Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, South Korea.
Department of Radiology, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, South Korea.
Atherosclerosis. 2017 Feb;257:47-54. doi: 10.1016/j.atherosclerosis.2016.12.011. Epub 2016 Dec 10.
Sarpogrelate, a 5-hydroxytryptamine type 2A antagonist, is a potential antiplatelet agent. We performed a randomized study to evaluate the effect of sarpogrelate on vascular health in Korean patients with diabetes.
Forty diabetic patients aged 58.6 ± 6.8 years with 10-75% coronary artery stenosis, as assessed by coronary computed tomography angiography, were randomly assigned to sarpogrelate 300 mg/day plus aspirin 100 mg/day (SPG + ASA group) or aspirin 100 mg/day alone (ASA group) for 6 months. The primary endpoint of this study was the change in coronary artery disease including the calcium score (CACS), maximal stenosis, and plaque volume (calcified vs. noncalcified). The secondary endpoints were changes in biochemical parameters related to glucose and lipid metabolism, and in subclinical atherosclerosis assessed by ankle-brachial index and pulse wave velocity.
After 6-month treatment, there was no significant difference in the changes in CACS, coronary stenosis, ankle-brachial index, and pulse wave velocity, between groups. The total plaque volume decreased from 82.4 ± 14.5 mm to 74.6 ± 14.4 mm in the SPG + ASA group, but increased from 64.9 ± 16.0 mm to 68.6 ± 16.3 mm in the ASA group (p < 0.05), mainly driven by changes in the noncalcified component (SPG + ASA group 15.6 ± 4.6 mm to 11.2 ± 3.7 mmvs. ASA group 21.2 ± 6.2 mm to 22.8 ± 6.6 mm, p < 0.01). Serum C-reactive protein levels and homeostasis model assessment of insulin resistance tended to decrease in the SPG + ASA group, but they were not altered in the ASA group.
The present study demonstrated that sarpogrelate treatment may decrease coronary artery plaque volume, particularly the noncalcified portion, in patients with diabetes.
沙格雷酯是一种 5-羟色胺 2A 拮抗剂，是一种有潜力的抗血小板药物。我们进行了一项随机研究，以评估沙格雷酯对韩国糖尿病患者血管健康的影响。
40 名年龄 58.6±6.8 岁的糖尿病患者，通过冠状动脉计算机断层血管造影术评估有 10-75%的冠状动脉狭窄，被随机分为沙格雷酯 300mg/天加阿司匹林 100mg/天（SPG+ASA 组）或阿司匹林 100mg/天单药治疗（ASA 组），疗程 6 个月。本研究的主要终点是冠状动脉疾病的变化，包括钙评分（CACS）、最大狭窄度和斑块体积（钙化与非钙化）。次要终点是与葡萄糖和脂质代谢相关的生化参数的变化，以及通过踝臂指数和脉搏波速度评估的亚临床动脉粥样硬化的变化。
治疗 6 个月后，两组间 CACS、冠状动脉狭窄、踝臂指数和脉搏波速度的变化无显著差异。SPG+ASA 组总斑块体积从 82.4±14.5mm 减少至 74.6±14.4mm，但 ASA 组从 64.9±16.0mm 增加至 68.6±16.3mm（p<0.05），主要是由于非钙化成分的变化（SPG+ASA 组 15.6±4.6mm 至 11.2±3.7mm，ASA 组 21.2±6.2mm 至 22.8±6.6mm，p<0.01）。SPG+ASA 组血清 C 反应蛋白水平和胰岛素抵抗稳态模型评估趋于降低，但 ASA 组无变化。
本研究表明，沙格雷酯治疗可能会减少糖尿病患者的冠状动脉斑块体积，特别是非钙化部分。
