Haffner Steven, Temprosa Marinella, Crandall Jill, Fowler Sarah, Goldberg Ronald, Horton Edward, Marcovina Santica, Mather Kieren, Orchard Trevor, Ratner Robert, Barrett-Connor Elizabeth
Diabetes. 2005 May;54(5):1566-72. doi: 10.2337/diabetes.54.5.1566.
Increases in subclinical inflammation (C-reactive protein [CRP]) and impaired coagulation have been associated with increased obesity and insulin resistance. Only a few small studies have examined the effect of lifestyle changes, such as weight loss, increased physical activity, and insulin-sensitizing intervention on inflammation and coagulation. The Diabetes Prevention Program (DPP) clinical trial studied the effect of an intensive lifestyle intervention or metformin on progression to diabetes relative to placebo in 3,234 adults with impaired glucose tolerance. The effects of these interventions on CRP and fibrinogen at 12 months are examined in this report. Metformin reduced CRP in women compared with the placebo group. In men, the median changes in CRP from baseline to 1 year were -33% in the lifestyle group, -7% in the metformin group, and +5% in the placebo group. In women, the changes in CRP from baseline to follow-up were -29% in the lifestyle group, -14% in the metformin group, and 0% in the placebo group. In the lifestyle group weight loss rather than increased physical activity seems to account for most of the changes in CRP. Only modest reductions (although significant) were seen in fibrinogen levels in the lifestyle group relative to the metformin and placebo group. Lifestyle intervention reduced levels of nontraditional cardiovascular risk factors relative to both placebo and to a lesser degree to metformin.
亚临床炎症（C反应蛋白[CRP]）增加以及凝血功能受损与肥胖增加和胰岛素抵抗有关。仅有少数小型研究探讨了生活方式改变，如体重减轻、体力活动增加以及胰岛素增敏干预对炎症和凝血的影响。糖尿病预防计划（DPP）临床试验研究了强化生活方式干预或二甲双胍相对于安慰剂对3234名糖耐量受损成年人患糖尿病进展的影响。本报告探讨了这些干预措施在12个月时对CRP和纤维蛋白原的影响。与安慰剂组相比，二甲双胍降低了女性的CRP水平。在男性中，从基线到1年CRP的中位数变化在生活方式干预组为-33%，二甲双胍组为-7%，安慰剂组为+5%。在女性中，从基线到随访时CRP的变化在生活方式干预组为-29%，二甲双胍组为-14%，安慰剂组为0%。在生活方式干预组中，体重减轻而非体力活动增加似乎是CRP变化的主要原因。相对于二甲双胍组和安慰剂组，生活方式干预组的纤维蛋白原水平仅出现适度降低（尽管具有统计学意义）。相对于安慰剂以及在较小程度上相对于二甲双胍，生活方式干预降低了非传统心血管危险因素水平。
