阿卡波糖干预老年冠心病并糖耐量减低患者疗效及机制的研究  

Effect of acarbose on elderly patients with coronary heart disease complicating impaired glucose tolerance and protective mechanism

作　　者：云鹏[1,2] 肖虎[1,2] 陈学军[1,3] 田志明[1,3] 龚婷[1,2] 

机构地区：[1]长江大学临床医学院 [2]长江大学附属第一医院内分泌科,湖北荆州434000 [3]长江大学附属第一医院心内科,湖北荆州434000

出　　处：《临床荟萃》2011年第19期1680-1683,共4页Clinical Focus

摘　　要：目的探讨阿卡波糖干预对合并糖耐量减低(IGT)的老年冠心病患者预后的影响及其心脏保护作用机制。方法 163例合并IGT的老年冠心病患者随机分为干预组(81例)和对照组(82例),两组给予相同基础治疗,干预组同时给予阿卡波糖(50mg,每日3次)治疗,平均随访2.4年,观察主要心血管事件(MACE)(包括心血管病因死亡、非致命性心肌梗死、新发生的心绞痛、非致命性脑卒中、严重心力衰竭)发生情况并对血清高敏C反应蛋白(hsCRP)与颈动脉内膜中层厚度(IMT)的关系进行统计学分析。结果平均随访2.4年后,干预组MACE发生率明显降低(19.8%vs 39.2%,P<0.01),同时干预组治疗后hsCRP和颈动脉IMT显著低于对照组,干预组hsCRP(2.92±0.63)mg/L vs对照组(6.69±0.92)mg/L,干预组IMT(1.13±0.45)mm vs对照组(1.32±0.55)mm(P<0.01或<0.05);多元逐步回归分析示餐后2小时血糖(2hPG)、体质量指数(BMI)为hsCRP升高的危险因素,同时hsCRP、2hPG为颈动脉IMT增厚的独立危险因素(均P<0.05);两组间严重胃肠不良反应发生率差异无统计学意义(P>0.05)。结论阿卡波糖可通过控制餐后血糖改善亚临床炎症状态,进而延缓颈动脉IMT增厚,最终获得心血管收益,同时老年患者对该药耐受性良好。Objective To study the effect of acarbose on the prognosis of elderly patients with coronary heart disease complicating impaired glucose tolerance（IGT） and its cardioprotective mechanism.Methods 163 elderly patients with coronary heart disease complicating IGT were randomly divided into treatment group（n=81） and control group（n=82）.All cases were given the same elementary treatment,those in treatment group were administered acarbose,50 mg,three times a day,additionally.Average follow-up was 2.4 years.The risk of major cardiovascular event（MACE）,highly sensitive C-reactive protein（hsCRP） and carotid intima-media thickness（IMT） were statistically analyzed.Results After the average follow-up of 2.4 years,MACE in treatment group was decreased significantly compared with that in control group,19.8% vs 39.2%（P0.01）,and at the same time,hsCRP and carotid IMT reduced in comparison significantly,（2.92±0.63） mg/L vs（6.69±0.92） mg/L,（1.13±0.45） mm vs（1.32±0.55） mm（P0.05 or 0.01）.Multiple stepwise regression analysis displayed that BMI and 2 hPG were closely related with hsCRP,simultaneously hsCRP and 2 hPG were closely related with carotid IMT（P0.05）.Conclusion Acarbose can significantly degrade the risk of MACE in elderly coronary heart disease patients with IGT.The cardioprotective effects may be related to the depression of subclinical inflammation and consequently retard thickening of carotid IMT.

关 键 词：冠状动脉疾病 冠状血管造影术 糖尿病前期 阿卡波糖 老年人 

分 类 号：R541.4[医药卫生—心血管疾病]