Shinoda-Tagawa T, Yamasaki Y, Yoshida S, Kajimoto Y, Tsujino T, Hakui N, Matsumoto M, Hori M
Department of Internal Medicine and Therapeutics, Osaka University Graduate School of Medicine, Suita City, Japan.
Diabetologia. 2002 Feb;45(2):188-94. doi: 10.1007/s00125-001-0740-2.
AIMS/HYPOTHESIS: This study aimed to evaluate the effect of a phosphodiesterase inhibitor, cilostazol, on the prevention of silent brain infarction in diabetic patients without symptoms of vascular events.
A total of 89 subjects were allocated at random to the cilostazol group ( n = 43) or the control group ( n = 46).
After the study period (3.2 +/- 0.5 years), carotid intima-media thickness (IMT) (means +/- SD) had increased ( p < 0.01) by 0.18 +/- 0.19 mm in the control group. In the cilostazol group, intima-media thickness showed almost no change (-0.00 +/- 0.16 mm). In the control group, 2 out of 46 subjects showed symptomatic brain infarctions and 10 out of 34 subjects without infarct-like region assessed by standard brain MRI examination showed silent brain infarctions after the observation period. On the other hand, no subjects in the cilostazol group showed silent brain infarction or strokes during the study period. Both at the beginning and end of the study period, the number of infarct-like regions positively correlated with IMT ( r = 0.335, p < 0.001 or r = 0.347, p < 0.001 respectively). The progression of infarct-like regions was directly related to the increase in IMT during the study period ( r = 0.299, p = 0.004).
CONCLUSION/INTERPRETATION: These data demonstrated that cilostazol could prevent the onset of silent brain infarction in Japanese subjects with Type II (non-insulin-dependent) diabetes mellitus. Also, an increase in intima-media thickness of the carotid artery wall could be able to predict the onset of silent brain infarction.
目的/假设：本研究旨在评估磷酸二酯酶抑制剂西洛他唑对无症状血管事件的糖尿病患者预防无症状脑梗死的效果。
总共89名受试者被随机分配到西洛他唑组（n = 43）或对照组（n = 46）。
在研究期（3.2±0.5年）后，对照组的颈动脉内膜中层厚度（IMT）（均值±标准差）增加了0.18±0.19毫米（p < 0.01）。在西洛他唑组，内膜中层厚度几乎没有变化（-0.00±0.16毫米）。在对照组中，46名受试者中有2名出现有症状的脑梗死，在观察期后，通过标准脑MRI检查评估，34名无梗死样区域的受试者中有10名出现无症状脑梗死。另一方面，在研究期间，西洛他唑组没有受试者出现无症状脑梗死或中风。在研究期开始和结束时，梗死样区域的数量均与IMT呈正相关（分别为r = 0.335，p < 0.001或r = 0.347，p < 0.001）。在研究期间，梗死样区域的进展与IMT的增加直接相关（r = 0.299，p = 0.004）。
结论/解读：这些数据表明，西洛他唑可以预防日本II型（非胰岛素依赖型）糖尿病患者无症状脑梗死的发生。此外，颈动脉壁内膜中层厚度的增加可能能够预测无症状脑梗死的发生。
