Department of Cardiovascular Medicine, Faculty of Life Sciences, Graduate School of Medical Sciences, Kumamoto University, and Department of Cardiovascular Clinical and Translational Research, Kumamoto University Hospital, Kumamoto, Japan.
Circ J. 2013;77(5):1337-44. doi: 10.1253/circj.cj-12-1168. Epub 2013 Feb 2.
Dipeptidyl peptidase 4 (DPP4) inhibitors are used for treatment of diabetes mellitus (DM). We hypothesized that sitagliptin, a DPP4-inhibitor, could improve endothelial dysfunction in DM patients with coronary artery disease (CAD).
The 40 patients with CAD and uncontrolled DM, aged 68.7±9.4 years (mean±standard deviation) (50% males, hemoglobin A1c [HbA1c] 7.4±1.0%) were assigned to either additional treatment with sitagliptin (50 mg/day, n=20) or aggressive conventional treatment (control, n=20) for 6 months. Endothelial function was assessed by the reactive hyperemia peripheral arterial tonometry index (RHI). The clinical characteristics at baseline were not different between the groups. After treatment, fasting blood glucose and insulin levels, and lipid profiles were not different between the groups. HbA1c levels significantly improved similarly in both groups. The percent change in RHI was greater in the sitagliptin group than in the control group (62.4±59.2% vs. 15.9±22.0%, P<0.01). Furthermore, treatment with sitagliptin resulted in a significant decrease in the high-sensitivity C-reactive protein (hsCRP) level, but no such change was noted in the control group. Linear regression analysis demonstrated a significant negative relation between changes in RHI and hsCRP, but not between RHI and HbA1c.
Sitagliptin significantly improved endothelial function and inflammatory state in patients with CAD and uncontrolled DM, beyond its hypoglycemic action. These findings suggest that sitagliptin has beneficial effects on the cardiovascular system in DM patients.
二肽基肽酶 4（DPP4）抑制剂被用于治疗糖尿病（DM）。我们假设西他列汀，一种 DPP4 抑制剂，可以改善合并冠心病（CAD）的糖尿病患者的内皮功能障碍。
40 例年龄为 68.7±9.4 岁（平均±标准差）（50%为男性，糖化血红蛋白 [HbA1c] 7.4±1.0%）的 CAD 合并未控制 DM 患者被随机分为西他列汀加用组（50mg/天，n=20）或强化常规治疗组（对照组，n=20），治疗 6 个月。内皮功能通过反应性充血外周动脉张力指数（RHI）评估。两组患者的基线临床特征无差异。治疗后，两组的空腹血糖和胰岛素水平以及血脂谱无差异。HbA1c 水平在两组中均显著改善。西他列汀组的 RHI 变化率显著大于对照组（62.4±59.2% vs. 15.9±22.0%，P<0.01）。此外，西他列汀治疗导致高敏 C 反应蛋白（hsCRP）水平显著降低，但对照组无此变化。线性回归分析表明，RHI 的变化与 hsCRP 呈显著负相关，但与 HbA1c 无相关性。
西他列汀除了降低血糖外，还显著改善了合并 CAD 和未控制 DM 患者的内皮功能和炎症状态。这些发现提示西他列汀对糖尿病患者的心血管系统具有有益作用。
