Christoph Marian, Herold Joerg, Berg-Holldack Anna, Rauwolf Thomas, Ziemssen Tjalf, Schmeisser Alexander, Weinert Sönke, Ebner Bernd, Said Samir, Strasser Ruth H, Braun-Dullaeus Ruediger C
Heart Center, University of Dresden, University Hospital, Germany, Fetscherstrasse 76, 01307, Dresden, Germany,
Heart Vessels. 2015 May;30(3):286-95. doi: 10.1007/s00380-014-0480-0. Epub 2014 Feb 12.
Despite the advanced therapy with statins, antithrombotics and antihypertensive agents, the medical treatment of coronary artery disease is less than optimal. Therefore, additional therapeutic anti-atherosclerotic options are desirable. This VH-IVUS study (intravascular ultrasonography with virtual histology) was performed to assess the potential anti-atherogenic effect of the PPARγ agonist pioglitazone in non-diabetic patients. A total of 86 non-culprit atherosclerotic lesions in 54 patients with acute coronary syndrome were observed in a 9-month prospective, double-blind, and placebo-controlled IVUS study. Patients were randomized to receive either 30 mg pioglitazone (Pio) or placebo (Plac). As primary efficacy parameter, the change of relative plaque content of necrotic core was determined by serial VH-IVUS analyses. Main secondary endpoint was the change of total plaque volume. In contrast to placebo, in the pioglitazone-treated group, the relative plaque content of necrotic core decreased significantly (Pio -1.3 ± 6.9% vs. Plac +2.6 ± 6.5%, p < 0.01). In comparison to the placebo group, the plaques in pioglitazone-treated patients showed significantly greater reduction of the total plaque volume (Pio -16.1 ± 26.4 mm3 vs. Plac -1.8 ± 30.9 mm3, p = 0.02). Treatment with a PPARγ agonist in non-diabetic patients results in a coronary artery plaque stabilization on top of usual medical care.
尽管使用了他汀类药物、抗血栓药物和抗高血压药物进行先进治疗，但冠状动脉疾病的医学治疗仍不尽如人意。因此，需要额外的抗动脉粥样硬化治疗选择。这项VH-IVUS研究（虚拟组织学血管内超声检查）旨在评估过氧化物酶体增殖物激活受体γ（PPARγ）激动剂吡格列酮在非糖尿病患者中的潜在抗动脉粥样硬化作用。在一项为期9个月的前瞻性、双盲、安慰剂对照的IVUS研究中，观察了54例急性冠状动脉综合征患者的86个非罪犯动脉粥样硬化病变。患者被随机分为接受30毫克吡格列酮（Pio）或安慰剂（Plac）治疗。作为主要疗效参数，通过连续的VH-IVUS分析确定坏死核心相对斑块含量的变化。主要次要终点是总斑块体积的变化。与安慰剂相比，在吡格列酮治疗组中，坏死核心的相对斑块含量显著降低（Pio -1.3±6.9% vs. Plac +2.6±6.5%，p<0.01）。与安慰剂组相比，吡格列酮治疗患者的斑块总斑块体积减少更为显著（Pio -16.1±26.4立方毫米 vs. Plac -1.8±30.9立方毫米，p = 0.02）。在非糖尿病患者中使用PPARγ激动剂进行治疗，在常规医疗基础上可实现冠状动脉斑块稳定。
