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目的 探讨过氧化物增殖物激活受体-γ激动剂吡格列酮能否依靠其抗炎作用改善持续性心房颤动(AF)患者电复律的效果.方法 前瞻性入选持续性AF合并2型糖尿病患者,随机分为吡格列酮组和对照组,均接受电复律治疗,术后随访3个月.吡格列酮组接受吡格列酮或其他药物联用控制血糖,对照组采用非吡格列酮控制血糖.入选患者于电复律前和电复律后3个月检查超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)和肿瘤坏死因子-α(TNF-α).结果 吡格列酮组和对照组分别入选48例和49例患者.随访期内吡格列酮组和对照组分别有22例(45.8％),24例(49.0％) AF复发(P=0.756),两组患者无AF复发的Kaplan-Meier生存分析亦无明显差异(P=0.567).电复律术后3个月吡格列酮组的hs-CRP、IL-6和TNF-α水平均明显低于对照组(P＜0.01).Cox多因素分析提示AF病程(RR 1.002,95％ CI 1.003～1.061,P=0.037)和左房直径(RR 1.131,95％ CI 1.029～1.242,P=0.010)是电复律术后AF复发的预测因素.结论 吡格列酮可减轻持续性AF合并2型糖尿病患者电复律术后炎症水平,但其并不能减少随访期内的AF复发.“,”Objective To test if peroxisome proliferators activated receptor-gamma (PPAR-γ) agonists pioglitazone reduce atrial fibrillation (AF) recurrence after electrical cardioversion (EC) by modifying systemic inflammation.Methods In this randomized and prospective trial,patients with persistent AF and type 2 diabetes mellitus were randomized into pioglitazone group or control group before EC.Patients in pioglitazone group received pioglitazone and standard therapy,while patients in control gourp took no pioglitazone in addition to standard therapy during this study.Treatment was continued for 3 months or until AF recurred.Serum inflammatory markers [high sensitivity C-reactive protein (hs-CRP),interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α)] were measured at baseline and on follow-up.Results Fortyeight and forty-nine patients were enrolled in pioglitazone and control group,respectively.AF recurred in 22 (45.8％) of pioglitazone and 24 (49.0％) of control group (P=0.756) during 3 months follow-up.There was no significant difference in the time to recurrence using Kaplan-Meier survival estimates (P =0.567 by Log Rank test).However,all determined inflammatory markers,hs-CRP,IL-6 and TNF-α were significantly lowered with pioglitazone treatment during follow-up.And Cox proportional hazards regression models showed that the predictors of recurrence included AF duration (relative risk RR 1.002,95％ CI 1.003-1.061,P=0.037) and left atrial diameter (RR 1.131,95％ CI 1.029-1.242,P =0.010).Conclusions Even though reducing some inflammatory markers,PPARγagonist (pioglitazone) don't affect the recurrence of AF after EC.