洛伐他汀治疗冠心病高胆固醇血症对血管内皮功能微循环及胰岛素敏感性的影响

Effects of lovastatin on insulin sensitivity,vascular endothelial function and microcirculation in primary hypercholesterolemia of with coronary heart disease.

目的 探讨洛伐他汀治疗冠心病高胆固醇血症患者 ,对血管内皮功能、微循环及胰岛素敏感性 (IS)的影响。方法 4 5例冠心病高胆固醇血症患者 (治疗组 )给予洛伐他汀 (血脂康 )治疗 ,测定治疗前和治疗后 4、8周以及 4 0例正常对照者血脂谱、空腹血糖 (FPG)、空腹胰岛素 (FINS)、一氧化氮 (NO)、内皮素 (ET)、6 -酮 -前列腺素 (6 -Keto -PGF1α)、血栓素B2 (TXB2 )以及甲襞微循环 (NFM )检测并计算总积分值 ,计算IS指数。结果 与对照组比较 ,治疗组治疗前ET、TXB2 、NFM总积分值显著升高 ,NO、6 -Keto -PGF1α、IS指数显著降低。治疗后 4周较治疗前ET、TXB2 、NFM总积分值显著下降 5 3 16± 15 2 3和 6 3 19± 18 72 (P <0 0 1) ,84 13± 2 2 6 7和 94 81± 2 4 6 6 (P <0 0 5 ) ,3 75± 1 0 2和 4 4 6± 1 84 (P <0 0 5 ) ;6 -Keto -PGF1α、NO、IS指数明显升高6 6 89± 18 0 4和 5 4 32± 2 1 73(P <0 0 1) ,5 89± 1 5 4和 5 13± 1 38(P <0 0 5 ) ,- 4 37± 0 34(0 5 2 )和 -4 5 9± 0 4 7(0 4 2 ) (P <0 0 5 ) ;治疗后 8周与治疗前比较TXB2 、NFM总积分值进一步下降P值均 <0 0 1。NO、IS指数进一步升高P值均 <0 0 1,且IS指数的升高与NFM总积分值的下降呈显著负相关关系r =-

Objective To study the effects of lovastatin in the therapy of primary hypercholesterolemia on insulin sensitivity,vascular endothelial function and microcirculation in patients with coronary heart disease.Methods Forty-five patients,diagnosed as coronary heart disease and primary hypercholesterolemia,were treated by lovastatin for 8 weeks.Serum lipids,fasting plasma glucose (FPG),fasting insulin(FINS),nitric oxide(NO),endothelin(ET),6-keto-prostacyclin F 1α(6-keto-PGF 1α),thromboxane B 2(TXB 2) and nail-fold microcirculation (NFM) were measured and the score value of NFM and insulin sensitivity(IS) index were calculated in treatment group before and after 4-week and 8-week treatment with lovastatin.Forty healthy persons were taken as control.Results In treatment group,ET,TXB 2,and the score value of NFM were higher and NO,6-keto-PGF 1α and IS index were lower than those in control group.After 4-week lovastatin treatment,compared with baseline value,ET,TXB 2,and the score value of NFM significantly decreased,which were 63.19±18.72 vs 53.16±15.23 (P<0.01),94.81±24.66 vs 84.13±22.67 (P<0.05),4.46±1.84 vs 3.75±1.02 (P<0.05);while 6-keto-PGF 1α,NO and IS index significantly increased,which were 54.32±21.73 vs 66.89±18.04 (P<0.01),5.13±1.38 vs 5.89±1.54 (P<0.05),-4.59±0.47(0.42) vs -4.37±0.34(0.52)(P<0.05),respectively.After 8-week treatment,TXB 2 and the score value of NFM decreased significantly (both P<0.01),but NO and IS index increased significantly (both P<0.01).The increase of IS index was correlated with the decrease of the score value of NFM (r=-0.71,P<0.05).Conclusion Lovastatin can lower serum lipid level,improve vascular endothelial function and microcirculation and reduce insulin resistance.