非诺贝特对高甘油三酯血症患者胰岛素敏感性和血管内皮功能的影响

Effects of Fenofibrate on insulin sensitivity and endothelial function in primary hypertriglyceridemia patients

目的观察非诺贝特对高血脂症患者代谢参数、胰岛素敏感性和血管内皮功能的影响。方法原发高甘油三酯血症患者60例,每天予非诺贝特0.2g治疗,共12周。治疗前后分别测定甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、游离脂肪酸(FFA)、空腹血糖和胰岛素、尿酸(UA)以及血流介导的血管舒张(FMD)。结果!"非诺贝特可显著降低TG、TC、FFA和UA,升高HDL-C(所有P<0.01);#"非诺贝特改善胰岛素的敏感性,使胰岛素抵抗减轻6%(P<0.05);"$非诺贝特可明显改善血流介导的血管扩张(FMD)(P<0.01)。结论非诺贝特不但具有调节血脂作用,还具有胰岛素增敏作用和改善内皮功能作用。胰岛素敏感性的增加与HDL水平的升高、FFA水平的降低以及内皮功能的改善有关。

Objective To observe the effects of Fenofibrate on metabolic parameters and insulin sensitivity and endothelial function in primary hypertriglyceridemia patients. Methods 60 cases of patiens with new diagnosed primary hypertriglyceridemia were studied. Fenofibrate 200mg daily was administrated to patients for 12 weeks. Serum triglycerides, total cholesterol, HDL cholesterol, LDL cholesterol, free fatty acids, fasting glucose and insulin, uric acid were tested. Flow-mediated dilation was measured to evaluate endothelial function. Results ①Fenofibrate significantly decreased TG, TC, FFA and UA levels, and increased HDL-C level （all P〈0.01）. ②Fenofibrate increased insulin sensitivity by 6%（P〈0.05）. ③Fenofibrate significantly im- proved percent flow-mediated dilation response to hyperemia （P〈0.01）. Conclusion Fenofibrate not only regulates lipid metabolism, but also increases insulin sensitivity and improves endothelial function. Increase in insulin sensitivity is associated with elevated HDL-C level and decreased FFA level and improvement of endothelial function.