C-reactive protein, its role in inflammation, Type 2 diabetes and cardiovascular disease, and the effects of insulin-sensitizing treatment with thiazolidinediones
C-reactive protein, its role in inflammation, Type 2 diabetes and cardiovascular disease, and the effects of insulin-sensitizing treatment with thiazolidinediones
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DOI：
10.1111/j.1464-5491.2004.01296.x
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发表时间：
2004-08-01
影响因子：
3.5
通讯作者：
Nesto, R
中科院分区：
文献类型：
--
作者：
Nesto, R
炎症标志物C-反应蛋白（CRP）浓度的增加与胰岛素抵抗、2型糖尿病和心血管疾病的发展有关。特别是炎症与内皮功能障碍密切相关，被认为是胰岛素抵抗综合征或代谢综合征中聚集的心血管危险因素之一。胰岛素抵抗和炎症的确切机制尚不清楚。然而，动脉粥样硬化形成中胰岛素抵抗和炎症之间的密切关系表明，解决这两个参数的治疗可能有利于减少糖尿病相关的大血管并发症。噻唑烷二酮类口服抗糖尿病药物是强效胰岛素增敏剂，也具有抗炎特性。这些药物治疗具有一系列抗动脉粥样硬化作用，包括降低CRP、纤溶酶原激活物抑制剂-1（派-1）、TNF-α和活性氧水平。此外，噻唑烷二酮类的胰岛素增敏作用改善了胰岛素抵抗综合征的其他因素，包括血脂异常和高血压。正在进行结果研究，以确定改善胰岛素敏感性和减少炎症的作用是否会转化为临床益处，并降低与胰岛素抵抗和2型糖尿病相关的心血管发病率和死亡率。
Increased concentrations of the marker of inflammation, C-reactive protein (CRP), are associated with insulin resistance, Type 2 diabetes and the development of cardiovascular disease. In particular, inflammation is closely associated with endothelial dysfunction and is recognized as one of the cardiovascular risk factors clustering in the Insulin Resistance Syndrome or Metabolic Syndrome. The exact mechanisms linking insulin resistance and inflammation remain unclear. However, the close association between insulin resistance and inflammation in atherogenesis suggests that therapies that address both parameters may have benefits in reducing diabetes-related macrovascular complications. The thiazolidinedione class of oral anti-diabetic agents are powerful insulin sensitizers that also have anti-inflammatory properties. Treatment with these agents has a range of anti-atherogenic effects, including reduced levels of CRP, plasminogen activator inhibitor-1 (PAI-1), TNF-alpha and reactive oxygen species. Additionally, the insulin-sensitizing effect of thiazolidinediones improves other factors of the Insulin Resistance Syndrome, including dyslipidaemia and hypertension. Outcome studies are underway to determine if the effects of improving insulin sensitivity and reducing inflammation will translate into clinical benefits and reduce the cardiovascular morbidity and mortality associated with insulin resistance and Type 2 diabetes.