Granberry Mark C, Hawkins Jason B, Franks Amy M
Department of Pharmacy Practice, University of the Incarnate Word, School of Pharmacy, San Antonio, TX, and Central Arkansas Veterans Healthcare System, Little Rock, AR 72205, USA.
Am J Health Syst Pharm. 2007 May 1;64(9):931-6. doi: 10.2146/ajhp060446.
A review of the significant findings related to the use of the thiazolidinediones (TZDs) in the treatment of patients with type 2 diabetes mellitus and heart failure was conducted.
TZDs are antihyperglycemic medications that increase insulin sensitivity and improve the underlying defect of insulin resistance and type 2 diabetes mellitus, and they have the potential to slow or decrease the cardiovascular damage that results from these conditions. TZDs are also implicated in weight gain; however, this is accompanied by an improvement in insulin sensitivity and, therefore, its clinical significance is unclear. Edema has been well characterized in patients treated with TZDs. Edema is more common in patients treated with a TZD in combination with insulin and higher doses of TZDs. Because of the potential for fluid retention and worsening edema, clinical studies have excluded patients with New York Heart Association (NYHA) functional class III or IV heart failure. In patients at risk for heart failure or those who have NYHA functional class I or II symptoms, initiation of therapy should be at the lower dose for TZDs with close monitoring of weight gain, edema, and other signs of worsening heart failure.
Current data suggest that TZDs may be used cautiously in patients with type 2 diabetes mellitus who are at risk for heart failure or who have NYHA functional class I or II heart failure. Patients with NYHA functional class III or IV heart failure should not receive TZDs.
对噻唑烷二酮类药物（TZDs）用于治疗2型糖尿病合并心力衰竭患者的相关重要研究结果进行综述。
TZDs是抗高血糖药物，可提高胰岛素敏感性，改善胰岛素抵抗和2型糖尿病的潜在缺陷，并且有可能减缓或减轻由这些病症导致的心血管损害。TZDs还与体重增加有关；然而，这伴随着胰岛素敏感性的改善，因此其临床意义尚不清楚。使用TZDs治疗的患者中水肿已得到充分描述。水肿在联合胰岛素和使用较高剂量TZDs治疗的患者中更为常见。由于存在液体潴留和水肿加重的可能性，临床研究已将纽约心脏协会（NYHA）心功能III级或IV级心力衰竭患者排除在外。对于有心力衰竭风险或有NYHA心功能I级或II级症状的患者，开始治疗时应使用较低剂量的TZDs，并密切监测体重增加、水肿及其他心力衰竭加重的迹象。
目前的数据表明，对于有心力衰竭风险或有NYHA心功能I级或II级心力衰竭的2型糖尿病患者，可谨慎使用TZDs。NYHA心功能III级或IV级心力衰竭患者不应使用TZDs。
