阿托伐他汀对2型糖尿病患者大血管病变的影响及机制

The Effect of Atorvastatin on Macroangiopathy in Patients with Type 2 Diabetes Mellitus and Possible Mechanism

目的观察阿托伐他汀对2型糖尿病患者大血管病变的保护作用,并初步探讨可能的机制。方法收集120例2型糖尿病患者,随机分为常规治疗组和阿托伐他汀治疗组,随访6个月,检测治疗前后血管内皮依赖性舒张功能和颈动脉内膜-中层厚度,同时检测血浆中一氧化氮、血管假性血友病因子、单核细胞趋化蛋白1水平。结果治疗6个月后常规治疗组和阿托伐他汀治疗组的血糖、血压均控制良好。虽然常规治疗组对血管内皮依赖性舒张功能、一氧化氮和血管假性血友病因子有一定的改善作用(P<0.05),但对血脂、单核细胞趋化蛋白1水平和颈动脉内膜-中层厚度没有明显改善(P>0.05)。与常规治疗组相比,阿托伐他汀治疗组对血管内皮的改善作用更为明显。只有阿托伐他汀治疗组血浆中单核细胞趋化蛋白1水平明显降低,颈动脉内膜-中层厚度有所减退(P<0.05)。结论阿托伐他汀能保护2型糖尿病患者大血管病变的发生,其机制可能与降低血脂、抑制血管炎症反应和强效的血管内皮保护作用有关。

Ahn To determine the effect of atorvastatin on macroangiopathy in patients with type 2 diabetes mellitus （DM） and further to explore the possible mechanism. Methods 120 patients with DM were enrolled in the present study and randomly divided into routine treatment group and atorvastatin treatment group. Flow-mediated dilation （ FMD） and intima-medial thickness （ IMT） was measured before treatment and after 6-month treatment. The levels of plasma monocyte chemoattractant protein-1 （ MCP-1）, nitric oxide （NO）, and vonwillebrand factor （vWF） were also determined. Results After 6 months therapy, the levels of blood glucose and blood pressure were well controlled in two groups. FMD and the levels of NO and vWF were also improved in both groups. However, compared with routine treatment group, endothelial function was more significantly improved by treatment with atorvastatin （P 〈 0.05 ）. Atorvastatin treatment controlled blood hpid, attenuated the levels of MCP-1 and the progress of IMT （ P 〈 0.05）, but routine treatment had no effect. Conclusion Atorvastatin may induce a markedly protective effect on the macroangiopathy of DM, which may be related to regulating blood lipids, protecting vascular endothelium and inhibiting vascular inflammation.