阿托伐他汀钙对高血压病患者餐后甘油三酯代谢异常及血管内皮功能的影响

Effect of Atorvastatinon Postprandial Serum Triglyceride Metabolism and Endothelial Function in Hypertensive Patients

目的阿托伐他汀钙(立普妥)对高血压病患者餐后甘油三酯代谢异常及血管内皮功能的影响。方法30例高血压病(Ⅰ级)患者并经标准脂肪负荷试验确定为餐后高甘油三酯症,采用高分辨率血管外彩超检测脂餐后4h肱动脉血流介导的内皮依赖性血管舒张功能(EDF),随后受试者随机分为立普妥治疗组和常规治疗组,常规治疗组服用双克25mgqd,而立普妥组在常规药物的基础上加服立普妥20mgqn。治疗4周后重复标准脂肪负荷试验和脂餐后4h肱动脉血流介导的内皮依赖性血管舒张功能。结果治疗前两组脂肪餐后EDF均较空腹明显下降(立普妥治疗组:13.89%±3.28%比9.88%±3.53%,P<0.05;常规治疗组:14.37%±3.51%比10.11%±3.62%,P<0.05),但两组间TGAUC,TGPR无显著性差别。治疗4周后两组血压均较治疗前有显著下降,立普妥组餐后TGAUC,TGPR较治疗前显著下降[TGAUC:(18.84±6.81比10.12±5.38)mmol/L,P<0.05;TGPR:(3.96±1.78比2.16±1.06)mmol/L,P<0.05],其餐前和餐后EDF较治疗前有明显改善(空腹:13.89%±3.28%比17.96%±3.87%,P<0.05,脂餐后4h:9.88%±3.53%比16.67%±3.35%,P<0.05),且空腹EDF和餐后EDF无显著差异。常规治疗组餐后TGAUC、TGPR、空腹EDF较治疗前无明显改善,餐后EDF虽有所改善,但仍较空腹受损(14.86%±2.75%比11.42%±2.65%,P<0.05)。相关分析显示餐后EDF下降值、SBP、DBP与餐后TGAUC,TGPR呈正相关(TGAUC:相关系数r分别为0.35,0.32,0.25,P<0.05;TGPR:相关系数r分别为0.34,0.31,0.21,P<0.05)。结论立普妥降脂治疗能显著改善高血压病患者餐后甘油三酯代谢及血管内皮功能。

Objective To investigate effect of atorvastatinon postprandial abnormal serum triglyceride metabolismand endothelial function in hypertensive patients(HT). Methods Thirty hypertensive patients with abnormal triglyceride metabolism after a standardized fat loading were recruited. Endothlium-dependant flowing-mediated dilation(EDF) was assessed by doppler flow in the brachial artery before and 4 hours after fat loading. Patients were randomly divided into conventional group and atorvastatingroup (20 mg per night for 4 weeks). After treatment, the standardized fatmeal test and endothelial function examination were repeated. Results The postprandial EDF in two groups were impaired significantly at 4 hours (P<0.05). There were no difference in TG-AUC and TGPR between conventional group and atorvastatingroup. After 4 weeks the blood pressure in both groups significantly were decreased. The TG-AUC, TGPR, fasting EDF and postprandial EDF in atorvastatingroup was improved obviously [TG-AUC: (18.84±6.81 vs 10.12±5.38)mmol/L, P < 0.05; TGPR: (3.96±1.78 vs 2.16±1.06)mmol/L, P < 0.05; fasting EDF: 3.89%±3.28% vs 17.96%±3.87%,P<0.05; postprandial EDF: 9.88%±3.53%vs 16.67%±3.35%,P<0.05)]. No difference between fasting EDF and postprandial EDF in atorvastatin group was shown. On contrary, no significant change in the TG-AUC,TGPR, fasting EDF was found in conventional group after 4 weeks conventional treatment, and the postprandial EDF was even obviously aggravated after 4 weeks. Correlation analysis showed SBP, DBP and the changes of fasting EDF were correlated with TG-AUC and TGPR (P<0.05). Conclusion Atorvastatinlipid-modulating therapy can effectively improve serum triglyceride metabolismand endothelial function in hypertensive patients.