medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-10-10-21medsovet-6903Research ArticleСАХАРНЫЙ ДИАБЕТDIABETES MELLITUSПереосмысление роли пиоглитазона в современной диабетологии с позиции его кардиоренопротективных свойствRethinking the role of pioglitazone in modern diabetology as a cardiorenoprotective agenthttps://orcid.org/0000-0003-1851-0941СалуховВ. B.SalukhovV. V.

Салухов Владимир Владимирович, доктор медицинских наук, начальник 1-й кафедры и клиники (терапии усовершенствования врачей)

SPIN-код: 4531-6011

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6

 

Vladimir V. Salukhov, Dr. Sci. (Med.), Head of the 1st Department and Clinic (Advanced Therapy for Physicians)

6, Akademik Lebedev St., St Petersburg, 194044

vlasaluk@yandex.ruhttps://orcid.org/0000-0002-3784-8473КовалевскаяЕ. А.KovalevskayaE. A.

Ковалевская Елена Александровна, кандидат медицинских наук, старший преподаватель 1-й кафедры и клиники (терапии усовершенствования врачей)

SPIN-код: 6229-1315

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6

Elena A. Kovalevskaya, Cand. Sci. (Med.), Senior Lecturer of the 1st Department and Clinic (Advanced Therapy for Physicians)

6, Akademik Lebedev St., St Petersburg, 194044

fiil-elena@yandex.ruВоенно-медицинская академия имени С.М. КироваРоссияMilitary Medical Academy named after S.M. KirovRussian Federation2022180620220101021Copyright © Салухов В.B., Ковалевская Е.А., 20222022Салухов В.B., Ковалевская Е.А.Salukhov V.V., Kovalevskaya E.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6903

Тиазолидиндионы (ТЗД) представляют собой инсулиносенситайзеры – класс антидиабетических препаратов, которые, снижая инсулинорезистентность, убедительно улучшают гликемический контроль у пациентов с сахарным диабетом 2-го типа (СД2). Помимо сахароснижающего действия, представитель этого класса пиоглитазон в исследованиях демонстрирует дополнительные плейотропные эффекты, связанные со снижением артериального давления, уменьшением уровня провоспалительных цитокинов и протромботических факторов, коррекцией дислипидемии и улучшением состояния сосудистой стенки. В соответствии с этими антиатерогенными и метаболическими эффектами пиоглитазон у пациентов с подтвержденными сердечно-сосудистыми заболеваниями снижает частоту развития больших атеросклеротических событий в проспективных рандомизированных клинических исследованиях (PROactive и IRIS), а также в метаанализах других опубликованных исследований пиоглитазона. Пиоглитазон уменьшает альбуминурию и протеинурию, смертность от всех причин и сердечно-сосудистые события у пациентов с СД2 и хронической болезнью почек. В других исследованиях прием пиоглитазона оказался ассоциирован с мобилизацией жира из печени у больных неалкогольной жировой болезнью печени с улучшением ее функции и позитивным влиянием на фиброз. В настоящей статье также приведен анализ нежелательных явлений, которые были отмечены в ходе изучения пиоглитазона. Выявленные увеличение массы тела, отеки, переломы костей конечностей имеют редкую частоту встречаемости и дозозависимый характер. Действительно, при применении низких доз пиоглитазона (7,5–30 мг/сут) отношение «польза/риск» для препарата представляется чрезвычайно благоприятным. При этом польза от пиоглитазона со значимым улучшением сердечно-сосудистых и цереброваскулярных исходов выше при вторичной, чем при первичной профилактике у пациентов как с СД2, так и с предиабетом/инсулинорезистентностью, скорее всего, за счет позитивного воздействия на атеросклероз.

Thiazolidinediones are insulin sensitizers – a class of antidiabetic drugs that reducing insulin resistance, convincingly improve glycemic control in patients with type 2 diabetes. In addition to glucose-reducing action, a representative of this class – pioglitazone in studies demonstrates other pleiotropic effects associated with a decrease in blood pressure, a decrease in the level of pro-inflammatory cytokines and prothrombotic factors, correction of dyslipidemia and improving the state of the vascular wall. In accordance with these anti-atherogenic and metabolic effects of pioglitazone in patients with confirmed cardiovascular diseases, he reduced the frequency of development of large atherosclerotic events in prospective randomized clinical studies (studies of PROactive and IRIS), as well as in meta-analyses of all published studies of pioglitazone. Pioglitazone reduces albuminuria and proteinuria, mortality from all causes and cardiovascular events in patients with diabetes and chronic kidney disease. In other studies, the intake of pioglitazone was associated with mobilization of fat from liver in patients with non-alcoholic fatty liver disease with an improvement in its function and a positive effect on fibrosis. This article also provides an analysis of unwanted phenomena that were noted during the study of pioglitazone. The identified weight increase, swelling, bone fractures of the limbs, have a rare frequency of occurrence and dose-dependent nature. Indeed, when using low doses of pioglitazone (7.5–30 mg/day), the ratio of benefit/risk for the drug seems very favorable. At the same time, the benefits of pioglitazone with a significant improvement in cardiovascular and cerebrovascular outcomes are higher with secondary than with primary prevention in patients with both 2TDM and prediabetes/insulin resistance, most likely due to positive effects on atherosclerosis

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The authors declare that there are no conflicts of interest present.