Deeg Mark A, Buse John B, Goldberg Ronald B, Kendall David M, Zagar Anthony J, Jacober Scott J, Khan Mehmood A, Perez Alfonzo T, Tan Meng H
Department of Endocrinology and Metabolism, Veterans Affairs Hospital and Indiana University, Indianapolis, Indiana, USA.
Diabetes Care. 2007 Oct;30(10):2458-64. doi: 10.2337/dc06-1903. Epub 2007 Jun 26.
Associated with insulin resistance in type 2 diabetes are increased serum triglycerides, decreased HDL cholesterol, and a predominance of large VLDL, small LDL, and small HDL particles. The comparative effects of thiazolidinedione insulin sensitizers on serum lipoprotein particle concentrations and sizes in type 2 diabetes are not known. We studied the effects of pioglitazone (PIO) and rosiglitazone (ROSI) treatments on serum lipoprotein particle concentrations and sizes in type 2 diabetic patients with dyslipidemia.
This is a prospective, randomized, double-blind, multicenter, parallel-group study. After a 4-week placebo washout period, patients randomized to PIO (n = 369) were treated with 30 mg q.d. for 12 weeks followed by 45 mg q.d. for another 12 weeks, while patients randomized to ROSI (n = 366) were treated with 4 mg q.d. followed by 4 mg b.i.d. for the same intervals. Lipoprotein subclass particle concentrations and sizes were determined by proton nuclear magnetic resonance spectroscopy at baseline and end point (PIO [n = 333] and ROSI [n = 325] patients).
PIO treatment increased total VLDL particle concentration less than ROSI treatment and decreased VLDL particle size more than ROSI. PIO treatment reduced total LDL particle concentration, whereas ROSI treatment increased it. Both treatments increased LDL particle size, with PIO treatment having a greater effect. Whereas PIO treatment increased total HDL particle concentration and size, ROSI treatment decreased them; both increased HDL cholesterol levels.
PIO and ROSI treatments have different effects on serum lipoprotein subclass particle concentrations and sizes in patients with type 2 diabetes and dyslipidemia.
2型糖尿病患者的胰岛素抵抗与血清甘油三酯升高、高密度脂蛋白胆固醇降低以及富含大颗粒极低密度脂蛋白、小颗粒低密度脂蛋白和小颗粒高密度脂蛋白有关。噻唑烷二酮类胰岛素增敏剂对2型糖尿病患者血清脂蛋白颗粒浓度和大小的比较影响尚不清楚。我们研究了吡格列酮（PIO）和罗格列酮（ROSI）治疗对2型糖尿病血脂异常患者血清脂蛋白颗粒浓度和大小的影响。
这是一项前瞻性、随机、双盲、多中心、平行组研究。经过4周的安慰剂洗脱期后，随机分配至PIO组（n = 369）的患者先接受每日30 mg治疗12周，随后每日45 mg再治疗12周，而随机分配至ROSI组（n = 366）的患者先每日4 mg治疗，随后相同疗程每日4 mg、每日两次给药。在基线和终点时（PIO组[n = 333]和ROSI组[n = 325]患者），通过质子核磁共振波谱法测定脂蛋白亚类颗粒浓度和大小。
PIO治疗使总极低密度脂蛋白颗粒浓度的增加低于ROSI治疗，且使极低密度脂蛋白颗粒大小的减小大于ROSI治疗。PIO治疗降低了总低密度脂蛋白颗粒浓度，而ROSI治疗使其升高。两种治疗均增加了低密度脂蛋白颗粒大小，其中PIO治疗的效果更显著。PIO治疗增加了总高密度脂蛋白颗粒浓度和大小，而ROSI治疗则使其降低；两种治疗均提高了高密度脂蛋白胆固醇水平。
PIO和ROSI治疗对2型糖尿病合并血脂异常患者的血清脂蛋白亚类颗粒浓度和大小有不同影响。
