Department of Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Kurume, Japan.
JACC Cardiovasc Imaging. 2013 Nov;6(11):1172-82. doi: 10.1016/j.jcmg.2013.09.004.
The aim of this study was to compare the effect of pioglitazone with glimepiride on coronary arterial inflammation with serial (18)F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) combined with computed tomography (CT) angiography.
Recent studies have shown that FDG-PET combined with CT is a reliable tool to visualize and quantify vascular inflammation. Although pioglitazone significantly prevented the progression of coronary atherosclerosis and reduced the recurrence of myocardial infarction in patients with type 2 diabetes mellitus (DM), it remains unclear whether pioglitazone could attenuate coronary artery inflammation.
Fifty atherosclerotic patients with impaired glucose tolerance or type 2 DM underwent determination of blood chemistries, anthropometric and inflammatory variables, and FDG-PET/CT angiography, and then were randomized to receive either pioglitazone or glimepiride for 16 weeks. Effects of the treatments on vascular inflammation of the left main trunk were evaluated by FDG-PET/CT angiography at baseline and end of the study. Vascular inflammation of the left main trunk was measured by blood-normalized standardized uptake value, known as a target-to-background ratio.
Three patients dropped out of the study during the assessment or treatment. Finally, 25 pioglitazone-treated patients and 22 glimepiride-treated patients (37 men; mean age: 68.1 ± 8.3 years; glycosylated hemoglobin: 6.72 ± 0.70%) completed the study. After 16-week treatments, fasting plasma glucose and glycosylated hemoglobin values were comparably reduced in both groups. Changes in target-to-background ratio values from baseline were significantly greater in the pioglitazone group than in the glimepiride group (-0.12 ± 0.06 vs. 0.09 ± 0.07, p = 0.032), as well as changes in high-sensitivity C-reactive protein (pioglitazone vs. glimepiride group: median: -0.24 [interquartile range (IQR): -1.58 to -0.04] mg/l vs. 0.08 [IQR: -0.07 to 0.79] mg/l, p = 0.031).
Our study indicated that pioglitazone attenuated left main trunk inflammation in patients with impaired glucose tolerance or DM in a glucose-lowering independent manner, suggesting that pioglitazone may protect against cardiac events in patients with impaired glucose tolerance or DM by suppressing coronary inflammation. (Anti-Inflammatory Effects of Pioglitazone; NCT00722631).
本研究旨在比较吡格列酮和格列美脲对冠状动脉炎症的影响，采用（18）F-氟脱氧葡萄糖（FDG）-正电子发射断层扫描（PET）联合计算机断层扫描（CT）血管造影进行连续检测。
最近的研究表明，FDG-PET 联合 CT 是一种可靠的工具，可以可视化和定量血管炎症。虽然吡格列酮可显著预防 2 型糖尿病（DM）患者的冠状动脉粥样硬化进展和减少心肌梗死复发，但吡格列酮是否能减轻冠状动脉炎症仍不清楚。
50 例糖耐量受损或 2 型 DM 患者进行血液化学、人体测量和炎症变量以及 FDG-PET/CT 血管造影检查，然后随机分为吡格列酮或格列美脲组，治疗 16 周。在基线和研究结束时通过 FDG-PET/CT 血管造影评估治疗对左主干血管炎症的影响。通过血标准化摄取值（即靶与背景比值）测量左主干的血管炎症。
在评估或治疗期间，有 3 名患者退出研究。最终，25 名吡格列酮治疗患者和 22 名格列美脲治疗患者（37 名男性；平均年龄：68.1±8.3 岁；糖化血红蛋白：6.72±0.70%）完成了研究。16 周治疗后，两组空腹血糖和糖化血红蛋白值均明显降低。与格列美脲组相比，吡格列酮组的靶与背景比值的变化明显更大（-0.12±0.06 对 0.09±0.07，p=0.032），高敏 C 反应蛋白也有类似变化（吡格列酮组与格列美脲组：中位数：-0.24[四分位距（IQR）：-1.58 至-0.04]mg/L 对 0.08[IQR：-0.07 至 0.79]mg/L，p=0.031）。
我们的研究表明，吡格列酮以不依赖于降血糖的方式减轻糖耐量受损或 DM 患者的左主干炎症，提示吡格列酮通过抑制冠状动脉炎症可能预防糖耐量受损或 DM 患者的心脏事件。（吡格列酮的抗炎作用；NCT00722631）。
