Xiang Anny H, Peters Ruth K, Kjos Siri L, Ochoa Cesar, Marroquin Aura, Goico Jose, Tan Sylvia, Wang Chengwei, Azen Stanley P, Liu Chao-Ran, Liu Ci-Hua, Hodis Howard N, Buchanan Thomas A
Department of Preventive Medicine, University of Southern California Keck School of Medicine, Room 6602 GNH, 1200 North State Street, Los Angeles, California 90089-9317, USA.
J Clin Endocrinol Metab. 2005 Apr;90(4):1986-91. doi: 10.1210/jc.2004-1685. Epub 2004 Dec 28.
We tested the effects of treatment with a thiazolidinedione drug on rates of progression of carotid intima-media thickness (CIMT) and some putative determinants of CIMT in young women at high risk for type 2 diabetes. A total of 266 nondiabetic, Hispanic women with recent gestational diabetes were randomized to placebo or troglitazone. CIMT measurements were made at baseline, annually, and at study end, together with measurements of obesity, serum lipids, and glucose and insulin levels during oral glucose tolerance tests. Insulin sensitivity (minimal model analysis) was measured at baseline and 3 months later. Data were analyzed to compare CIMT progression rates between treatment groups and investigate potential determinants of differences in CIMT progression. One hundred ninety-two women had a CIMT measurement at baseline and at least one follow-up visit. The mean rate of CIMT change was 31% lower in women assigned to troglitazone (P = 0.048). This intergroup difference was not explained by baseline or on-trial differences in obesity, lipids, glucose, or insulin. The reduction in CIMT progression developed gradually, occurred only in women who had an increase in insulin sensitivity, and was unrelated to the presence of the metabolic syndrome at baseline. Troglitazone reduced the progression of subclinical atherosclerosis via a mechanism that involved unmeasured mediators of atherosclerosis, either in the circulation or directly in the arterial wall.
我们测试了噻唑烷二酮类药物治疗对2型糖尿病高危年轻女性颈动脉内膜中层厚度（CIMT）进展率及一些CIMT假定决定因素的影响。共有266名近期患有妊娠期糖尿病的非糖尿病西班牙裔女性被随机分为安慰剂组或曲格列酮组。在基线期、每年以及研究结束时进行CIMT测量，同时在口服葡萄糖耐量试验期间测量肥胖、血脂、血糖和胰岛素水平。在基线期和3个月后测量胰岛素敏感性（最小模型分析）。对数据进行分析，以比较治疗组之间的CIMT进展率，并研究CIMT进展差异的潜在决定因素。192名女性在基线期和至少一次随访时进行了CIMT测量。分配到曲格列酮组的女性CIMT变化的平均速率低31%（P = 0.048）。肥胖、血脂、血糖或胰岛素的基线或试验期差异无法解释这种组间差异。CIMT进展的降低是逐渐出现的，仅发生在胰岛素敏感性增加的女性中，且与基线期代谢综合征的存在无关。曲格列酮通过一种涉及未测定的动脉粥样硬化介质（无论是在循环中还是直接在动脉壁中）的机制降低了亚临床动脉粥样硬化的进展。
