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J Clin Endocrinol Metab：PDE5抑制剂可改善糖尿病前期患者胰岛素敏感性

2015-11-24 MedSci MedSci原创

西地那非糖尿病前期
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一项新的研究发现勃起功能障碍药物西地那非（伟哥）改善糖尿病前期患者的胰岛素敏感性和内皮功能标志物状态。研究结果11月18日在线发表在Journal of Clinical Endocrinology and Metabolism。

一项新的研究发现勃起功能障碍药物西地那非（伟哥）可改善糖尿病前期患者的胰岛素敏感性和内皮功能标志物状态。

研究结果11月18日在线发表在Journal of Clinical Endocrinology and Metabolism。作者是Vanderbilt 大学Claudia E Ramirez医学博士和同事。

糖尿病前期与心脏病和肾脏病的风险增加有关。西地那非似乎也改善其他的心脏和肾脏疾病相关的危险因素。

改善机制可能是这类药物的类似效果是通过抑制磷酸二酯酶5(PDE5)增加脏器血流。

Brown博士说她的团队正在计划一个更大的和长期的随机安慰剂对照试验研究PDE5抑制是否能改善糖尿病前期受试者的糖尿病临床标志物状态。

西地那非并不影响体重和血压

在这项研究招募的51例超重且伴有糖尿病前期的受试者中研究人员使用经批准的剂量的西地那非（25mg）治疗肺动脉高压，受试者服用西地那非25mg，tid。

试验用西地那非的剂量25mg，tid高于西地那非用于勃起功能障碍的剂量，用于治疗勃起功能障碍的剂量不太可能具有同样的效果。

共有35例女性和16例男性受试者随机分配连续3个月服用西地那非或安慰剂，在研究基线和治疗结束时接受高血糖测试。西地那非组和安慰剂组中分别有21例受试者完成了研究。

受试者参与试验3个月后，调整基线因素后西地那非组与安慰剂组比较，胰岛素敏感性指数显著增加(P=0.049)。西地那非组处置指数(综合测量胰岛素敏感性和分泌)也倾向于增加(P=0.070)。

然而两组间第一时相或第三时相葡萄糖刺激的胰岛素分泌、精氨酸注射后胰岛素浓度或C肽浓度没有明显差异(P>0.30)。

西地那非对体重、静息能量消耗或者游离脂肪含量并没有显着影响。

2例安慰剂组受试者和4例西地那非组受试者出现微蛋白尿。西地那非组受试者尿白蛋白/肌酐比率从12.67µg/mg降低到6.84µg/mg，停用药物后效果仍然可以持续3个月。

相比之下，安慰剂组尿白蛋白/肌酐比从研究开始8.45µg/mg增加到研究结束时13.41µg/mg，停药后3个月内尿白蛋白/肌酐比仍然保持在18.35µg/mg。

安慰剂组四个受试者在治疗后3个月出现微蛋白尿，而西地那非组没有(P=0.036)。

西地那非治疗也显著降低血浆纤溶酶原激活物抑制因子-1的浓度(P=0.01)，同时不影响组织纤维蛋白溶酶原活化因子的浓度，而安慰剂组患者中两种因子都没有受到影响。西地那非治疗对血液循环中的环鸟苷酸、细胞因子浓度、醛固酮或尿F2-isoprostanes都没有影响。西地那非也不影响收缩压或舒张压。

西地那非和安慰剂之间由于发生副作用或特定副作用的发生频次过多的停药率没有明显差异。

其他西地那非类药物也可能有类似的效果

Brown博士的团队正在计划实施一个规模更大的关于PDE5抑制剂的长期临床试验。Brown博士认为其他西地那非类的药物尤其是可溶性鸟苷酸环化酶刺激药也有开发前景。

在2013年Riciguat(拜耳公司)第一个在美国被批准用于治疗肺动脉高压。Riciguat类药物也可能有类似于西地那非的有利影响。

研究由美国国立卫生研究院和其他机构资助。布朗博士是诺华公司的顾问，接收来自Shire and New Haven 制药的资金资助。布朗博士也在Alnylam制药顾问委员会任职。合著者没有相关的财务关系。

原始出处：

1.Sildenafil Improves Risk Markers in Prediabetes, Small Study Shows. Medscape Medical News.November 20,2015.


2.Claudia E Ramirez, Nian Hui, Chang Yu, et all. Treatment with Sildenafil Improves Insulin Sensitivity in Prediabetes: A Randomized, Controlled Trial.J Clin Endocrinol Metab. Published online November 18,2015.

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    2016-11-24 1771ae4158m

    学习中，很好

    0

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    2016-10-11 1e128d2fm65(暂无匿称)

    伟哥一药多用

    0

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    2016-09-26 1e0a2178m68(暂无匿称)

    伟哥还有这种作用，太有趣了

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=157799, encodeId=b43815e799a9, content=学习中，很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Thu Nov 24 07:54:22 CST 2016, time=2016-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=144082, encodeId=4290144082b1, content=伟哥一药多用, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161012/IMG57FE37B9D8B7C2781.jpg, createdBy=05f31956923, createdName=1e128d2fm65(暂无匿称), createdTime=Tue Oct 11 11:40:11 CST 2016, time=2016-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=135594, encodeId=8ef8135594c6, content=伟哥还有这种作用，太有趣了, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cd381919282, createdName=1e0a2178m68(暂无匿称), createdTime=Mon Sep 26 21:15:02 CST 2016, time=2016-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1944963, encodeId=a40e1944963d4, content=<a href='/topic/show?id=b2fd838849c' target=_blank style='color:#2F92EE;'>#胰岛素敏感#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83884, encryptionId=b2fd838849c, topicName=胰岛素敏感)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e68e415, createdName=juliusluan78, createdTime=Tue Apr 26 13:00:00 CST 2016, time=2016-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1895851, encodeId=2498189585161, content=<a href='/topic/show?id=4a391158248' target=_blank style='color:#2F92EE;'>#MET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11582, encryptionId=4a391158248, topicName=MET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18fc139, createdName=一闲, createdTime=Tue Jun 21 05:00:00 CST 2016, time=2016-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=82626, encodeId=673582626c7, content=继续努力, beContent=null, objectType=article, channel=null, level=null, likeNumber=113, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Apr 24 22:35:00 CST 2016, time=2016-04-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=82627, encodeId=00b68262e91, content=继续努力, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Apr 24 22:35:00 CST 2016, time=2016-04-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=82622, encodeId=1f3a82622c9, content=继续努力, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Apr 24 22:34:00 CST 2016, time=2016-04-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=82625, encodeId=1c978262508, content=继续努力, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Apr 24 22:34:00 CST 2016, time=2016-04-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=82624, encodeId=f2b28262431, content=继续努力, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Apr 24 22:34:00 CST 2016, time=2016-04-24, status=1, ipAttribution=)]
    2016-04-26 juliusluan78

    #胰岛素敏感#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=157799, encodeId=b43815e799a9, content=学习中，很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/23/ac01daf0962458a9eb8c0b1e2f6ce5bc.jpg, createdBy=04b81710322, createdName=1771ae4158m, createdTime=Thu Nov 24 07:54:22 CST 2016, time=2016-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=144082, encodeId=4290144082b1, content=伟哥一药多用, beContent=null, objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20161012/IMG57FE37B9D8B7C2781.jpg, createdBy=05f31956923, createdName=1e128d2fm65(暂无匿称), createdTime=Tue Oct 11 11:40:11 CST 2016, time=2016-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=135594, encodeId=8ef8135594c6, content=伟哥还有这种作用，太有趣了, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cd381919282, createdName=1e0a2178m68(暂无匿称), createdTime=Mon Sep 26 21:15:02 CST 2016, time=2016-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1944963, encodeId=a40e1944963d4, content=<a href='/topic/show?id=b2fd838849c' target=_blank style='color:#2F92EE;'>#胰岛素敏感#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83884, encryptionId=b2fd838849c, topicName=胰岛素敏感)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e68e415, createdName=juliusluan78, createdTime=Tue Apr 26 13:00:00 CST 2016, time=2016-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1895851, encodeId=2498189585161, content=<a href='/topic/show?id=4a391158248' target=_blank style='color:#2F92EE;'>#MET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11582, encryptionId=4a391158248, topicName=MET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18fc139, createdName=一闲, createdTime=Tue Jun 21 05:00:00 CST 2016, time=2016-06-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=82626, encodeId=673582626c7, content=继续努力, beContent=null, objectType=article, channel=null, level=null, likeNumber=113, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Apr 24 22:35:00 CST 2016, time=2016-04-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=82627, encodeId=00b68262e91, content=继续努力, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Apr 24 22:35:00 CST 2016, time=2016-04-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=82622, encodeId=1f3a82622c9, content=继续努力, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Apr 24 22:34:00 CST 2016, time=2016-04-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=82625, encodeId=1c978262508, content=继续努力, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Apr 24 22:34:00 CST 2016, time=2016-04-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=82624, encodeId=f2b28262431, content=继续努力, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=45101626056, createdName=忠诚向上, createdTime=Sun Apr 24 22:34:00 CST 2016, time=2016-04-24, status=1, ipAttribution=)]
    2016-06-21 一闲

    #MET#

    0

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    2016-04-24 忠诚向上

    继续努力

    0

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    2016-04-24 忠诚向上

    继续努力

    0

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    2016-04-24 忠诚向上

    继续努力

    0

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    2016-04-24 忠诚向上

    继续努力

    0

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    2016-04-24 忠诚向上

    继续努力

    0

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