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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机制。方法:选择置入雷帕霉素洗脱支架的非糖尿病患者128例,并排除糖耐量异常者,随机分成吡格列酮组(71例)和对照组(57例),吡格列酮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,于治疗前及随访6～8个月复查时先后分别测定血脂、空腹血糖、空腹胰岛素、血清瘦素及血清脂联素,并计算胰岛素抵抗指数(HOMA-IR)。结果:吡格列酮组支架内再狭窄的发生率显著低于对照组(2.82%∶12.28%,P=0.037);冠脉支架术后6～8个月,2组血脂指标、空腹血糖差异无统计学意义,但HOMA-IR、脂联素及脂联素/瘦素比值均差异有统计学意义(均P<0.05)。结论:吡格列酮能够降低非糖尿病患者药物洗脱支架的再狭窄,这种作用独立于调整血糖、血脂之外,改善胰岛素抵抗和血管内皮功能可能是吡格列酮阻止支架内再狭窄的重要机制。
Objective: To investigate the effect of pioglitazone on restenosis of coronary artery (coronary artery) in non-diabetic patients and its possible mechanism. Methods: A total of 128 non-diabetic patients with rapamycin-eluting stent were enrolled. Patients with abnormal glucose tolerance (IGT) were randomly divided into pioglitazone group (n = 71) and control group (n = 57) Based on the use of pioglitazone (30mg, qd); coronary stenting 6 to 8 months after the elective coronary angiography, before treatment and follow-up of 6 to 8 months of retest, respectively, were measured lipid, fasting blood glucose , Fasting insulin, serum leptin and serum adiponectin, and calculated insulin resistance index (HOMA-IR). Results: The incidence of in-stent restenosis in pioglitazone group was significantly lower than that in control group (2.82% vs12.28%, P = 0.037). There was no statistic difference between the two groups in 6-8 months after PCI However, the HOMA-IR, adiponectin and adiponectin / leptin ratios were significantly different (all P <0.05). CONCLUSION: Pioglitazone can reduce the restenosis of drug-eluting stents in non-diabetic patients. This effect may be an important mechanism by which pioglitazone can prevent in-stent restenosis independently of regulating blood glucose and blood lipids, and improving insulin resistance and vascular endothelial function.