吡格列酮对非糖尿病患者冠状动脉药物洗脱支架内再狭窄的影响

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的机制。方法选择置入雷帕霉素药物洗脱支架的非糖尿病患者,随机分成治疗组48例和对照组41例,治疗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,并于治疗前及随访6～8个月复查时分别测定血脂、空腹血糖,空腹胰岛素,并计算胰岛素抵抗指数（HOMA-IR）。结果冠脉支架置入术后6～8个月,治疗组支架内再狭窄的患者0例（0%）,对照组5例（12.20%）,两组比较有统计学差异（P〈0.05）。两组患者术后6～8个月分别与治疗前比较,血脂指标均明显降低（P〈0.05或P〈0.01）,空腹血糖均无明显变化（P〉0.05）,HOMA-IR治疗组较治疗前明显降低（P〈0.01）,而对照组无明显变化（P〉0.05）。治疗组与对照组比较,血脂指标、空腹血糖在治疗前及术后6～8个月均无显著性差异（P均〉0.05）,而HOMA-IR在治疗前无显著性差异（P〉0.05）,术后6～8个月治疗组却较对照组降低（P〈0.05）。结论吡格列酮可以防止非糖尿病患者药物洗脱支架的再狭窄,增加胰岛素敏感性,可能是吡格列酮防止洗脱支架内再狭窄的机制之一。

Influence of pioglitazone on restenosis of coronary drug eluting stents in nondiabetic patients

Objective To discuss the influence and possible mechanism of pioglitazone on in-stent coronary restenosis in nondiabetic patients. Methods The nondiabetic patients implanted with Rapamycin eluting stents were chosen and randomly divided into the treatment group （n=48） and control group （n=41）. The treatment group was given pioglitazone （30 mg,qd） on the base of routine treatment like the control group. The selective coronary angiography （CAG） was performed in the patients 6 to 8 months after the implantation of coronary stent. The levels of blood fat,fasting plasma glucose and fasting insulin were detected,and homeostasis model assessment of insulin resistance index （HOMA-IR） were calculated respectively before the treatment and in re-examination after 6 to 8 months follow-up. Results After the implantation of coronary stents for 6 to 8 months there were 0 case of in-stent coronary restenosis in the treatment group （0%） and 5 in the control group （12.20%）. The comparison between two groups had statistical significance （P0.05）. In two groups after the treatment for 6 to 8 months,compared with those before the treatment,the index of blood fat decreased significantly （P0.05 or P0.01）,and fasting plasma glucose had no significant change （P0.05）. HOMA-IR decreased significantly in the treatment group （P0.01） and had no change in the control group （P0.05）. The comparison between two groups showed that the indexes of blood fat and fasting plasma glucose had no significant difference before the treatment and after the treatment for 6 to 8 months （all P0.05）,but HOMA-IR had no significant difference before the treatment （P0.05） and decreased in the treatment group （P0.05） after the treatment for 6 to 8 months. Conclusion Pioglitazone can prevent the nondiabetic patients from coronary restenosis after the implantation of medical eluting stent and improve insulin sensitivity,which may be its one of the mechanisms for preventing in-stent coronary restenosis.