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目的观察罗格列酮对非糖尿病代谢综合征(MS)患者代谢指标以及颈动脉内膜中层厚度(IMT)、臂踝脉搏波速度(baPWV)、踝臂指数(ABI)的影响。方法非糖尿病MS患者79例随机分为两组:治疗组(41例)在生活方式干预的基础上加用罗格列酮4mg/d;对照组(38例)仅给予生活方式干预。每3个月随访1次,共随访9个月。所有患者随访前后均进行体质量指数(BMI)、腰围(WC)、收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白-胆固醇(HDL-C)、低密度脂蛋白-胆固醇(LDL-C)、高敏C反应蛋白(hsCRP)、糖化血红蛋白(HbA1c)、空腹胰岛素(FIns)、胰岛素抵抗指数(HOMA-IR)、IMT、baPWV及ABI的测定。结果 (1)治疗6个月后,治疗组FPG、TG、HDL-C、hsCRP、HbA1c、FIns和HOMA-IR明显改善(P<0.01),并且随治疗时间的延长,FPG、HDL-C、hsCRP、HbA1c、FIns和HOMA-IR进一步改善(P<0.01);9个月后,治疗组FPG、HDL-C、hsCRP、HbA1c、FIns和HOMA-IR与对照组相比,差异有高度统计学意义(P<0.01)。(2)治疗6个月后,治疗组baPWV和ABI明显改善(P<0.01),IMT无变化;9个月后,IMT得到改善(P<0.01),治疗组IMT、baPWV和ABI与对照组相比,差异有高度统计学意义(P<0.01)。(3)多因素分析显示,ABI的改善主要与HbA1c和HOMA-IR水平的下降相关(P<0.01)。结论罗格列酮能明显改善非糖尿病MS患者的胰岛素抵抗,调节糖脂代谢,减轻炎症反应,并在一定程度上延缓动脉粥样硬化的进程。
Objective To observe the effects of rosiglitazone on the metabolic parameters of carotid intima-media thickness (IMT), brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index (ABI) in non-diabetic metabolic syndrome (MS) patients. Methods A total of 79 patients with non-diabetic MS were randomly divided into two groups: treatment group (41 cases) received lifestyle rosiglitazone 4 mg / d on the basis of lifestyle intervention; and control group (38 cases) received lifestyle intervention only. Follow-up every 3 months 1, a total of 9 months follow-up. Body mass index (BMI), waist circumference (WC), SBP, DBP, FPG, TG, TC, HDL-C, LDL-C, hsCRP, HbA1c, FIns, HOMA-IR ), IMT, baPWV and ABI. Results After treatment for 6 months, the levels of FPG, HDL-C, hsCRP, HbA1c, FIns and HOMA-IR in treatment group were significantly improved (P <0.01) The levels of hsCRP, HbA1c, FIns and HOMA-IR were further improved (P <0.01). After 9 months, the differences of FPG, HDL-C, hsCRP, HbA1c, FIns and HOMA-IR between the two groups were statistically significant Significance (P <0.01). (2) After 6 months treatment, the baPWV and ABI in the treatment group were significantly improved (P <0.01), while the IMT was unchanged. After 9 months, the IMT was improved (P <0.01) The differences were highly statistically significant (P <0.01). (3) Multivariate analysis showed that the improvement of ABI was mainly associated with the decrease of HbA1c and HOMA-IR (P <0.01). Conclusion Rosiglitazone can significantly improve insulin resistance in non-diabetic MS patients, regulate glucose and lipid metabolism, reduce inflammation, and to some extent, delay the process of atherosclerosis.