PPARγ激动剂对冠心病合并糖尿病患者血管内皮功能的影响

张喆

北京大学第三医院 心脏外科

李昭屏, 冯新恒, 毛节明, 王广, 王宪

北京大学第三医院 心内科

摘要

目的：探讨罗格列酮对冠心病合并糖尿病患者血管内皮功能及血浆炎症标志物的影响。

方法：共有56名冠心病合并2型糖尿病患者入选本研究，随机分为罗格列酮治疗组（4mg/日，12周）与对照组。所有患者均接受冠状动脉造影，分别在造影前与12周后留取血液标本进行常规生化检查与炎症因子测定。冠状动脉血流储备也在上述时间点测定。

结果：与对照组相比，12周后罗格列酮治疗组血浆C反应蛋白明显下降。罗格列酮治疗组冠状动脉血流储备较治疗前[ 2.78 (2.52 – 3.18) vs 2.13 (1.85 – 2.43),P < 0.001]与对照组[2.78 (2.52 – 3.18) vs 2.26 (2.14 –2.75), P < 0.001]明显升高。

结论：罗格列酮可能在改善代谢状态的基础上，通过影响动脉粥样硬化的炎症水平改善冠状动脉血管内皮功能。

关键词：PPARγ，内皮功能，冠脉血流储备

Summary

The aim of this study was to assess the effect of rosiglitazone on endothelial function of coronary artery and the plasma levels of inflammatory markers in diabetic patients with coronary artery disease (CAD). Fifty-six patients with type 2 diabetes and coronary artery disease were randomized to either receive or not receive rosiglitazone (4 mg/day) treatment for 12 weeks. All patients had undergone angiography. Blood was sampled before and after angiography 12 weeks for analysis of the clinical chemistry and inflammatory factors. Coronary flow velocity reserve (CFVR) was assessed in baseline and after 12 weeks, respectively. After 12 weeks follow-up, Plasma level of C-reactive protein (CRP) was decreased significantly in the rosiglitazone treatment group when compared with the control group. Furthermore, after 12 weeks rosiglitazone treatment, CFVR value was improved significantly in the rosiglitazone group than the baseline levels [ 2.78 (2.52 – 3.18) vs 2.13 (1.85 – 2.43)] and the control group [2.78 (2.52 – 3.18) vs 2.26 (2.14 –2.75)], P < 0.001 and 0.05, respectively.These results indicate that rosiglitazone treatment may improves endothelial function of coronary artery due to the reduction of inflammation. Thus, in addition to the beneficial metabolic effects, the antiinflammative action of rosiglitazone may potential protect coronary artery endothelial function in patients with CAD.

Key words: PPAR gamma; endothelial function; coronary flow velocity reserve;

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