瑞舒伐他汀联合睾酮对T2DM合并CSA患者动脉斑块和血管内皮功能的影响

Effects of rosuvastatin combined with testosterone replacement therapy on the carotid plaque and vascular endothelial function in patients with type 2 diabetes mellitus complicated by carotid atherosclerosis

目的观察瑞舒伐他汀联合睾酮补充治疗对2型糖尿病(T2DM)合并颈动脉粥样硬化(CAS)患者动脉斑块和血管内皮功能的影响。方法将2017年5月至2018年5月我院收治的T2DM合并CAS患者70例纳入研究范围,随机分为对照组和观察组,每组35例。2组均接受降糖、降脂、溶栓、饮食指导、运动锻炼等常规治疗。对照组给予瑞舒伐他汀片治疗,观察组在对照组基础上加用十一酸睾酮胶丸治疗,疗程3个月。比较2组临床疗效及治疗前后性激素[总睾酮(TT)、性激素结合球蛋白(SHBG)]、颈动脉斑块[斑块面积、斑块数量、颈动脉内膜-中层厚度(IMT)、Crouse积分]、血管内皮功能[一氧化氮(NO)、内皮素(ET-1)、肱动脉血流介导的血管舒张功能(FMD)、含服硝酸甘油后FMD(NID)]、炎性因子[白介素6(IL-6)、肿瘤坏死因子(TNF-α)、超敏C-反应蛋白(hs-CRP)]、氧化应激[丙二醛(MDA)、脂质过氧化物(LPO)、超氧化物歧化酶(SOD)]变化。结果治疗后,观察组总有效率明显高于对照组(P<0.05)。治疗前,2组TT、SHBG、斑块面积、斑块数量、IMT、Crouse积分、NO、ET-1、FMD、NID、IL-6、TNF-α、hs-CRP、MDA、LPO、SOD比较差异无统计学意义(P>0.05);治疗后,2组TT、SHBG、NO、FMD、NID、SOD均明显高于治疗前(P<0.05),斑块面积、斑块数量、IMT、Crouse积分、ET-1、IL-6、TNF-α、hs-CRP、MDA、LPO均明显低于治疗前(P<0.05),且观察组上述指标变化幅度大于对照组(P<0.05)。结论瑞舒伐他汀联合睾酮补充治疗T2DM合并CAS疗效显著,能够有效提高性激素含量,稳定斑块并保护血管内皮功能,其机制与抑制炎性反应和氧化应激有关。

Objective To investigate the effects of rosuvastatin combined with testosterone replacement therapy on the carotid plaque and vascular endothelial function in patients with type 2 diabetes mellitus T2DM complicated by carotid atherosclerosis(CAS).Methods A total of 70 patients with T2DM complicated by CAS who were admitted and treated in our hospital from May 2017 to May 2018 were enrolled in the study,who were randomly divided into the control group(n=35)and observation group(n=35).On the basis of routine treatment,the patients in control group were treated by rosuvastatin,however,the patients in observation group,on the basis of control group,were treated by testosterone replacement therapy.After 3-month treatment,the clinical efficacy,the changes of sexual hormones(TT and SHBG),carotid atherosclerosis related indicators(carotid plaque area,plaque number,IMT and Crouse score),vascular endothelial function(NO,ET-1,FMD and NID),inflammatory cytokines(IL-6,TNF-αand hs-CRP)and oxidative stress(MDA,LPO and SOD)before and after treatment were observed and compared between the two groups.Results After treatment,the total remission rate in observation group(88.57%)was significantly higher than that(62.86%)in control group(P<0.05).Before treatment,there were no significant differences in the levels of TT,SHBG,carotid plaque area,plaque number,IMT,Crouse score,NO,ET-1,FMD,NID,IL-6,TNF-α,hs-CRP,MDA,LPO and SOD between the two groups(P>0.05).After treatment,the levels of TT,SHBG,NO,FMD,NID and SOD in both groups were significantly higher than those before treatment,however,the carotid plaque area,plaque number,IMT,Crouse score,ET-1,IL-6,TNF-α,hs-CRP,MDA and LPO in both groups were significantly lower than those before treatment(P<0.05),moreover,the the changes in the indexes mentioned above in observation group were more significant than those in control group(P<0.05).Conclusion The rosuvastatin combined with testosterone replacement therapy in treatment of T2DM complicated by CAS can significantly increase serum sexual hormones levels,stabilize plaque andprotect vascular endothelial function of patients,andits action mechanism may be associated with theinhibition of inflammation and oxidative stress.