摘要
目的探讨瑞舒伐他汀对代谢综合征(Ms)患者的干预作用及其安全性。方法将80例MS患者随机分为两组,瑞舒伐他汀组(40例)给予瑞舒伐他汀10mg/d口服;阿托伐他汀组(40例)给予阿托伐他汀10mVd口眼。随访12周,主要观察指标:载脂蛋白B/载脂蛋白A1(ApoB/ApoAl)比值及炎症因子超敏C反应蛋白(hs.CRP)、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、白细胞介素18(IL-18),次要观察指标:血脂、血糖、空腹胰岛素(FIN)、胰岛素抵抗指数(HOMA.IR)、血压、尿白蛋白排泄率(UAER)、体质量指数(BMI),安全性指标:肝肾功能、肌酸激酶(CK)。比较两组患者治疗前、后及两组治疗后各指标的差异。结果(1)与治疗前比较,治疗12周后两组患者ApoB/ApoAl、hs—CRP、TNF-α、IL-6、IL-18及ApoB、总胆固醇(Tc)、低密度脂蛋白胆固醇(LDL—C)、甘油三酯(TG)、FIN、HOMA—IR、收缩压(SBP)、舒张压(DBP)、UAER均显著下降[瑞舒伐他汀组分别为:1.26±0.25降至0.63±0.22,t=4.44;(6.89±1.43)mg/L降至(2.41±0.36)mg/L,t=7.12;(27.63±7.12)ng/L降至(12.98±3.74)ng/L,t=4.23;(26.47±6.59)ng/L降至(13.16±3.55)ng/L,t=4.45;(318.36±90.45)ng/L降至(172.77±50.65)ng/L,t=3.92;(1.58±0.29)g/L降至(0.83±0.23)g/L,t=4.20;(5.78±0.86)mmol/L降至(3.53±0.69)mmol/L,t=3.85;(3.52±0.54)mmoL/L降至(2.04±0.49)mmol/L,t=3.89;(2.87±0.65)mmol/L降至(1.91±0.57)mmoL/L,t=3.78;(12.08±2.87)mU/L降至(6.87±1.89)mU/L,t=3.98;3.42±0.57降至1.60±0.31,t=4.65;(144.6±13.3)mmHg降至(135.1±12.7)mmHg,t=3.57;(93.6±9.5)mmHg降至(85.2±7.6)mmHg,t=3.59;(29.86±3.37)μg/min降至(22,52±2.56)Ixg/min,t=3.71;阿托伐他汀组:1.24±0.23降至0.92±0.24,t=3.74;(6.84±1.37)mg/L降至(3.50±0.75)mg/L,t=4.24;(27.22±7.36)ng/L降至(18.70±5.82)ng/L,t=3.76;(26.28±6.84)ng/L降至(19.34±5.96)n#L,t=3.75;(311.22±91.98)n#L降至(246.50±74.73)ng/L,t=3.63;(1.56±0.27)g/L降至(1.14±0.26)g/L,t=3.74;(5.65±0.76)mmol/L降至(4.67±0.65)mmol/L,t=3.68;(3.51±0.55)mmol/L降至(2.65±0.57)mmol/L,t=3.70;(2.86±0.68)mmol/L降至(2.05±0.54)mmol/L,t=3.78;(12.04±2.95)mU/L降至(8.91±2.32)mU/L,t=3.74;3.38±0.54降至2.18±0.35,t=3.80;(144.0±13.8)mmHg降至(135.7±12.5)mmHg,t=3.56;(93.4±9.3)miD-Hg降至(85.8±8.9)mmHg,t=3.58;(29.77±3.28)μg/min降至(23.02±2.83)μg/min,t=3.67;P均〈0.01];ApoAl、高密度脂蛋白胆固醇(HDL—C)有所升高,但差异均无统计学意义(尸均〉0.05);空腹血糖(FPG)、餐后2h血糖(2hPG)、BMI有下降趋势,但差异均无统计学意义(P均〉0.05)。(2)治疗12周后,瑞舒伐他汀组的ApoB/ApoAl、hs-CRP、TNF—α、IL-6、IL-18及ApoB、TC、LDL—C、FIN、HOMA.IR与阿托伐他汀组相比明显降低(t值分别为2.11、2.10、2.09、2.12、2.08、2.07、2.05、2.04、2.04、2.06,P均〈0.05);瑞舒伐他汀组的HDL-C、ApoAl与阿托伐他汀组相比有增高趋势,但差异均无统计学意义(P均〉0.05);两组对TG的改善差异均无统计学意义(P均〉0.05);两组对SBP、DBP、UAER的改善亦无统计学意义(P均〉0.05)。(3)瑞舒伐他汀组不良反应少,安全性好。结论瑞舒伐他汀可降低MS患者ApoB/ApoAl比值和炎症因子水平,改善胰岛素抵抗,其安全性良好。
Objective To investigate the efficacy of rosuvastatin on treating patients with metabolic syndrome (MS). Methods Eighty MS patients were divided into rosuvastatin group (n = 40 ) and atorvastatin group(n = 40)i Patients in rosuvastatin group were received schufftan at dose of 10 mg/d and in atorvastatin group were received lipitor at dose of 10 mg/d orally. Patients were followed-up for 12 weeks. The ratio of apolipoprotein B/apolipopmtein A1 ( ApoB/ApoA1 ) and inflammatory factors including high-sensitivity C- reactive protein ( hs-CRP), tumor necrosis factor-or ( TNF-ct), interleukin-6 ( IL-6 ), and intedeukin -18 ( IL-18 ) were measured. Meanwhile Secondary factors:blood lipids, blood glucose, fasting insulin(FIN) , insulin resistance index ( HOMA-IR), blood pressure, urine albumin excretion rate ( UAER ), body mass index ( BMI ). As well as safety indicators : hepatic and renal function and ereatine kinase (CK) were detected. Results ( 1 ) After 12- week's treatment, the serum levels of ApoB/ApoA1, hs-CRP, TNF-α, IL-6, IL-18, ApoB, total cholesterol ( TC ), low-density lipoprotein cholesterol ( LDL-C ), triglyceride ( TG), FIN, HOMA-IR, systolic blood pressure ( SBP), diastolic blood pressure (DBP), and UAER significantly decreased compared to before treatment in the two groups ( rosuvastatin group: 1.26 ±0. 25 vs. 0. 63 ± 0. 22, t = 4.44 ; ( 6. 89 ± 1.43 ) mg/L vs. ( 2. 41 ± 0. 36 ) mg/L,t =7.12;(27.63 ±7. 12) ng/L vs. (12.98 ±3.74) ng/L,t =4. 23;(26. 47 ±6.59) ng/L vs. (13.16 ±3.55 ) ng/L, t = 4. 45 ; ( 318.36± 90. 45 ) ng/L vs. ( 172.77 ± 50. 65 ) ng/L, t = 3.92 ; ( 1.58± 0. 29 ) g/L vs. (0. 83± 0. 23 ) g/L, t = 4. 20 ; ( 5. 78± 0. 86 ) mmol/L vs. ( 3.53 ± 0. 69 ) mmol/L, t = 3.85 ; ( 3.52 ± 0. 54 ) mmol/L vs. ( 2. 04± 0. 49 ) mmol/L, t = 3.89 ; ( 2. 87 ± 0. 65 ) mmol/L vs. ( 1.91 ± 0.57 ) mmol/L, t = 3.78 ; (12.08 ±2. 87) mU/L vs. ( 6. 87±1. 89 ) mU/L,t=3.98;3.42±0.57 vs. 1.60±0.31,t=4.65;(144.6± 13.3) mmHgvs.(135.1±12.7) mmHg,t=3.57;(93.6±9.5) mmHgvs.(85.2±7.6) mmHg,t=3.59; ( 29. 86 ± 3.37 ) μg/min vs. ( 22. 52 ± 2. 56 ) μg/min, t = 3.71 ; atorvastatin group: 1.24± 0.23 vs. 0. 92± 0. 24, t = 3.74 ; ( 6. 84± 1.37 ) mg/L vs. ( 3.50 ±0.75 ) mg/L, t = 4. 24 ; ( 27. 22 ± 7. 36 ) ng/L vs. ( 18. 70 ±5. 82) ng/L, t = 3.76 ; ( 26. 28 ±6. 84) ng/L vs. ( 19. 34± 5.96 ) ng/L, t = 3.75 ; (311.22 ± 91.98 ) ng/L vs. (246.50±74.73) ng/L,t =3.63; (1.56 ±0.27) g/L vs. (1.14 ±0.26) g/L,t =3.74;(5.65 ±0.76) mmol/L vs. (4. 67 ± 0. 65 ) mmol/L, t = 3.68 ; (3.51 ± 0. 55 ) mmol/L vs. ( 2. 65 ±0. 57 ) mmol/L, t = 3.70 ; (2.86±0.68) mmol/L vs. (2.05 ±0.54) mmol/L,t =3.78; (12.04±2.95) mU/L vs. (8.91±2.32) mU/L,t =3. 74;3. 38 ±0. 54 vs. 2.18±0.35,t=3.80;(144.0±13.8) mm Hgvs. (135.7±12.5) mm Hg, t=3.56;(93.4±9.3) mm Hgvs. (85.8 ±8.9) mm Hg,t=3.58;(29.77±3.28) μg/min vs. (23.02± 2. 83) μg/min,t =3.67;P 〈0. 01 ). ApoA1 and high-density lipoprotein cholesterol (HDL-C) had increase , but there was no significant difference (P 〉 0. 05 ). Fasting plasma glucose ( FPG), 2 h postprandial blood glucose (2 hPG) and BMI tended to decrease, but there were no significant differences (P 〉 0. 05 ). (2)The serum levels of ApoB/ApoA1, hs-CRP,TNF-ct, IL-6, IL-18, ApoB, TC, LDL-C, FIN and HOMA-IR in the rosuvastatin group were significantly lower than those in the atorvastatin group at the 12th-week follow-up (t = 2. 11,2. 10,2. 09, 2. 12,2. 08,2. 07,2.05,2.04,2. 04,2.06 respectively; P 〈 0.05 ). The serum levels of HDL-C and ApoA1 in the rosuvastatin group tended to increase compared with the atorvastatin group after 12-week treatment (P 〉 0.05 ). There were no statistically significant differences in term of TG, SBP, DBP, UAER between the two groups (P 〉 0.05 ) . (3) The adverse effect in the rosuvastatin group was fewer than that in atorvastatin group. Conclusion Rosuvastatin can reduce ApoB/ApoA1 ratio and the levels of inflammatory cytokines, improve insulin resistance in patients with MS and less adverse effect were seen.
出处
《中国综合临床》
2013年第12期1268-1272,共5页
Clinical Medicine of China