他汀类药物强化治疗对首诊冠心病的糖尿病患者血脂和动脉内皮功能的影响  

Effect of intensive statin on the lipids and arterial endothelial function in diabetic patients with initially diagnosed coronary heart disease

作　　者：郭雷生 丁守坤 韩跃刚 王丽霞 GUO Leisheng;DING Shoukun;HAN Yuegang;WANG Lixia(Department of Cardiovascular Disease,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院心血管综合科郑州大学人民医院,郑州450003

出　　处：《中华实用诊断与治疗杂志》2020年第6期631-634,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划项目(201602237)。

摘　　要：目的探讨首诊冠心病的2型糖尿病患者应用他汀类药物强化治疗对血脂、动脉内皮功能及粥样硬化斑块的影响。方法首诊冠心病的2型糖尿病患者60例,随机分为常规组和强化组各30例,常规组口服阿托伐他汀20 mg/d,强化组口服阿托伐他汀40 mg/d,连续治疗6个月。分别于治疗前及治疗6周、6个月检测血浆总胆固醇(total cholesterol,TC)、三酰甘油(triacylglycerol,TG)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)及一氧化氮水平;分别于治疗前及治疗6个月测定肱动脉内皮依赖性舒张功能,超声测定颈动脉斑块最大厚度、不稳定性斑块比率。结果强化组、常规组治疗6周、6个月血浆TC[强化组(2.94±0.61)、(2.88±0.72)mmol/L,常规组(3.31±0.65)、(3.27±0.63)mmol/L]、LDL-C[强化组(1.60±0.34)、(1.54±0.28)mmol/L,常规组(1.85±0.37)、(1.82±0.31)mmol/L]、TG[强化组(2.19±0.49)、(2.27±0.59)mmol/L,常规组(2.45±0.67)、(2.39±0.51)mmol/L]水平均低于治疗前[强化组(4.72±0.67)、(3.01±0.31)、(3.69±0.51)mmol/L,常规组(4.67±0.74)、(2.97±0.39)、(3.66±0.54)mmol/L](P<0.05),血浆HDL-C[强化组(1.26±0.22)、(1.28±0.23)mmol/L,常规组(1.21±0.24)、(1.20±0.17)mmol/L]水平均高于治疗前[(1.07±0.19)、(1.09±0.21)mmol/L](P<0.05),治疗6周与治疗6个月比较差异均无统计学意义(P>0.05);强化组治疗6周、6个月血浆TC、LDL-C、TG水平均低于常规组(P<0.05),血浆HDL-C水平与常规组比较差异无统计学意义(P>0.05)。强化组和常规组治疗6个月颈动脉不稳定性斑块比率[(31.29±19.54)%、(49.46±18.71)%]均低于治疗前[(75.97±16.31)%、(77.23±15.49)%](P<0.05),血浆一氧化氮水平[(84.42±17.20)、(71.19±16.64)μmol/L]、肱动脉内皮依赖性舒张功能[(7.94±0.76)%、(6.28±0.71)%]高于治疗前[(54.95±16.73)、(55.74±17.12)μmol/L,(4.31±0.69)%、(4.26±0.74)%](P<0.05),强化组高于常�Objective To investigate the effect of intensive statin on the lipids,arterial endothelial function and atherosclerotic plaques in type 2 diabetes mellitus patients with initially diagnosed coronary heart disease.Methods Sixty type 2 diabetes mellitus patients with initially diagnosed coronary heart disease were randomly divided into 30 patients receiving oral administration of 20 mg atorvastatin per day(standard group)and 30 patients receiving oral administration of 40 mg atorvastatin(intensive group)for 6 months.The plasma levels of total cholesterol(TC),triacylglycerol(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C)and nitric oxide were detected before as well as 6 weeks and 6 months after treatment.The blood flow-mediated dilation of the brachial artery,the maximum thickness and the stability of carotid atherosclerotic plaques were measured by ultrasound Doppler before and 6 months after treatment.Results The levels of TC(intensive group:(2.94±0.61),(2.88±0.72)mmol/L;standard group:(3.31±0.65),(3.27±0.63)mmol/L),LDL-C(intensive group:(1.60±0.34),(1.54±0.28)mmol/L;standard group:(1.85±0.37),(1.82±0.31)mmol/L),and TG(intensive group:(2.19±0.49),(2.27±0.59)mmol/L;standard group:(2.45±0.67),(2.39±0.51)mmol/L)in 6 weeks and 6 months after treatment were lower than those before treatment(intensive group:(4.72±0.67),(3.01±0.31),(3.69±0.51)mmol/L;standard group:(4.67±0.74),(2.97±0.39),(3.66±0.54)mmol/L),and the levels of HDL-C(intensive group:(1.26±0.22),(1.28±0.23)mmol/L;standard group:(1.21±0.24),(1.20±0.17)mmol/L)in 6 weeks and 6 months after treatment were higher than those before treatment((1.07±0.19),(1.09±0.21)mmol/L)(P<0.05),and all the above showed no significant differences in 6 weeks after treatment compared with those in 6 months after treatment(P>0.05).The levels of TC,LDL-C and TG in 6 weeks and 6 months after treatment were lower in intensive group than those in standard group(P<0.05),and HDL-C level showed no significant difference bet

关 键 词：冠心病 2型糖尿病 强化 动脉内皮功能 动脉粥样硬化斑块 

分 类 号：R541.4[医药卫生—心血管疾病] R587.1[医药卫生—内科学]