辛伐他汀对2型糖尿病患者血管内皮功能及炎症因子的影响

The effects of simvastatin therapy on endothelial function and inflammatory factor in type 2 diabetes mellitus without cardiovascular disease

目的观察辛伐他汀对2型糖尿病患者血管内皮功能及炎症因子的影响。方法选择30例2型糖尿病(T2DM)患者及25例对照者,给予辛伐他汀20mg/d治疗12个月。分别于治疗前、治疗1个月及12个月时,检测肱动脉血流介导性扩张,并测定主要血脂参数、超敏C反应蛋白(hsCRP)、空腹血糖(FPG)、胰岛素(FIns)和胰岛素抵抗指数(HOMA-IR)。结果①辛伐他汀治疗可明显改善T2DM组及对照组患者血脂水平。②辛伐他汀治疗1个月后,T2DM组患者肱动脉内皮依赖性舒张功能(FMD)较治疗前无明显变化[(5.94±0.87)%vs.(5.65±0.65)%,P﹥0.05],治疗12个月后,FMD虽有上升趋势[(6.10±0.71)%],但仍无显著性差异。辛伐他汀可明显改善对照组的FMD。③治疗12个月时T2DM组患者血清hs-CRP水平由(15.21±3.71)mg/L降至(10.51±2.90)mg/L(P﹤0.01)。④辛伐他汀对T2DM患者FPG、FIns及HOMA-IR均无影响。结论辛伐他汀治疗12个月,尽管可以显著降低T2DM患者血脂水平,减轻炎症反应,但受损的血管内皮功能并未得到改善。

Objective To investigate the effects of simvastatin on vascular endothelial function and hypersensitivity C-reactive protein （hs-CRP） in patients with type 2 diabetes mellitus （T2DM）. Methods A total of 32 T2DM patients and 25 control subjects received the treatment of 20 mg/d simvastatin for 12 months. Endothelial dependent flow-mediated vasodilation （FMD） was assessed at baseline, after 1 month and 12 months of simvastatin therapy. Serum lipid profiles, hs-CRP, fasting glucose （FPG）, fasting insulin （Fins） and homeostasis model assessment-insulin resistance （HOMA-IR） were measured simultaneously. Results①Simvastatin significantly improved serum lipid disorders in patients with T2DM.②Compared with baseline level, there was no change of FMD in pateints with T2DM after one month simvastatin treatment. Furthermore, no significant increase of FMD was found after 12-month simvastatin treatment [（5.65±0.65）% vs. （6.10±0.71）%, P 〉 0.05]. In contrast, simvastatin treatment caused a significant improvement of FMD in control subjects.③A significant reduction of hs-CRP level was observed in patients with T2DM after 12-month treatment.④Simvastatin had no effect on FPG, Fins and HOMA-IR in both groups. Conclusions Despite of substantial lowering of lipid parameters and inflammatory marker after 12-month simvastatin therapy, no improvement of endothelium-dependdnt vasodilation is found in T2DM.