Asal Nicole J, Wojciak Karolina A
Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA.
Endocrine. 2017 May;56(2):240-244. doi: 10.1007/s12020-017-1279-4. Epub 2017 Mar 14.
Cilostazol (Pletal), a phosphodiesterase-3 inhibitor, was approved in the United States in 1999 to reduce symptoms of intermittent claudication. Cyclic adenosine monophosphate levels increase from inhibition of phosphodiesterase resulting in anti-platelet, anti-inflammatory, and vasodilatory effects. Diabetes mellitus is a chronic disease that causes endothelial and platelet dysfunction leading to both microvascular and macrovascular complications. This mini-review highlights the emerging evidence suggesting benefits of using cilostazol in treating microvascular complications associated with diabetes mellitus.
A review of literature was conducted using PubMed and Embase databases focusing on cilostazol use in diabetes mellitus.
Cilostazol demonstrated renoprotective effects in patients with diabetic nephropathy by reducing serum soluble adhesion molecule-1 and monocyte chemoattractant protein-1. Cilostazol's anti-inflammatory actions predictably attenuate glomerular damage from increased leukocyte adherence. Additionally, cilostazol delayed renal dysfunction secondary to type 2 diabetes mellitus as albuminuria was reduced most likely resulting from inhibition of nuclear factor kappa-induced inflammatory and endothelial markers. Cilostazol's anti-inflammatory actions in addition to its vasodilatory actions relieved retinal hypoxia and decreased excessive production of retinal blood vessels suggesting benefit in diabetic retinopathy. Cilostazol did not improve neuropathy symptom scores signifying that it may not be as beneficial in patients with diabetic peripheral neuropathy without diabetic nephropathy or diabetic retinopathy.
Cilostazol's pleiotropic effects may be beneficial in patients with type 2 diabetes mellitus and diabetic nephropathy. Additional, larger studies need to be conducted to assess the benefits and risks of using cilostazol as an alternative agent in treating patients with diabetic microvascular complications.
西洛他唑（培达）是一种磷酸二酯酶-3抑制剂，于1999年在美国获批用于减轻间歇性跛行症状。抑制磷酸二酯酶会使环磷酸腺苷水平升高，从而产生抗血小板、抗炎和血管舒张作用。糖尿病是一种慢性病，会导致内皮和血小板功能障碍，进而引发微血管和大血管并发症。本综述强调了新出现的证据，表明使用西洛他唑治疗与糖尿病相关的微血管并发症有益。
使用PubMed和Embase数据库对文献进行综述，重点关注西洛他唑在糖尿病中的应用。
西洛他唑通过降低血清可溶性黏附分子-1和单核细胞趋化蛋白-1，对糖尿病肾病患者具有肾脏保护作用。西洛他唑的抗炎作用可预见地减轻了因白细胞黏附增加而导致的肾小球损伤。此外，西洛他唑延缓了2型糖尿病继发的肾功能障碍，因为蛋白尿减少，这很可能是由于抑制了核因子κB诱导的炎症和内皮标志物。西洛他唑的抗炎作用及其血管舒张作用减轻了视网膜缺氧，并减少了视网膜血管的过度生成，提示对糖尿病视网膜病变有益。西洛他唑并未改善神经病变症状评分，这表明它对无糖尿病肾病或糖尿病视网膜病变的糖尿病周围神经病变患者可能没有那么有益。
西洛他唑的多效性作用可能对2型糖尿病和糖尿病肾病患者有益。需要进行更多、更大规模的研究，以评估使用西洛他唑作为治疗糖尿病微血管并发症替代药物的益处和风险。
