Yanai Hidekatsu, Adachi Hiroki
Department of Internal Medicine, National Center for Global Health and Medicine Kohnodai Hospital, Chiba, Japan.
J Clin Med Res. 2017 Oct;9(10):821-825. doi: 10.14740/jocmr3144w. Epub 2017 Sep 1.
Pioglitazone is one of thiazolidinedione derivatives, which stimulates nuclear peroxisome proliferator-activated receptor gamma and improves glucose and lipid metabolism and insulin sensitivity. A recent systematic review and meta-analysis showed that pioglitazone therapy was associated with a lower risk of major adverse cardiovascular events in patients with pre-diabetes and diabetes. Further, in a cohort study of patients with type 2 diabetes, pioglitazone therapy was associated with a statistically significant decrease in the risk of all-cause mortality. Despite these beneficial effects, the meta-analysis showed that pioglitazone therapy had higher risks of heart failure, bone fractures, edema and weight gain. To find out the efficacy and safety of the low-dose (7.5 mg/day) pioglitazone therapy, we reviewed the dose-response of pioglitazone on favorable effects and adverse effects due to pioglitazone, by searching the reports on effects of daily dose of 7.5 mg and/or 15 mg and/or 30 mg of pioglitazone. The low-dose pioglitazone therapy may show the same degree of improvements in glucose and lipid metabolism, fatty liver, insulin resistance, and adiponectin as the standard- and high-dose pioglitazone therapy. Furthermore, the low-dose pioglitazone therapy may also show less adverse effects on weight gain, edema and heart failure as compared with the standard- and high-dose pioglitazone therapy.
吡格列酮是噻唑烷二酮衍生物之一，它能刺激核过氧化物酶体增殖物激活受体γ，改善糖脂代谢及胰岛素敏感性。最近一项系统评价和荟萃分析表明，吡格列酮治疗可降低糖尿病前期和糖尿病患者发生主要不良心血管事件的风险。此外，在一项2型糖尿病患者队列研究中，吡格列酮治疗与全因死亡率风险的显著降低相关。尽管有这些有益作用，但荟萃分析显示，吡格列酮治疗有更高的心力衰竭、骨折、水肿和体重增加风险。为了探究低剂量（7.5毫克/天）吡格列酮治疗的疗效和安全性，我们通过检索每日剂量为7.5毫克和/或15毫克和/或30毫克吡格列酮作用的报告，回顾了吡格列酮对有利和不利影响的剂量反应。低剂量吡格列酮治疗在改善糖脂代谢、脂肪肝、胰岛素抵抗和脂联素方面可能与标准剂量和高剂量吡格列酮治疗有相同程度的效果。此外，与标准剂量和高剂量吡格列酮治疗相比，低剂量吡格列酮治疗在体重增加、水肿和心力衰竭方面可能也显示出较少的不良反应。
