辛伐他汀对Ⅱ型糖尿病合并肾病葡萄糖代谢的研究

Research on the Effect of Simvastatin Treatment on the Glucose Metabolism of Type 2 Diabetes Patients with Nephrosis

目的:探讨辛伐他汀治疗对Ⅱ型糖尿病(T2DM)合并肾病患者糖代谢水平的影响。方法:选取新乡医学院第一附属医院60名T2DM合并肾病患者行辛伐他汀治疗3个月。比较治疗前后空腹血糖(FBG)、游离脂肪酸(FFA)、脂联素(ANP)、C肽、HOMA-IR、胰岛素/葡萄糖比率(IGR)、胰岛素敏感指数(ISI)、空腹胰岛素水平(FINS)、C反应蛋白(CRP)、糖基化血红蛋白(HbA1c)水平等变化,以评价辛伐他汀对T2DM病合并肾病患者的治疗效果。结果:在辛伐他汀治疗3个月后的葡萄糖耐量试验(OGTT)中,对比治疗前,各时点血糖水平均显著下降(P<0.05),而C肽与胰岛素在0 min和30 min时显著下降(P<0.05)。在辛伐他汀治疗后,HO-MA-IR、游离脂肪酸(FFA)、ISI、FINS、胰岛素AUC、血糖曲线下面积(AUC)、CRP、HbA1c、FBG与治疗前相比均显著下降(P<0.05),尿白蛋白排泄率(UAER)也明显下降(P<0.01),但是APN(P<0.01)以及C肽AUC(P<0.05)均显著上升,而校正胰岛素反应(CIR)及IGR无显著变化(P>0.05)。结论:辛伐他汀治疗可以改善胰岛素抵抗,提高患者对胰岛素的敏感性,并显著降低血糖,从而改善T2DM合并肾病患者的糖代谢。

Objective： To explore the effect of simvastatin treatments the glucose metabolism in type 2 diabetes patients with nephrosis.Methods： Totally 60 type 2 diabetes patients with nephrosis in First Affiliated Hospital of Xinxiang Medical College were treated with simvastatin for 3 months.Before and after treatment,the fasting blood glucose（FBG）,free fatty acid（FFA）,Adiponectin（APN）,C-peptide,homeostasis model assessment-insulin resistance（HOMA-IR）,insulin-to-glucose ratio（IGR）,insulin sensitive index（ISI）,fasting insulin（FINS）,glycosylated hemoglobin（HbA1c）,C-reactive protein（CRP）were detected and compared,to evaluate the therapy effect of simvastatin on type 2 diabetes patients with nephrosis.Results： In OGTT test at 3 months after simvastatin treatment,blood glucose at each time point significantly decreased in comparison with before treatment（P0.05）,while insulin and C-peptide at 0 min and 30 min significantly decereased in compar ison with before treatment（P0.05）.Compared with before treatment,HOMA-IR,FFA,ISI,FINS,the AUC of FBG and insulin,CRP,HbA1c,FBG,significantly decreased after simvastatin treatment（P0.05）,and UAER also decreased（P0.01）.However,the APN（P0.01） and the AUC of C-peptide（P0.05） notably increased,while no significant change of CIR and IGR was Observed（P0.05）.Conclusion： Simvastatin treatment can significantly lower blood giucose,increase insulin sensitivity of patient,modify insulin resistance and finally improve gulcose metabolism of type dibetic patients with nephrosis.