吡格列酮和阿卡波糖对老年2型糖尿病合并高血压患者的疗效比较

Efficiency of pioglitazone and acarbose in type 2 diabetic patients with coexisting hypertension

摘要:

目的 观察吡格列酮和阿卡波糖两种经典降糖药物对2型糖尿病合并高血压患者的疗效比较。方法 选择2011年5月至2013年5月在第四军医大学西京医院住院的糖尿病伴高血压患者150例，其中男82例，女68例，年龄61～89岁。将入选者随机分为两组（每组75例），分别接受吡格列酮和阿卡波糖治疗。观察治疗前和治疗后12周的收缩压（SBP）、舒张压（DBP）、糖化血红蛋白（HbA1c）、血清肿瘤坏死因子α（TNF-α）、脂联素（APN）、胰岛素抵抗指数稳态模型（HOMA-IR）、尿白蛋白排泄率（AER）、左心室肥厚（LVH）、血清中内皮祖细胞（EPC）相关因子CD34及血管内皮生长因子受体2（VEGFR-2）、一氧化氮（NO）、一氧化氮合酶（NOS）的变化。结果 吡格列酮组患者在治疗12周后 SBP/DBP均降至140/90mmHg以下，与阿卡波糖组比较差异有统计学意义（P＜0.05）。治疗12周后，吡格列酮组APN含量较阿卡波糖组升高（P＜0.05），HbA1c水平较阿卡波糖组降低（P＜0.05），TNF-α和HOMA-IR较阿卡波糖组降低（P＜0.05）。吡格列酮组血尿素氮（BUN）、血肌酐（SCr）较阿卡波糖组降低（P＜0.05），AER和LVH也较阿卡波糖组降低（P＜0.05），CD34及VEGFR-2水平较阿卡波糖组明显升高（P＜0.01）、NO和NOS的含量较阿卡波糖组明显升高（P＜0.01）。结论 与阿卡波糖治疗相比较，采用吡格列酮治疗2型糖尿病合并高血压患者，可降低HbA1c水平，升高血清APN浓度，减少对肾功能的损害；降低LVH，保护心脏的效应显著；同时降低血清CD34及VEGFR-2水平，使EPC耗损减少；提高血清NO和NOS的含量，具有保护血管、延缓血管硬化进程的功能。

Abstract:

Objective To determine the hypoglycemic effect of pioglitazone and acarbose on the patients with type 2 diabetes mellitus (T2DM) and hypertension. Methods A total of 150 diabetic patients (82 males and 68 females, age ranging from 61 to 89 years) with coexisting hypertension admitted in Xijing Hospital from May 2011 to May 2013 were enrolled in this study. They were randomly divided into 2 matched groups (n＝75 for each group), and treated by pioglitazone and acarbose respectively. Before and at 12 weeks after treatment, their systolic blood pressure (SBP), diastolic blood pressure (DBP), glycosylated hemoglobin (HbA1c), tumor necrosis factor-α (TNF-α), adiponectin (APN), Homeostasis Model Assessment Insulin Resistance (HOMA-IR), albumin excretion rate (AER), left ventricular hypertrophy(LVH), peripheral blood CD34 and vascular endothelial growth factor receptor 2 (VEGFR-2) levels, CD34+/VEGFR-2+ endothelial progenitor cells (EPC), nitric oxide (NO) and nitric oxide synthase (NOS) were determined or calculated, and compared between the 2 groups. Results After 12 weeks treatment of pioglitazone, the patients had their blood pressure lower than 140/90mmHg, significantly different from the acarbose group (P＜0.05). The pioglitazone group had significantly higher APN levels, and obviously lower HbA1c, TNF-α and HOMA-IR when compared with the acarbose group (P＜0.05). Compared with acarbose treatment, pioglitazone treatment resulted in markedly reduced BUN, SCr, AER and LVH (all P＜0.05), but remarkably increased CD34 and VEGFR-2 levels, and NO and NOS levels (all P＜0.01). Conclusion Pioglitazone treatment results in decreased HbA1c and increased APN to reduce renal damage; induces to lower LVH to protect heart function; decreases serum levels of CD34 and VEGFR-2 to protect EPC; and improves the contents of NO and NOS to exert a protective role in the hardening process of arteries.