吡格列酮与胰岛素治疗对2型糖尿病患者血小板功能影响的对比

目的比较吡格列酮（Pio）、胰岛素（Ins）治疗对T2DM患者血小板功能的影响。方法经二甲双胍治疗效果不佳的44例新诊断T2DM患者随机分为2组：Ins组在二甲双胍基础上联合皮下注射胰岛素；Pio组在二甲双胍基础上加用吡格列酮。检测0周、4周、24周时各组的FPG、HbA1c、HOMA-IR，血小板膜上GMP-140、PAC-1的表达率及ADP诱导的血小板的聚集率。结果41例完成治疗。（1）4周后，Pio组FPG高于Ins组，差异有统计学意义；Ins、Pio组间HOMA-IR、ADP诱导的血小板聚集率、血小板GMP-140、PAC-1的表达率差异无统计学意义。（2）24周后，Pio组FPG、HbA1c高于Ins组；Pio组HOMA—IR、ADP诱导的血小板聚集率、血小板PAC-1、GMP-140的表达率低于Ins组；差异均有统计学意义。结论胰岛素、吡格列酮治疗均能抑制T2DM患者的血小板功能，但吡格列酮效果优于胰岛素，推测吡格列酮可能具有独立于降糖以外的抑制血小板功能的作用。

The effect of insulin versus pioglitazone treatment on the platelet function in type 2 diabetics

Objective To observe the effect of pioglitazone versus insulin on the platelet function of type 2 diabetics. Methods 44 newly diagnosed type 2 diabetics who had been treated ineffectively with metformin （1.5g/d）were divided randomly into two groups, and insulin （group I） and pioglitazone （group P） were added to the former metformin. At the beginning and at 4^th and 24^th week of the study, the levels of FBG, HbA1c, HOMA-IR and variables of platelet activation, including the expression ratio of GMP-140 to PAC-1 on the platelet membrane, and the packing fraction of the platelets derived by ADP were measured in all the subjects. Results （1） At 4^th week, the FBG in group P was higher than in group I. The differences of HOMA-IR and platelet activation parameters had no statistical significance between group I and group P. ②At 24^th week, the FBG and HbA1c were also higher in group P than in group I, the HOMA-IR, the packing fraction of the platelets derived by ADP and the expression of ratio of PAC-1 to GMP-140 were lower in group P than in group I. Conclusions Insulin and pioglitazone can suppress the platelet function of type 2 diabetics. Pioglitazone is more effective than insulin in lowering the enhanced platelet function, which is independent of its hypoglycemic effect.