阿司匹林联合阿托伐他汀治疗高血压合并糖尿病的效果观察

Effects of aspirin combined with atorvastatin on hypertensive patients with diabetes mellitus

目的探讨阿司匹林联合阿托伐他汀治疗高血压合并糖尿病的临床效果。方法选取2016年1月至2017年12月山西医科大学第一医院收治的高血压合并糖尿病患者100例,按照随机数字表法分为阿司匹林组和阿司匹林联合阿托伐他汀治疗组(联合治疗组),每组50例。阿司匹林组给予拜阿司匹林(100 mg/d)治疗,联合治疗组给予拜阿司匹林(100 mg/d)+阿托伐他汀(20 mg/d)治疗。测定并比较两组治疗前及治疗后20周的血脂、尿白蛋白、β2微球蛋白(β2-MG)、尿白蛋白排泄率(UAER)、心踝血管指数(CAVI)、踝臂指数(ABI),通过随访对其非致死性心肌梗死发生率进行对比分析。结果与治疗前比较,两组患者总胆固醇和低密度脂蛋白胆固醇水平降低,CAVI和ABI水平得到改善,差异有统计学意义(P<0.05);且联合治疗组CAVI和ABI水平改善程度优于阿司匹林组(P<0.05)。治疗后,阿司匹林组高密度脂蛋白胆固醇、尿白蛋白、β2-MG、三酰甘油、UAER与治疗前比较差异未见统计学意义(P>0.05);而联合治疗组尿白蛋白、三酰甘油、UAER、β2-MG均低于治疗前(P均<0.05)。阿司匹林组非致死性心肌梗死主要终点的发生率高于联合治疗组(P<0.05)。通过多元逐步回归分析发现,影响动脉僵硬度和微量蛋白尿的危险因素为舒张压、收缩压、餐后2 h血糖以及空腹血糖。结论阿司匹林与阿托伐他汀合用能够降低高血压合并糖尿病患者尿微量蛋白水平,明显缓解动脉僵硬度,有效减少非致死性心肌梗死主要终点发生率,并发现动脉僵硬度及微量蛋白尿与血压及血糖水平具有直接关系。

Objective To investigate the effects of aspirin combined with atorvastatin on hypertensive patients with diabetes mellitus.Methods One hundred hypertensive patients with diabetes mellitus admitted to the First Hospital of Shanxi Medical University from January 2016 to December 2017 were selected and divided into aspirin group and aspirin combined with atorvastatin group(combined treatment group)according to random number table method,with 50 cases in each group.Patients in aspirin group were treated with aspirin,100 mg/d;while patients in combined treatment group were treated with aspirin,100 mg/d,and atorvastatin,20 mg/d.Blood lipid,urinary albumin,β2-microglobulin(β2-MG),urinary albumin excretion rate(UAER),cardioankle vascular index(CAVI)and ankle brachial index(ABI)of the two groups were measured and compared before and 20 weeks after treatment,and the incidences of non fatal myocardial infarction of the two groups were compared and analyzed by follow-up.Results Compared with preoperative levels,the levels of total cholesterol and low-density lipoprotein cholesterol of the two groups were reduced,and the levels of CAVI and ABI were improved after treatment(P<0.05).And the improvement in CAVI and ABI in the combined treatment group was better than aspirin group(P<0.05).In the aspirin group,the levels of high-density lipoprotein cholesterol,urinary albumin,β2-MG,triacylglycerol and UAER had no significant change after treatment,compared with preoperative levels(P>0.05).However,the urinary albumin,triacylglycerol,UAER andβ2-MG in the combined treatment group were decreased after treatment(P<0.05).During the median follow-up period,the incidence of major endpoints in non fatal myocardial infarction in aspirin group was higher than that in combined treatment group(P<0.05).Multiple stepwise regression analysis showed that the risk factors of arterial stiffness and microalbuminuria were diastolic pressure,systolic pressure,2 h postprandial blood glucose and fasting blood glucose.Conclusions The combined use of aspirin and atorvastatin can significantly reduce the level of urinary microprotein in patients with hypertension and diabetes mellitus,alleviate arterial stiffness,effectively reduce the incidence of non fatal myocardial infarction.And the study finds that arterial stiffness and microalbuminuria are directly related to blood pressure and blood glucose level.