Pioglitazone可能降低非糖尿病患者冠狀動脈支架中新生血管內皮的生長


  March 15, 2005(奧蘭多)-德國研究者於美國心臟學會(ACC)2005年會的臨床試驗座談中表示,口服治療糖尿病藥物pioglitazone降低冠狀動脈支架植入後新生血管內皮的生長,而不會影響血糖、血紅素A1C、或是其他代謝相關數值。
  
  德國Ulm大學內科主治醫師Nicholas Marx醫師發表這項收納50位非糖尿病患的試驗,試驗中隨機分派受試者在植入支架後,每天服用pioglitazone 30毫克、或是安慰劑加上標準療法。
  
  當研究者在6個月後透過血管內超音波檢驗病患,他們發現試驗組相較於安慰劑組,新生血管內皮顯著地降低,而且斑塊生長也較少。
  
  Marx醫師表示,pioglitazone對於血管壁有保護作用;我們看到新生血管內皮生長顯著地減少。
  Pioglitazone並不會改變血紅素A1C、血糖或是血脂;Marx醫師附帶表示,這可以轉換為對臨床情況的影響嗎?我們會等著看這個結果。
  
  Marx醫師表示,類似的結果也可以在植入冠狀動脈支架的糖尿病患身上見到,但是他表示那些發現可能與改善血糖有關。
  
  臨床試驗座談的引言人伊利諾州芝加哥Rush大學醫學中心的介入性心臟學家Lloyd Klein醫師指出,pioglitazone並不像藥物洗滌支架一樣具有抑制增生作用,但是這個藥物對新生血管內皮生長有些微降低的效果,而達到可以被偵測到的程度。

Pioglitazone May Reduce Neoint

By Martha Kerr
Medscape Medical News

March 15, 2005 (Orlando) — The oral diabetic agent pioglitazone reduced neointimal formation after coronary stent implantation, without affecting blood glucose, hemoglobin A1c or other measures of the metabolic profile, German investigators announced here during a late-breaking clinical trials session of the American College of Cardiology (ACC) 2005 Annual Scientific Sessions.

Nicholas Marx, MD, attending physician in the department of internal medicine at the University of Ulm, Germany, announced the findings of the pilot study of 50 nondiabetic patients randomized to receive pioglitazone, 30 mg, daily or placebo plus standard therapy after coronary stent implantation.

When the investigators examined patients six months later using intravascular ultrasound, they found a significant reduction in neointimal growth and less plaque formation in the study group compared with controls.

"[Pioglitazone] has a protective effect on the vessel wall," Dr. Marx told meeting attendees. "We saw a significant decrease in neointimal growth formation." Pioglitazone did not change hemoglobin A1c, glucose levels or lipid profile, Dr. Marx added. "Does this translate into clinical impact? We'll have to wait and see."

Dr. Marx noted that similar effects were seen in diabetic patients undergoing coronary stent implantation, but he said that those findings could possibly be attributed to an improvement in glycemic control.

The panel moderator at the late-breaking clinical trials session, Lloyd Klein, MD, an interventional cardiologist at Rush University Medical Center in Chicago, Illinois, commented that "pioglitazone does not have the same antiproliferative effects as the other drug-eluting stent platforms, but it just takes a small decrease" in neointimal growth to achieve a measureable effect.

ACC 2005 Annual Scientific Session: Late-breaking clinical trials session 25-3. Presented March 6, 2005.

Reviewed by Gary D. Vogin, MD

    
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