阿托伐他汀10mg与辛伐他汀20mg对2型糖尿病合并血脂异常的藏族患者降脂疗效及炎性指标比较

Comparison of the effects of atorvastatin 10 mg or simvastatin 20 mg on serum lipids and inflammatory index in Tibetan type 2 diabetic patients with dyslipidemias

目的评价阿托伐他汀10mg和辛伐他汀20mg对2型糖尿病合并血脂异常的藏族患者降脂疗效和对血清高敏C反应蛋白（hs—CRP）的影响。方法选择2型糖尿病合并血脂异常的藏族患者70例，按随机数字表法分为阿托伐他汀10mg组和辛伐他汀20mg组，每组35例。治疗前和治疗后4周分别测定总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、三酰甘油（TG）、载脂蛋白B（ApoB）、白细胞（WBC）计数、空腹血糖（FBG）和hs-CRP水平，并观察两组的不良反应。结果治疗后4周，两组TC、LDL-C、ApoB均较治疗前显著下降（P〈0．01）。阿托伐他汀10mg组治疗后4周TG水平较治疗前显著降低[（1．39±0．63）mmol／L比（1．95±1．62）mmol／L，P〈0．05]，而辛伐他汀20mg组治疗后4周TG水平有下降趋势但差异无统计学意义[（1．72±0．32）mmol／L比（1．93±0．83）mmol／L，P〉0．05]。两组治疗后hs—CRP水平均较治疗前显著降低，阿托伐他汀10mg组hs—CRP水平降低幅度大于辛伐他汀20mg组（40．51％比35．34％），差异有统计学意义（P〈0．05）。逐步回归分析表明，hs—CRP水平的降低独立于降脂效果，仅与他汀种类相关（标准化回归系数=-0．384，P=0．022）。结论辛伐他汀20mg对于血清Tc和LDL-C水平的降低作用与阿托伐他汀10mg相当，两种他汀类药物均可降低藏族2型糖尿病患者hs-CRP水平，阿托伐他汀疗效略优于辛伐他汀。

Objective To evaluate the effects of atorvastatin 10 mg or simvastatin 20 mg on serum lipids and high sensitive C-reactive protein （hs-CRP） in Tibetan type 2 diabetic patients with dyslipidemias. Methods Seventy Tibetan type 2 diabetic patients with dyslipidemias were divided into two groups by random number table： atorvastatin 10 mg group（ 35 cases, treated with atorvastatin 10 mg/d ） and simvastatin 20 rag group （35 cases, treated with simvastatin 20 mg/d）. Before and 4 weeks after treatment, total cholesterol （TC）, low density tipoprotein cholesterol （LDL-C）, high density lipoprotein cholesterol （HDL-C）, triglyceride （TG）, apolipoprotein B （ApoB）, white blood cell （WBC） count, fasting blood glucose （FBG） and hs-CRP were measured and adverse reactions were observed. Results After treatment for 4 weeks, the levels of TC, LDL-C and ApoB were significandy decreased in two groups （P 〈 0.01 ）, and the level of TG was significantly decreased in atorvastatin 10 mg group [ （ 1.39 ±0.63 ） mmol/L vs. （ 1.95 ± 1.62 ） mmol/L, P 〈 0.05 ], but was not significantly decreased in simvastatin 20 mg group [ （ 1.72 ± 0.32 ） mmol/L vs. （ 1.93 ± 0.83 ） mmol/L, P 〉 0.05 ]. The level of hs-CRP was significantly decreased in two groups （P 〈 0.05 ）, and the decreased range in atorvastatin 10 mg group was higher than that in simvastatin 20 mg group （40.51% vs. 35.34%,P 〈 0.05）. Stepwise regression analysis showed that the decreased hs-CRP was independent of reduced serum lipids and had relationship with the kinds of statins （B = -0.384, P = 0.022）. Conclusions The effects of simvastatin on serum TC, LDL-C are the same as atorvastatin. Both have significant anti-inflammatory effects, while the degree of hs-CRP reducing by atorvastatin 10 mg is higher than that by simvastatin 20 mg in Tibetan type 2 diabetes.