Chou Ping-Song, Ho Bo-Lin, Yang Yuan-Han
Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of and Master's Program in Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
J Diabetes Complications. 2017 Jun;31(6):1053-1057. doi: 10.1016/j.jdiacomp.2017.01.006. Epub 2017 Jan 20.
Peroxisome proliferator-activated receptor gamma (PPAR-γ) agonists exert neuroprotective effects in the brain. Therefore, in this population-based cohort study, we investigated the effects of pioglitazone, a PPAR-γ agonist, on the risk of dementia.
By using claims data from Taiwan's National Health Insurance Research Database, we included 6401 patients with diabetes who were treated with pioglitazone and 12,802 age- and sex-matched patients with diabetes who were never treated with pioglitazone from 2004 to 2009 and who were free of dementia at baseline.
In total, 113 (1.8%) and 323 (2.5%) patients in the pioglitazone-treated and comparison cohorts, respectively, developed dementia during the 5-year follow-up. The risk of dementia decreased by 23% in the pioglitazone-treated cohort compared with that in the comparison cohort after adjustment for age, sex, hypertension, and stroke (adjusted hazard ratio [HR], 0.77; 95% confidence interval [CI]=0.62-0.96). In addition, the adjusted HRs (95% CIs) for dementia were 0.50 (0.34-0.75, P=.001) in high-cumulative dose users, 0.53 (0.36-0.77, P<.001) in long-term users, and 0.66 (0.49-0.90, P=.009) in high-mean daily dose users.
Pioglitazone is a time- and dose-dependent protective factor against dementia in patients with diabetes. The risk of dementia is lower in long-term and high-dose pioglitazone users than in never users of pioglitazone.
过氧化物酶体增殖物激活受体γ（PPAR-γ）激动剂对大脑具有神经保护作用。因此，在这项基于人群的队列研究中，我们调查了PPAR-γ激动剂吡格列酮对痴呆风险的影响。
利用台湾国民健康保险研究数据库的理赔数据，我们纳入了6401例接受吡格列酮治疗的糖尿病患者以及12802例年龄和性别匹配、2004年至2009年期间从未接受过吡格列酮治疗且基线时无痴呆的糖尿病患者。
在5年随访期间，吡格列酮治疗组和对照组分别有113例（1.8%）和323例（2.5%）患者发生痴呆。在调整年龄、性别、高血压和中风因素后，吡格列酮治疗组的痴呆风险比对照组降低了23%（调整后风险比[HR]，0.77；95%置信区间[CI]=0.62-0.96）。此外，高累积剂量使用者的痴呆调整后HR（95%CI）为0.50（0.34-0.75，P=0.001），长期使用者为0.53（0.36-0.77，P<0.001），高平均日剂量使用者为0.66（0.49-0.90，P=0.009）。
吡格列酮是糖尿病患者预防痴呆的时间和剂量依赖性保护因素。长期和高剂量使用吡格列酮的患者患痴呆的风险低于从未使用过吡格列酮的患者。
