匹伐他汀对肝功能正常冠心病合并NAFLD患者胰岛素抵抗的影响和安全性分析

Influence of pitavastatin on insulin resistance in CHD + NAFLD patients with normal liver function and its safety analysis

目的:探讨匹伐他汀对肝功能正常的冠心病(CHD)合并非酒精性脂肪肝(NAFLD)患者胰岛素抵抗(IR)的影响和安全性。方法:选择我院205例CHD+NAFLD患者为NAFLD组,另外70例CHD未合并NAFLD患者为非NAFLD组。根据NAFLD严重程度,NAFLD组被进一步分为轻度组(87例)、中度组(64例)和重度组(54例)。所有患者均在常规治疗基础上接受匹伐他汀,治疗时间为12周。观察比较四组治疗前后稳态模型胰岛素抵抗指数(HOMA-IR)和严重肝功能损害发生率。结果:与治疗前比较,四组治疗后HOMA-IR均显著降低,P均=0.001。治疗前,与非NAFLD组比较,NAFLD轻、中、重度组HOMA-IR[(3.08±0.35)比(3.65±0.42)比(4.12±0.31),(4.21±0.47)]均显著升高,中、重度组HOMA-IR显著高于轻度组,P均=0.001;治疗后,与非NAFLD组比较,NAFLD轻度组HOMA-IR无显著差异,与非NAFLD组、NAFLD轻度组比较,中、重度组HOMA-IR[(2.54±0.38),(2.61±0.47)比(2.97±0.35),(3.08±0.44)]仍然显著升高,P均=0.001。四组严重肝功能损害发生率无显著差异,P=0.872。结论:匹伐他汀治疗肝功能正常冠心病合并NAFLD可显著降低患者的HOMA-IR,安全性良好,值得临床推广。

Objective:To explore influence of pitavastatin on insulin resistance(IR)in patients with coronary heart disease(CHD)complicated non-alcoholic fatty liver disease(NAFLD)and normal liver function and its safety.Methods:A total of 205 CHD+NAFLD patients from our hospital were selected as NAFLD group,another 70 CHD patients without NAFLD were regarded as non-NAFLD group.According to NAFLD severity,NAFLD group was further divided into NAFLD mild group(n=87),moderate group(n=64)and severe group(n=54).All patients received pitavastatin based on routine treatment for 12 weeks.Homeostasis model-insulin resistance index(HOMA-IR)before and after treatment,and incidence rate of severe liver damage were observed and compared among four groups.Results:Compared with before treatment,there was significant reduction in HOMA-IR in four groups after treatment,P=0.001 all.Compared with non-NAFLD group before treatment,there was significant rise in HOMA-IR[(3.08±0.35)vs.(3.65±0.42)vs.(4.12±0.31),(4.21±0.47)]in mild,moderate and severe group,and those of moderate and severe group were significantly higher than that of mild group,P=0.001 all;after treatment,compared with non-NAFLD group,the HOMA-IR of mild group was no significant difference,but compared with non-NAFLD group and mild group there was significant rise in HOMA-IR[(2.54±0.38),(2.61±0.47)vs.(2.97±0.35),(3.08±0.44)]in moderate and severe group,P=0.001 all.There was no significant difference in incidence rate of severe liver damage among four groups,P=0.872.Conclusion:Pitavastatin can significantly reduce HOMA-IR with good safety in CHD+NAFLD patients with normal liver function,which is worth extending.