国产苯扎贝特对高三酰甘油血症脂代谢及糖代谢影响的研究

The effects of homemade Bezafibrate on abnormal metabolism of glucose and lipid in patients with high serum triglycerides level.

目的研究国产苯扎贝特与非诺贝特对中老年高三酰甘油(TG)血症患者脂代谢及糖代谢的影响。方法收集2006年5月至2007年7月在解放军总医院门诊、住院142例患者,随机入选苯扎贝特组(苯组)、非诺贝特组(非组)和空白对照组(对照组),分别接受每日600 mg苯扎贝特、300 mg非诺贝特或作为空白对照,疗程3个月。对比各组治疗前后及3组间脂代谢指标:总胆固醇(TC),低密度脂蛋白胆固醇(LDL-C),高密度脂蛋白胆固醇(HDL-C),TG;糖代谢指标:空腹血糖(FBG),餐后2 h血糖(2 h PBG),空腹胰岛素(F-INS);胰岛素抵抗指数(IRI);糖耐量异常发病率(IGTR)的变化。结果脂代谢:治疗后,苯组、非组的TC、LDL-C、TG均显著降低,HDL升高(P均<0.01)。治疗后3组间比较,苯组TC、LDL-C、TG均低于对照组(P<0.05,P<0.01,P<0.01),HDL-C高于对照组(P<0.05);非组LDL-C、TG低于对照组(P<0.05,P<0.01),TC差异无统计学意义(P>0.05),HDL-C高于对照组(P<0.05)。两治疗组比较,各项血脂指标差异均无统计学意义(P>0.05)。糖代谢:治疗后,苯组、非组、对照组IGTR下降62.1%(P<0.05),20.0%(P>0.05),0(P>0.05);治疗后3组IGTR存在差异(P<0.05),苯组显著低于对照组和非组(P<0.025)。治疗后,苯组FBG无显著变化(P>0.05),2 h PBG、F-INS、IRI均下降(P<0.01);非组FBG无显著变化(P>0.05),2 h PBG、F-INS、IRI均降低(P<0.05)。治疗后3组间比较,FBG差异无统计学意义(P>0.05);苯组2 h PBG、F-INS、IRI均低于对照组(P<0.01);非组F-INS、IRI低于对照组(P<0.05),2 h PBG虽低于对照组,但差异无统计学意义(P>0.05);治疗后的两药物组比较,苯组2 h PBG、F-INS、IRI均低于非组,2 h PBG、F-INS的差异具有统计学意义(P<0.05),IRI差异无统计学意义(P>0.05)。结论国产苯扎贝特和非诺贝特不仅具有肯定的、相似的调脂作用,而且还具有不同程度改善糖代谢的作用,其中,国产苯扎贝特的作用更显著。

Objective To estimate effects of bezafibrate and fenofibrate on metabolisms of lipid and glucose among middle or old age patients with high serum TG. Methods Randomly, middle or old age 142 patients with high serum TG were designed to bezufibrate （ Beza ） grou p, fenofibrate （Feno） group or black control （ Cont ） group, accepting therapy with bezafibrate 600 mg, fenofibrate 300 mg or black control each day respectively for three months. The parameters reflecting lipid or glucose,just as cholesterol （ TC ）, low density lipoprotein cholesterol （ LDL-C ）, high density lipoprotein cholesterol （ HDL-C）, last blood glucose （FBG） ,2 hours postpradial blood glucose （ 2 h PBG）, fast insulin （ F-INS）, insulin resistant index（IRI） and morbidity of Impaired Glucose Tolerance（IGT） were compared between pre and post theray in each group and among three groups. Results Lipid ： TC, LDL-C,TG levels all decreased（ all P 〈 0.01 ） and HDL-C increased（ Both P 〈 0. 01 ）markedly after therapy both in Beza group and Feno group. Among three groups after therapy, TC, LDL-C and TG levels in Beza group were lower but HDL-C was higher than Cont group（P 〈0. 05,P 〈0. 01 ,P 〈0. 01 ,P 〈0. 05）. However,in Feno group, LDL-C and TG levels were lower but HDL-C level was higher than Cont group （P 〈 0.05, P 〈 0. 01, P 〈 0.05）, the TC difference was not significant （ P 〉 0. 05 ）. There were not remarkable differents of TC, LDL-C, HDL and TG levels between Beza and Feno groups （ all P 〉 0.05 ）. Glucose： IGTR deceased 62. 1% （ P 〈 0.05 ）, 20.0% （ P 〉 0.05 ） ,0（P 〉 0.05） in Beza, Feno and Cont group, respectively. The difference of IGTR among three groups was signifi- cant（P 〈0. 05） ,IGTR in Beza group lower than thar in Feno combined with Cont group（P 〈0.05） o Compare with pretreatment, FBG in Beza or Feno group were both unchanged （both P 〉 0.05 ） ,2 h PBG, F-INS and IRI all dereased in Be- za gruop （ all P 〈 0.01 ） and in Feno group （ P 〈 0. 05, P 〈 0. 01, P 〈 0. 01 ） o After treatmet, the differences of FBG among three groups were not significant（ all P 〉 0. 05 ）. Compared with Cont group,2 h PBG, F-INS and IRI were lower in Beza gruop（P 〈0. 0. ,P 〈0. 01 ,P 〈0. 01 ）,F-INS,IRI were lower in Feno group（ P 〈0.01 ,P 〈0. 05）,but the reduction of 2 h PBG was not marked （ P 〉 0.05 ）. The 2 h PBG, F-INS, IRI and IGTR in Beza group were all lower than those in Feno group, but the difference of 2 h PBG F-INS, IGTR was significantly （ Both P 〈 0.05）. Conclusion Bezafibrate and fenofibrate not only have the reliable and similar effects on regulation of lipids, but have different level effects on improvement of glucose metabolism parameters, including IRI, Esp 2 h PBG, F-INS, IGTR. The effects of bezafibrate is stranger than those of fenofibrate.