Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom.
Department of Clinical Radiology, Ninewells Hospital and Medical School, Dundee, United Kingdom.
J Am Coll Cardiol. 2013 Dec 17;62(24):2284-93. doi: 10.1016/j.jacc.2013.07.074. Epub 2013 Aug 28.
This study sought to ascertain whether high-dose allopurinol causes regression of left ventricular mass (LVM) in patients with type 2 diabetes mellitus (T2DM).
Left ventricular hypertrophy (LVH) is common in T2DM and contributes to patients' high cardiovascular (CV) event rate. Oxidative stress (OS) has been implicated in LVH development, and allopurinol has been previously shown to reduce vascular OS. We therefore investigated whether allopurinol causes regression of LVH in patients with T2DM.
We conducted a randomized, double-blind, placebo-controlled study of 66 optimally-treated T2DM patients with echocardiographic evidence of LVH. Allopurinol, 600 mg/day, or placebo was given over the study period of 9 months. The primary outcome was reduction in LVM as calculated by cardiac magnetic resonance imaging at baseline and at 9 months' follow-up. Secondary endpoints were change in flow-mediated dilation and augmentation index.
Allopurinol significantly reduced absolute LVM (-2.65 ± 5.91 g vs. placebo group +1.21 ± 5.10 g [p = 0.012]) and LVM indexed to body surface area (-1.32 ± 2.84 g/m(2) vs. placebo group +0.65 ± 3.07 g/m(2) [p = 0.017]). No significant changes were seen in either flow-mediated dilation or augmentation index.
Allopurinol causes regression of LVM in patients with T2DM and LVH. Regression of LVH has been shown previously to improve CV mortality and morbidity. Therefore, allopurinol therapy may become useful to reduce CV events in T2DM patients with LVH. (Allopurinol in Patients with Diabetes and LVH; UKCRN 8766).
本研究旨在确定高剂量别嘌醇是否可使 2 型糖尿病（T2DM）患者的左心室质量（LVM）得到逆转。
左心室肥厚（LVH）在 T2DM 中很常见，导致患者心血管（CV）事件发生率较高。氧化应激（OS）被认为与 LVH 的发生有关，别嘌醇先前已被证明可减少血管 OS。因此，我们研究了别嘌醇是否可使 T2DM 患者的 LVH 得到逆转。
我们对 66 例经超声心动图证实存在 LVH 的最佳治疗的 T2DM 患者进行了一项随机、双盲、安慰剂对照研究。别嘌醇（600 mg/天）或安慰剂在 9 个月的研究期间内给药。主要终点是通过心脏磁共振成像在基线和 9 个月随访时测量的 LVM 减少。次要终点是血流介导的扩张和增强指数的变化。
别嘌醇可显著降低 LVM 的绝对值（-2.65 ± 5.91 g 与安慰剂组+1.21 ± 5.10 g [p = 0.012]）和 LVM 与体表面积的比值（-1.32 ± 2.84 g/m2 与安慰剂组+0.65 ± 3.07 g/m2 [p = 0.017]）。血流介导的扩张或增强指数均未见明显变化。
别嘌醇可使 T2DM 合并 LVH 患者的 LVM 得到逆转。先前的研究表明，LVH 的逆转可改善 CV 死亡率和发病率。因此，别嘌醇治疗可能有助于降低合并 LVH 的 T2DM 患者的 CV 事件。（糖尿病和 LVH 患者中的别嘌醇；UKCRN 8766）。
