Rosiglitazone in diabetes control in hemodialysis patients with and without viral hepatitis infection - Effectiveness and side effects
Rosiglitazone in diabetes control in hemodialysis patients with and without viral hepatitis infection - Effectiveness and side effects
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DOI：
10.2337/dc06-0956
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发表时间：
2007-01-01
期刊：
影响因子：
16.2
通讯作者：
Wu, Kwan-Dun
中科院分区：
文献类型：
--
作者：
Chiang, Chih-Kang;Ho, Tai-I.;Wu, Kwan-Dun
目的-噻唑烷二酮（TZD）可能通过靶向治疗胰岛素抵抗，为糖尿病患者提供额外的心血管保护获益。然而，TZD的使用受到液体潴留和肝毒性的可能影响的阻碍。在这项研究中，我们的目的是确定是否TZD引起的液体潴留或肝损伤的风险是较高的血液透析患者持续性病毒性肝炎infection.RESEARCH设计和方法-这是一个前瞻性的，队列研究血液透析患者。A1 C水平> 8%的2型糖尿病患者随访至少12个月。Rosightazone以2-4 mg/天开始。主要结果是达到的目标A1 C（< 7%）和rosightazone的剂量。次要结局包括血脂谱和炎症生物标志物的变化。安全性评价的低血糖事件，肝转氨酶水平的变化，心胸比率（CTR），透析过程中的液体状态控制，和有症状的心脏failure.Results事件-共78例，包括15.4%（n = 12）的B表面抗原阳性和16.7%（n = 13）的抗丙型肝炎病毒（HCV）阳性患者，被纳入。平均随访时间为15.4 ± 3.8个月。糖尿病有效率（A1 C < 7%）为86.1%。血清甘油三酯水平的降低（194 +/- 112.5至168 mg/dl，P = 0.037）比总胆固醇水平（178 +/- 42.1至174 +/- 46.5 mg/dl，P = 0.13）更显著。大剂量罗格列酮（8 mg/d）可显著降低血清C反应蛋白水平，升高血清脂联素水平。使用rosightazone后，透析间期体重增加（2.0 +/- 1.6至3.2 +/- 1.2 kg，P < 0.01）和平均CTR（48.2 +/- 5.6至50.4 +/-6.2%，P = 0.0213）显著增加。然而，肝转氨酶（天冬氨酸转氨酶和丙氨酸转氨酶）水平并没有表现出增加的趋势，在患者（n = 25）与病毒性肝炎B或C infections.CONCLUSIONS -在定期血液透析慢性病毒性肝炎感染患者，罗格列酮可安全地用于糖尿病控制。然而，必须意识到，使用它的可能影响是心血管储备的恶化。
OBJECTIVE - Thiazolidinedione (TZD) may provide an additional benefit of cardiovascular protection in diabetic patients through targeting of insulin resistance. However, use of a TZD is hampered by possible effects of fluid retention and hepatotoxicity. In this study we aimed to determine whether the risk of TZD-induced fluid retention or hepatic injury is higher in hemodialysis patients with persistent viral hepatitis infection.RESEARCH DESIGN AND METHODS - This was a prospective, cohort study on hemodialysis patients. Type 2 diabetic patients with A1C levels of > 8% were followed for at least 12 months. Rosightazone was initiated at 2-4 mg/day. The primary outcome was the target A1C (< 7%) achieved and dosages of rosightazone. Secondary outcomes included changes in lipid profile and inflammatory biomarkers. Safety evaluations were number of hypoglycemic episodes, changes in liver transammase levels, cardiothoracic ratio (CTR), fluid status control during dialysis, and events of symptomatic heart failure.RESULTS- A total of 78 patients, including 15.4% (n = 12) hepatitis B surface antigen-positive and 16.7% (n = 13) anti-hepatis C virus (HCV)-positive patients, were enrolled. The mean follow-up period was 15.4 +/- 3.8 months. The diabetic response rate (A1C < 7%) to rosightazone was 86.1%. The serum triglyceride level was reduced (194 +/- 112.5 to 168 mg/dl, P = 0.037) more significantly than the total cholesterol level (178 +/- 42.1 to 174 +/- 46.5 mg/dl, P = 0.13). High-dose rosiglitazone (8 mg/day) reduced the serum level of C-reactive protein and increased the serum adiponectin level significantly. After rosightazone, interdialysis weight gain (2.0 +/- 1.6 to 3.2 +/- 1.2 kg, P < 0.01) and mean CTR (48.2 +/- 5.6 to 50.4 +/- 6.2 %, P = 0.0213) of individuals increased significantly. Nevertheless, liver aminotransferase (aspartate aminotransferase and alanine aminotransferase) levels did not show a tendency to increase in patients (n = 25) with viral hepatitis B or C infections.CONCLUSIONS - Among regular hemodialysis patients with chronic viral hepatitis infections, rosiglitazone may be safely used for diabetes control. However, one must be aware that a possible effect of its use is a deterioration in cardiovascular reserve.