瑞苏伐他汀与阿托伐他汀对2型糖尿病并发冠心病患者血管内皮功能的影响

The effect of atorvastatin and rosuvastatin on endothelial function in diabetics with coronary heart disease

目的观察2型糖尿病并发冠心病患者给予瑞苏伐他汀和阿托伐他汀治疗后血管内皮功能的变化。方法收集2008年1-4月门诊及病房临床确诊为2型糖尿病并发冠心病患者73例，随机给予瑞苏伐他汀（10mg／d）或阿托伐他汀（20mg／d），分别测定用药前及用药3个月后血脂、血清超敏C反应蛋白（high-sensitivity C-reactive protein，hs-CRP）、一氧化氮（NO）、内皮素（ET-1）及内皮依赖性血流介导的血管舒张功能（EDF）。结果用药后3个月后，瑞苏伐他汀组和阿托伐他汀组EDF水平增加[（5．2±2．4）％至（7．9±3．1）％和（5．0±2．8）％至（7．6±3．6）％，p=0．008和0．024]，NO水平增加[（46．6±14．5）pmmol／L至（73．3±18．5）“mmol／I，和（51．7±14．0）μmmol／L至（79．8±16．0）μmmol／L，均为P〈0．001]，ET-1水平下降[（108．2±29．6）Pg／L至（77．5±26．4）Pg／L和（117．1±34．5）Pg／L至（80．7±28．2）pg／L，P=0．005和0．003]，hsCRP水平下降[3．17（1．33～6．32）mg／L至1．39（0．81～2．58）mg／L和3．43（1．51～7．02）mg／L至1．63（0．69～3．11）mg／L，P=0．006和0．001]；但两组间进行比较，差异无统计学意义；血管舒张功能与hs-CRP呈负相关。结论瑞苏伐他汀和阿托伐他汀均可降低hs-CRP，减轻血管内局部炎症反应，改善2型糖尿病并发冠心病患者的血管舒张功能。

Objective To investigate the effect of atorvastatin and rosuvastatin on endothelial function in diabetics with coronary heart disease. Methods A total of 73 consecutive diabetics with coronary heart disease who were not receiving statins were randomized to receive atorvastatin 20 mg/d or rosuvastatin 10 mg/d. The levels of lipids, high sensitivity C reactive protein（hs CRP）, monoxide nitrogen（NO）, endothelin-1 （ET-1） and endothelium-dependent relaxing function（EDF） were assessed before and after 3 months of the treatment. Results The treatment with statins significantly improved endothelial function in diabetics with coronary heart disease. For both rosuvastatin group and atorvastatin group in pre-treatment versus post treatment, EDF was higher（（5.2 ± 2.4）% vs. （7.9±3.1）%, P=0.008; （5.0±2.8）% vs. （7.6±3.6）%, P=0.024, respectively], NO was also higher[（46.6 ±14.5） /μmmol/L vs. （73.3 ＋ 18.5 ）μmmol/L; （51.7 ± 14.0 ） μmmol/L vs. （79.8 ＋ 16.0） μmmol/L,bothP〈0.001], ET-1 waslower（（108.2±29.6） pg/L vs. （77.5±26.4） pg/L, P =0.005;（117.1＋34.5） pg/L vs. （80.7＋28.2） pg/L,P=0.003, respectiveIy）,and hs-CRP was lower[3.17（1.33±6.32） mg/L vs. 1.39（0.81～2.58） mg/L, P=0.006; 3.43（1.51～7.02） mg/L vs. 1. 63（0.69～3. 11） mg/L,P 0. 001, respectively]. There were no differences in these between rosuvastatin group and atorvastatin group. Significant negative correlation existed between EDF and hs-CRP. Conclusions A 3 months treatment with either atorvastatin 20 mg/d or rosuvastatin 10 mg/d is effective in improving endothelial funelion in diabetics with coronary heart disease.