Thiazolidinediones與Statins藥物併用對於第2型糖尿病病患的血脂改變之評估

The evaluation of dyslipidemia benefit effect of Thiazolidinediones with Statins in patients with type 2 diabetes mellitus

黃厚仁(Hou-Jen Huang)

指導教授 ： 蔡東榮

高雄醫學大學/藥學院/藥學研究所碩士在職專班/碩士(2008年)

摘要

研究背景與目的：患有新陳代謝症候群的病患其罹患冠狀動脈心臟疾病和第2型糖尿病的風險也會增加。對於罹患新陳代謝症候群的病患其首要治療的目標是糖尿病的血脂異常。Statin在臨床上對於第2型糖尿病通常用來降低低密度脂蛋白膽固醇(LDL-C)。Thiazolidinediones (TZDs)在肌肉及脂肪組織則會提高胰島素的敏感性，因而產生降低血糖之作用。對於三酸甘油脂及膽固醇則具有改善的效果。本研究的目的是要評估Thiazolidinediones(TZDs)加上statin合併治療後是否會有進一步的效果。
研究資料與方法：本研究採用回溯性的研究設計，資料來源為馬偕醫院台東分院2006年1月1日到2006年12月31日止，診斷為第2型糖尿病之病患並已使用口服降血糖藥物控制已達6個月以上，且於此期間使用Statins 類降血脂藥物，之後進行病歷審閱，記錄加入Statin給藥後之血糖、血脂生化值包括HbA1c、HDL-C、LDL-C、TG等，並分析其差異值作為有效性之評估。排除使用降血脂藥物未達3個月；使用降血脂藥物但未監測相關數值；嚴重的高三酸甘油脂（TG > 500 mg/dl 以上）；嚴重的鬱血性心臟衰竭（New York Heart Association class III or IV）之個案。
研究結果：共263位病人合乎收案條件納入研究分析。將這263位病人分為兩組，一組使用不含TZD之降血糖藥加上Statin藥物（稱為non-TZD組）共200人，另一組為使用含TZD之降血糖藥加上Statin藥物（稱為TZD組）的病人共63人。此兩組未使用Statins治療前的基本點除了TZD組之HbA1c高於non-TZD（9.08 ± 2.05: 8.20 ± 1.82%, P<0.05）外，其餘包括年齡、性別、併用可能影響血脂的藥物、血脂生化值均無統計學上的差異。而使用Statins的治療後在血脂的改善上此兩組並無明顯的差異。但在進一步分析顯示TZD組中pioglitazone與rosiglitazone 對HDL-C的影響有明顯的差異(1.19 ± 9.54 vs -5.40 ± 11.48, P < 0.05)。但TG、LDL-C 之改變值，二組並無差異。
結論：此兩組不論是否使用TZDs藥物，當併用Statins藥物時對於血脂異常的改善程度並無顯著差異。但pioglitazone對於HDL-C的效果明顯優於rosiglitazone。
關鍵詞：新陳代謝症候群; 第2型糖尿病; 血脂異常; Statins; Thiazolidinedione

關鍵字

新陳代謝症候群 ； 第2型糖尿病 ； 血脂異常 ； Statins ； Thiazolidinedione

並列摘要

Background and Objectives: People with the metabolic syndrome are at increased risk of coronary heart disease and type 2 diabetes. Treatment goal for diabetic dyslipidemia is the first strategy for metabolic syndrome with type 2 diabetes. Statins were used to lower blood LDL-C of patients with type 2 diabetes in clinical management. Thiazolidinediones (TZDs) enhance insulin action in muscle, fat and other tissues, lower blood sugar and are known as insulin sensitizers. It had been shown that TZDs can help, triglycerides (TGs) and cholesterol. In this study, the blood lipid modifying effect of Statins combined with TZDs treatment in patients with type 2 diabetes is further to evaluate.

Methods: Retrospective secondary data analysis was used in this study. For January 1 2006 to December 31 2006, the patients with type 2 diabetes mellitus had oral hypoglycermia agents treatment for 6 months at least in Mackay Memory Hospital in Taitung. After Statins treatment for 3 month, the patients’ blood sample was collected and used to detect the level of HbA1c, HDL-C, LDL-C, TG etc. The level of blood sugar and medical record of these patients were monitored in drug treatment period.

Results: 263 patients in this study had divided two groups, one group was non-TZDs hypoglycermia agents combined with Statin treatment (n=200) and the other was TZDs combined with Statin treatment (n=63). The baseline demographics and characteristics of two group before Statin treatment were no significance difference, expect the level of HbA1c. The HbA1c in TZD group was higher than non-TZD group (9.08±2.05% vs 8.20±1.82%, P<0.05). The effect of Statins treatment in two group had no significance difference. However, in TZD group, the levels of HDL-C with pioglitazone or rosiglitazone treatment were differential (1.19 ± 9.54 vs -5.40 ± 11.48, P < 0.05). The level of LDL-C and TG in two subgroups had no significance difference.

Conclusions: The effect of Statins treatment on dyslipidemia had no significance difference in TZD or non-TZD hypoglycermia agents treated patients. It suggested that TZD treatment had no enhancement effect on Statins to improve dyslipidemia. The level of HDL-C was increased with pioglitazone treatment.

Key word: dyslipidemia; metabolic syndrome; statin; thiazolidinedione; type 2 diabetes mellitus

並列關鍵字

dyslipidemia ； metabolic syndrome ； statin ； thiazolidinedione ； type 2 diabetes mellitus

參考文獻

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