冠心病患者降脂治疗对血浆内皮素及胰岛素抵抗的影响

Effects of Lipid Lowering Therapy on Plasma Endothelin and Insulin Resistance in Patients With Coronary Heart Disease

目的：探讨冠心病患者在降脂治疗的同时对血浆内皮素及胰岛素抵抗的影响。方法：测定７０例冠心病患者（冠心病组，血清总胆固醇≥５．２ｍｍｏｌ／Ｌ）降脂治疗（辛伐他汀，５ｍｇ／ｄ，疗程４周）前后及３０例健康人（正常对照组）血脂、血浆内皮素、空腹血糖、胰岛素及计算胰岛素敏感性变化。测定冠心病组降脂治疗前后、糖耐量试验前后血糖及胰岛素水平，并计算曲线下面积。分别分析血清总胆固醇与血糖、血浆内皮素、胰岛素及其曲线下面积的相关性；血浆内皮素与胰岛素及其曲线下面积的相关性。结果：①冠心病组用辛伐他汀降脂疗效肯定。②血浆内皮素在冠心病组显著高于正常对照组，冠心病组降脂治疗后比治疗前血浆内皮素下降３０％。③冠心病组胰岛素敏感性指数显著低于正常对照组（Ｐ＜０．０１）。冠心病组空腹及糖负荷后血胰岛素水平，血胰岛素／葡萄糖及各曲线下面积在治疗后均有下降（Ｐ＜０．０５），胰岛素敏感性指数上升。④冠心病组血清总胆固醇分别与血浆内皮素，服糖后６０分钟、１２０分钟胰岛素及胰岛素曲线下面积呈正相关（ｒ分别为０．３８，０．３６，０．３２，０．３４，Ｐ均＜０．０５）；血浆内皮素分别与服糖后６０分钟、１２０分钟胰岛素及胰岛素曲线下面积呈显著正相关（ｒ?

Objective:In order to clarify the effects of lipid lowering therapy on plasma endothelin and insulin resistance in patients with coronary heart disease(CHD). Methods:Fasting serum lipids,glucose and insulin and plasma endothelin were measured and insulin sensitivity index(ISI) was calculated in 30 healthy subjects and 70 non diabetic patients with CHD before and after 4 weeks of simvastatin treament (5mg/d).Serum glucose and insulin were measured during oral glucose tolerance test (OGTT) in patient group. The areas under the glucose tolerance curve and insulin releasing curve were also calculated. Results:①After simvastatin treament,serum TC,TG,LDL C and Apo B were lower and HDL C,Apo AⅠ were higher than those before.②Plasma endothelin in patients with CHD was obviously higher than in normal subjects.After treament,endothelin in patients with CHD decreased by 30%.③ISI in patients with CHD was obviously lower than in normal subjects( p <0 01).After simvastatin administration,insulin,insulin/glucose(I/G) ratio and the areas under the curve for insulin and I/G( I, I/G )during OGTT were significantly reduced ( p <0 05).ISI was remarkably increased after treament.④In patient group,serum TC was positively correlated with plasma endothelin(ET) and insulin level at 60min,120min after loading and the area under the curve for insulin ( r =0 38,0 36,0 32,0 34,respectively,all p <0 05);ET was positively correlated with insulin level at 60min,120min after loading and the area under the curve for insulin( r =0 43,0 44,0 46,respectively,all p <0 01). Conclusion:The results suggest that lipid lowering therapy has beneficial effects on lowering plasma ET and improving insulin resistance(IR).The interaction between serum lipids and ET and IR might be involved in the development of CHD.