依折麦布联合阿托伐他汀治疗冠状动脉粥样硬化性心脏病合并糖尿病的效果

Effect of ezetimibe combined with atorvastatin in the treatment of coronary heart disease with diabetes mellitus

目的观察依折麦布联合他汀类药物对冠状动脉粥样硬化性心脏病(CHD)合并糖尿病患者的治疗效果。方法选取2019年9月至2020年6月阜外华中心血管病医院(河南省人民医院心脏中心)心脏康复科收治的114例CHD合并糖尿病患者,男61例,女53例,年龄(56.17±8.95)岁,年龄范围为45~67岁。根据治疗方法不同分为单药治疗组与联合治疗组,每组57例。单药治疗组给予他汀类药物治疗,联合治疗组给予依折麦布联合他汀类药物治疗。比较两组患者的心绞痛发生情况和硝酸甘油用量、治疗前后血脂指标、几丁质酶-3样蛋白-1(YKL-40)、高迁移率族蛋白B-1(HMGB-1)、亲环素A、基质金属蛋白酶-9(MMP-9)水平及不良反应发生情况。结果联合治疗组心绞痛发作次数[(1.02±0.24)次/周]和硝酸甘油用量[(10.52±2.41)mg/7 d]少于单药治疗组[(1.74±0.45)次/周、(17.65±4.56)mg/7 d];治疗后,联合治疗组高密度脂蛋白胆固醇(HDL-C)水平[(1.78±0.52)mmol/L]高于单药治疗组[(1.51±0.49)mmol/L],联合治疗组总胆固醇[(4.52±0.98)mmol/L]、甘油三酯[(1.48±0.57)mmol/L]、低密度脂蛋白胆固醇(LDL-C)水平[(2.95±0.87)mmol/L]低于单药治疗组[(5.24±1.05)mmol/L、(1.75±0.69)mmol/L、(3.42±0.98)mmol/L],联合治疗组YKL-40[(46.95±15.74)μg/L]、HMGB-1[(4.22±0.84)μg/L]、亲环素A[(4.85±1.98)μg/L]、MMP-9水平[(45.98±10.74)ng/L]均低于单药治疗组[(57.88±21.36)μg/L、(5.25±1.04)μg/L、(6.89±2.11)μg/L、(61.25±12.44)ng/L],差异均有统计学意义(P<0.05)。联合治疗组不良反应发生率[14.0%(8/57)]低于单药治疗组[10.5%(6/57)],差异无统计学意义(P=0.568)。结论依折麦布联合他汀类药物治疗CHD合并糖尿病可有效控制血脂,降低YKL-40、HMGB-1、亲环素A、MMP-9的表达水平,提高治疗效果,且不增加不良反应。

Objective To observe the effect of etzomab combined with statins in patients with coronary heart disease(CHD)and diabetes mellitus.Methods A total of 114 CHD patients with diabetes mellitus admitted to the department of Cardiology,Fuwai Huazhong Cardiovascular Hospital(Henan Provincial People′s Hospital Heart Center),from September 2019 to June 2020 were selected.There were 61 males and 53 females,aged(56.17±8.95)years old,and the age range was 45 to 67 years old.According to different treatment methods,they were divided into single-agent treatment group and combined treatment group,with 57 cases in each group.The single-agent treatment group was treated with statins,and the combined treatment group was treated with ezetimibe combined with statins.To compare the occurrence of angina pectoris and the dosage of nitroglycerin,blood lipids before and after treatment,chtinase-3-like-1protein(YKL-40),high mobility group box 1 protein(HMG B-1),cyclophilin A,matrix metalloproteinase-9(MMP-9)levels,and the adverse effects of clinical treatment between the two groups of patients The reaction happened.Results The number of episodes of angina pectoris[(1.02±0.24)times/week]and the dosage of nitroglycerin[(10.52±2.41)mg/7 d]in the combined treatment group were less than those in the single-agent treatment group[(1.74±0.45)times/week,(17.65±4.56)mg/7 d].After treatment,the high-density lipoprotein cholesterol(HDL-C)level[(1.78±0.52)mmol/L]in the combination treatment group was higher than that in the single-agent treatment group[(1.51±0.49)mmol/L],and the total cholesterol in the combination treatment group[(4.52±0.98)mmol/L]L],triglycerides[(1.48±0.57)mmol/L],low-density lipoprotein cholesterol(LDL-C)levels[(2.95±0.87)mmol/L]are lower than the monotherapy group[(5.24±1.05)mmol/L,(1.75±0.69)mmol/L,(3.42±0.98)mmol/L],combined treatment group YKL-40[(46.95±15.74)μg/L],HMGB-1[(4.22±0.84)μg/L],cyclophilinA[(4.85±1.98)μg/L],MMP-9 levels[(45.98±10.74)ng/L]were lower than the monotherapy group[(57.88±21.36)μg/L,(5.25±1.04)μg/L,(6.89±2.11)μg/L,(61.25±12.44)ng/L],the differences were statistically significant(P<0.05).The incidence of adverse reactions in the combination therapy group[14.0%(8/57)]was lower than that in the monotherapy group[10.5%(6/57)],and the difference was not statistically significant(P=0.568).Conclusion Echomab combined with statins in the treatment of coronary heart disease with diabetes can effectively control blood lipids,reduce the level of YKL-40、HMGB-1、CypA、MMP-9 expression,improve the efficacy,and do not increase adverse reactions.