- 期刊
一個負面研究結果的正面含意－ACCORD研究與第二型糖尿病人危險因子的控制
Positive Implication in a Negative Study-ACCORD Study and Risk-Factor Control in Type 2 Diabetes
摘要
糖尿病本身和它常伴隨的疾患（如高血壓與血脂異常）都是心血管疾病的獨立危險因子。然而在糖尿病人更嚴格地控制血糖和其他危險因子的效益如何，仍缺乏明確證據。爲了解決這個長期持續的問題，「控制糖尿病患者心血管疾病風險的行動」Action to Control Cardiovascular Risk in Diabetes(ACCORD)研究是評估加強血糖、血壓以及血脂（合併fibrate和statin）治療，在高危險糖尿病人的好處與風險。遺憾的是ACCORD血糖試驗因爲加強治療組的死亡率增加而在2008年2月提前結束。2010年4月同樣出人意外的新發表數據顯示ACCORD血壓試驗中將收縮壓控制在120毫米汞柱以下和140毫米汞柱以下比較，無法減少致死性和非致死性心血管事件的複合預後。ACCORD血脂試驗中合併fibrate和simvastatin也呈現負面結果。本文中我們將回顧告一段落的ACCORD研究和它對臨床實踐的影響，雖然它是一個負面結果的研究，但在糖尿病人的完整處置上提供了許多正面的含意。
並列摘要
The common conditions coexisting with type 2 diabetes (e.g., hypertension and dyslipidemia) are clear risk factors for cardiovascular disease, and diabetes itself confers independent risk. However, there is a lack of definitive data on the effects of the intensive control of glycemia and other risk factors on cardiovascular event rates in patients with type 2 diabetes. To resolve this ongoing question, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial assessed the benefits and risks of intensive glucose control, intensive blood pressure control, and the combination of fibrate and statin drugs in managing blood lipids in high-risk patients with type 2 diabetes. Unfortunately, in February 2008, the ACCORD glycemia trial was stopped early because of higher mortality in the intensive treatment group. In April 2010, new data from the ACCORD study again defied our expectations and showed that in the blood pressure trial targeting a systolic blood pressure of less than 120mmHg, as compared with less than 140mmHg, did not reduce the rate of a composite outcome of fatal and nonfatal major cardiovascular events. The same negative result was observed for the combination of fenofibrate and simvastatin in the lipid trial. In this article we review the completed ACCORD study and its influence on the clinical practice. Despite of a negative study, ACCORD study providing some positive implications for the comprehensive management in T2DM patients.