格列酮类药物在2型糖尿病管理中的作用。是梦想还是噩梦？

The role of glitazones in management of type 2 diabetes. A dream or a nightmare?

作者信息

Lindberg M, Astrup A

出版信息

Obes Rev. 2007 Sep;8(5):381-4. doi: 10.1111/j.1467-789X.2007.00399.x.

DOI:10.1111/j.1467-789X.2007.00399.x

Abstract

Glitazones have been introduced as second-step medication for type 2 diabetics, and today rosiglitazone and pioglitazone are blockbuster drugs. However, glitazones may have important adverse effects that outweight their beneficial effect on insulin resistance and glycemia. The larger trials have shown that glitazones produce a weight gain of 4-5 kg over 3-4 years of treatment, and the weight gain cannot be explained by fluid retention. Moreover, the risk of myocardial infarction is increased by 43% by rosiglitazone, and there are clear indications of increased risk of heart failure. Furthermore, there are studies to suggest that glitazones also increase the risk of fractures, whereas an increased cancer risk is not supported. In conclusion, given the increased cardiovascular risk, and that a weight gain of few kg can increase risks of cancer of the breast, colon, prostate and endometrium, the use of glitazones should be questioned. There is a need for more safe and weight neutral drugs to treat type 2 diabetes.

摘要

格列酮类药物已被用作2型糖尿病患者的二线用药，如今罗格列酮和吡格列酮都是畅销药。然而，格列酮类药物可能具有重要的不良反应，其对胰岛素抵抗和血糖的有益作用被其不良反应所抵消。规模较大的试验表明，在3至4年的治疗中，格列酮类药物会使体重增加4至5千克，且这种体重增加无法用液体潴留来解释。此外，罗格列酮会使心肌梗死风险增加43%，且有明确迹象表明心力衰竭风险增加。此外，有研究表明格列酮类药物还会增加骨折风险，而癌症风险增加的说法则缺乏依据。总之，鉴于心血管风险增加，且几千克的体重增加会增加乳腺癌、结肠癌、前列腺癌和子宫内膜癌的风险，格列酮类药物的使用值得质疑。治疗2型糖尿病需要更安全且不引起体重增加的药物。