吉非罗齐对代谢综合征血脂及胰岛素抵抗的影响(英文)

Effect of Gemfibrozil therapy on lipids disorders and insulin resistance in patients with metabolic syndrome

目的观察吉非罗齐调脂效果及对代谢综合征患者胰岛素抵抗(IR)的影响;探讨血压或血脂变化与IR变化的关系。方法将60例代谢综合征(MS)患者按随机、对照、单盲方法分为尼群地平加吉非罗齐治疗组(n=40)和尼群地平加安慰剂对照组(n=20)。两组服尼群地平将血压控制到正常;同时分别服用吉非罗齐胶囊0.6 g,2次/d,或安慰剂2粒,2次/d,共12周。服药前后分别测定BMI,WHR,SBP,DBP,FBS,FINS,FFAs,TG,TC,LDL-C和HDL-C。研究各指标变化与IR变化的相关性。运用多因素逐步回归分析筛选对改善IR有显著贡献的变量。结果①12周后,在吉非罗齐治疗组中,与治疗前比较,SBP,DBP,FBS,FINS,TG,TC和FFAs显著降低(P<0.05),ISI显著增高(P<0.05);FINS,TG,TC,HDL-C,LDL-C,FFAs和ISI的变化值与安慰剂对照组各指标变化值比较具有显著差异性(P<0.05);②吉非罗齐治疗组ISI上升值与FFAs的下降值呈显著正相关(P<0.05,r=0.353,Y=166.804X+30.769);亦与TG的下降值显著正相关(P<0.05,r=0.329,Y=0.776X+0.67)。多因素逐步回归分析发现仅TG的降低对ISI的上升有显著贡献。结论尼群地平控制MS患者血压后并不能改善其IR状态;常规剂量的吉非罗齐可以有效地降低血TG,TC,LDL-C,FFAs,升高HDL-C,并可能通过降低TG及FFAs改善了MS患者的IR。

Objective: To study the effect of routine Gemfibrozil therapy on lipids disorders and insulin resistance in patients with MS and investigate the association between alterative free fatty acids (FFAs) and insulin resistance (IR). Methods: In the randomized, placebo-controlled and single blind study, 60 patients with MS were divided into two groups. 40 of them were treated for 12 weeks with 600 mg oral Gemfibrozil twice a day , 20 of them were treated for 12 weeks with 2 pills of placebo twice a day. Higher blood pressures in two groups were reduced to normal by oral Nitrendipine. Physical and biochemistric parameters were measured in the beginning and end of the therapy. Analysis of the association of each alterative parameter and IR was done. Factors contributed to improving IR were picked up with multivariate regression analysis. Results: ①Treated by Gemfibrozil and Nitrendipine for 12 weeks , some parameters (SBP, DBP, FBS, FINS, TG, TC, FFAs) significantly decreased, while ISI significantly increased;there were marked difference between alterations of some parameters(FINS, TG, TC, HDL-C, LDL-C, FFAs, ISI ) in the group treated by Gemfibrozil and those in the group treated by placebo. ②In the group treated by Gemfibrozil, there was a marked positive correlation between reduced value of FFAs or TGs and elevated value of ISI;reduced value of TGs treated by Gemfibrozil was the only factor contributed to improvement of ISI with multivariate regression analysis. Conclusions: ①IR could not be improved only by reducing higher blood pressure with oral Nitrendipine in patients with MS. ②Lipids disorders and IR in patients with MS could be improved by routine Gemfibrozil therapy. Maybe the improvement of IR is due to reduction of TG and FFAs.