, FINS, NO, FMD had no change in metformin group compared with those before the treatment. CONCLUSION: Endothelium-dependent vasodilation function is impaired in patients with Type 2 diabetes. The therapy with rosiglitazone can increase the serum NO level, and improve endothelium-dependent vasodilation,but metformin has no influence on the above-mentioned indexes.