贝特类降脂药对2型糖尿病患者的降脂作用及脑血管病变的影响

The effect of fibrates on blood lipid and cerebral vessels in patients with NIDD

目的 :观察贝特类降脂药对 2型糖尿病 (DM )伴高三酰甘油血症患者的降脂作用及对脑血管病变的影响。方法 :入选 86例患者在降糖治疗的基础上随机分为试验组 (n =4 6 )和对照组 (n =4 0 ) ,试验组加服非诺贝特10 0mg或吉非贝齐 30 0mg ,tid ,4周后改为非诺贝特 10 0mg或吉非贝齐 30 0mg ,qd ,共用 12周。对照组不用降脂药。12周后检测血脂指标的变化及应用经颅多谱勒 (TCD)检测动脉的脉动指数 (PI)、平均血流速度值 (Vm)的变化。结果 :治疗后试验组三酰甘油 (TG)和低密度脂蛋白胆固醇 (LDL C)较治疗前分别下降 4 8 3%及 2 8 7% ,与对照组比较差异有显著性 (P <0 0 5 ) ,而血清胆固醇 (TC)的下降值及高密度脂蛋白胆固醇 (HDL C)的上升值与对照组比较差异无显著性 (P >0 0 5 ) ;试验组治疗后各检测动脉的PI值及大脑中动脉 (MCA)、基底动脉 (BA)及颈内动脉起始段 (ICA)的Vm 值均显著低于治疗前 (P <0 0 5 ) ,也显著低于对照组 (P <0 0 5 )。结论 :贝特类降脂药对伴有高三酰甘油血症的 2型DM患者在显著降低TG的同时 ,起到了改善脑血管弹性及狭窄病变的作用。

Objective:To study the effect of fibrates on blood lipid and cerebral vessels in patients with NIDD.Methods:86 patients were enrolled.46 of them were allocated to receive fenofibrate 100mg 3 times daily or gemfibrozil 300mg 3 times daily,after 4 weeks the regimen was changed to fenofibrate 100mg or gemfibrozil 300mg daily with a total duration of 12 weeks.The rest of them were allocate to receive no lipid-lowering agents.After 12 weeks treatment,PI(pulsatility index) and V m (mean flow velocity) of cerebral artery were determined by transcranial Doppler.Results:The TG and LDL-C level were decreased by 48.3% and 28.7% respectively in the active group after treatment and there were significant difference between active and control groups(P<0.05).The PI,MCA(middle cerebral artery),BA(basilar artery),ICA(internal artey) and V m were significantly decreased in the active group after treatment (P<0.05) and there were significant difference between groups (P< 0.05).Conclusion:The TG level and the cerebral vessel elasticity and stenosis in NIDD patients with hyperlipemia can be obviously improved by fibrates.