阿司匹林联合阿托伐他汀对高血压病合并糖尿病伴早期肾损害患者动脉僵硬度的影响  

Influence of Aspirin Combined with Atorvastatin on Arterial Stiffness in Hypertensive Patients with Complicating Diabetes and Early Renal Damage

作　　者：张灵[1] 田国祥[2] 魏万林[1] 

机构地区：[1]北京军区总医院京西医院心内科,北京市100144 [2]北京军区总医院急诊科,北京市100125

出　　处：《中国动脉硬化杂志》2013年第8期745-750,共6页Chinese Journal of Arteriosclerosis

摘　　要：目的观察阿司匹林联合阿托伐他汀对高血压病合并糖尿病伴早期肾损害患者的动脉僵硬度的影响。方法 80例高血压病合并糖尿病伴早期肾损害患者,随机分为阿司匹林组(拜阿司匹林每天100 mg)、阿司匹林与阿托伐他汀联合治疗组(简称联合治疗组)(拜阿司匹林每天100 mg,阿托伐他汀每天20 mg),治疗前和治疗后20周分别测定血脂、尿白蛋白、β2微球蛋白、尿白蛋白排泄率(UAER)、心踝血管指数、踝臂指数。结果 (1)血脂:阿司匹林组、联合治疗组总胆固醇和低密度脂蛋白胆固醇水平均低于治疗前(P<0.05和P<0.01);20周后联合治疗组总胆固醇水平低于阿司匹林组(P<0.05)。(2)动脉僵硬度:阿司匹林组、联合治疗组治疗前与治疗后心踝血管指数(12.67±1.40比11.20±0.87,11.64±1.28比9.58±1.04)和踝臂指数(0.87±0.12比0.98±0.11,0.88±0.40比1.06±0.10)比较都有明显改善(均P<0.05);20周后联合治疗组与阿司匹林组相比,心踝血管指数和踝臂指数改善更明显(均P<0.05)。(3)尿微量蛋白:阿司匹林组尿白蛋白、β2微球蛋白、UAER治疗前后无明显差异,20周后联合治疗组的尿白蛋白、β2微球蛋白、UAER不仅与治疗前比较下降,而且与阿司匹林组治疗后比较也降低(分别为13.30±2.87 mg/L比15.70±3.73 mg/L,2.15±1.29 mg/L比3.13±0.38 mg/L,20.02±7.62μg/min比23.13±7.60μg/min,均P<0.05)。(4)多元线性回归分析显示,血压和血糖水平是影响动脉僵硬度和微量蛋白尿的因素。结论对于高血压病合并糖尿病伴早期肾损害患者,阿司匹林与阿托伐他汀合用可以降低尿微量蛋白,改善动脉僵硬度。动脉僵硬度和微量蛋白尿与血压及血糖水平相关。Aim To observe the influence of aspirin combined with atorvastatin on arterial stiffness in the hyper- tensive patients with complicating diabetes and early renal damage. Methods The hypertensive patients with compli- cating diabetes and early renal damage （n = 80） were randomly divided into the aspirin group （treated with 100 mg,/d ba- yaspirin） and combination group （treated with 100 mg/d bayaspirin and 20 mg/d atorvastatin）. The levels of blood lip- ids, urinary albumin, 132-microglobulin （f32-MG）, urinary albumin excretion rate （UAER）, cardio-ankle vascular index （CAVI） and ankle-brachial index （ABI） were detected before the treatment and 20 weeks after the treatment respectively. Results （1）Blood lipids： the levels of total cholesterol （TC） and low density lipoprotein cholesterol （LDLC） in two groups were lower than those before the treatment （P 〈 0. 05 and P 〈 0.01 ）. The TC level was lower in the combination group than that in the aspirin group （ P 〈 0. 05 ） after 20 weeks. （2） Arterial stiffness ： the indexes of CAVI （ 12. 67 ± 1.40 vs 11.20 ±0. 87, 11.64 ± 1.28 vs 9. 58 ± 1.04） increased and ABI （0. 87 ±0. 12 vs 0. 98 ±0. 11, 0. 88 ±0. 40 vs 1.06 ± 0. 10） in two groups were decreased significantly （ all P 〈 O. 05 ） after the treatment. After 20 weeks the index changes of CAVI and ABI were more significant （ all P 〈 0.05 ）. （3） Urine microprotein： the difference in the levels of u- rinary albumin, [32-MG and UAER was not statistically significant in the aspirin group, but decreased in the combination group with statistical significance after the treatment, and compared to the aspirin group after the treatment, the decrease of urine microprotein was statistically significant （ 13.30 ~2. 87 mg/L vs 15.70 ~3.73 mg/L, 2. 15 ± 1.29 mg/L vs 3.13 ~ O. 38 mg/L, 20.02 ~ 7. 62 ~g/min vs 23.13 ~ 7.60 ~g/min, all P 〈 O. 05 ）. （4） In multiple linear regression model, CAVI, ABI, UAER were all significantly associa

关 键 词：动脉僵硬度 阿司匹林 阿托伐他汀 尿微量蛋白 心踝血管指数 踝臂指数 

分 类 号：R5[医药卫生—内科学]