De Flines J, Scheen A J
Université de Liège, Service de diabétologie, nutrition et maladies métaboliques, CHU Sart Tilman, B-4000 Liège I.
Rev Med Suisse. 2007 Aug 29;3(122):1876, 1878-83.
Thiazolidinediones (TZDs) are used as insulin sensitizers in the treatment of type 2 diabetes, but are associated with an increased risk of congestive heart failure (CHF). The odds ratio of ICC was 1.43 (pioglitazone vs placebo) in diabetic patients with high cardiovascular risk in the PROactive trial while it averaged 1.22 (rosiglitazone vs metformin) and 2.20 (rosiglitazone vs metformin) in the ADOPT study. In the interim analysis of the ongoing RECORD trial, the odds ratio averaged 2.15 (rosiglitazone vs metformin or sulfonylureas). In four real life registries, the relative risk of CHF with TZDs varied between 1.06 and 1.76 (between 1.10 and 1.44 combined with insulin) as compared to a treatment without TZDs. Such higher CHF risk should be appreciated according to the potential benefits of glitazones in the management of type 2 diabetes.
噻唑烷二酮类药物（TZDs）作为胰岛素增敏剂用于治疗2型糖尿病，但与充血性心力衰竭（CHF）风险增加相关。在PROactive试验中，心血管风险高的糖尿病患者中，与安慰剂相比，吡格列酮导致充血性心力衰竭的比值比为1.43；而在ADOPT研究中，罗格列酮与二甲双胍相比，该比值比平均为1.22，罗格列酮与磺脲类药物相比则为2.20。在正在进行的RECORD试验的中期分析中，罗格列酮与二甲双胍或磺脲类药物相比，比值比平均为2.15。在四个现实生活登记处中，与未使用TZDs的治疗相比，使用TZDs发生CHF的相对风险在1.06至1.76之间（与胰岛素联合使用时在1.10至1.44之间）。鉴于格列酮类药物在2型糖尿病管理中的潜在益处，应认识到这种较高的CHF风险。
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