阿托伐他汀對(duì)2型糖尿病患者內(nèi)皮微粒和頸動(dòng)脈內(nèi)膜中層厚度的影響
發(fā)布時(shí)間：2018-08-10 07:43
【摘要】：糖尿病是加速動(dòng)脈粥樣硬化(atherosclerosis,As)的重要危險(xiǎn)因素,相關(guān)的并發(fā)癥是患者致殘和致死的主要原因,而內(nèi)皮功能障礙是促進(jìn)糖尿病患者As發(fā)生、發(fā)展的關(guān)鍵環(huán)節(jié)。因而早期改善內(nèi)皮功能障礙是防治As的關(guān)鍵途徑。內(nèi)皮細(xì)胞微粒(endothelial microparticle,EMP)是內(nèi)皮細(xì)胞在活化或凋亡時(shí)釋放的一種微粒,包含了前體細(xì)胞特有的細(xì)胞膜、細(xì)胞核和細(xì)胞質(zhì)結(jié)構(gòu),因而攜帶著其特有的生物信息。目前的研究證實(shí)EMP在糖尿病、As、自身免疫性疾病、炎癥性疾病等與血管內(nèi)皮功能障礙密切相關(guān)的疾病中顯著升高。國(guó)內(nèi)外對(duì)EMP影響糖尿病血管病變的發(fā)生、發(fā)展的機(jī)制及以EMP為靶點(diǎn)的治療尚處于探索階段,在應(yīng)用他汀類藥物后EMP的變化方面仍存在爭(zhēng)論。頸動(dòng)脈內(nèi)膜中層厚度(intima-media thickness,IMT)增厚是As的早期指征,可作為評(píng)價(jià)藥物療效的可靠指標(biāo)。本實(shí)驗(yàn)旨在評(píng)價(jià)2型糖尿病(type 2 diabetes mellitus,T2DM)患者應(yīng)用他汀類藥物前后EMP、低密度脂蛋白膽固醇(low density lipoprotein cholester,LDL-C)與IMT的變化及三者之間是否具有相關(guān)性做一探討,并將阿托伐他汀與辛伐他汀進(jìn)行比較。選取T2DM住院患者90例,年齡45-75歲,隨機(jī)分為阿托伐他汀組和辛伐他汀組。所有患者均在生活方式干預(yù)的同時(shí)給予口服降糖藥和(或)胰島素治療,腸溶阿司匹林0.1g qd,阿托伐他汀組給予每晚加服阿托伐他汀片20mg,辛伐他汀組給予每晚加服辛伐他汀片20mg,總療程24周,觀察治療前后EMP、LDL-C、IMT的變化,并分析它們之間的相關(guān)性。實(shí)驗(yàn)結(jié)果顯示,與治療前相比,阿托伐他汀組和辛伐他汀組IMT、EMP及LDL-C水平均明顯下降(P0.05),阿托伐他汀降低IMT、EMP及LDL-C的作用強(qiáng)于辛伐他汀(P0.05),兩組降低幅度差異有統(tǒng)計(jì)學(xué)意義(P0.05)。直線相關(guān)分析表明,實(shí)驗(yàn)結(jié)束時(shí)兩組治療前后EMP變化值與IMT變化值呈正相關(guān),阿托伐他汀組r=0.483,P㩳0.05,辛伐他汀組r=0.423,P㩳0.05;兩組治療前后LDL-C變化值與IMT變化值呈正相關(guān),阿托伐他汀組r=0.512,P㩳0.05,辛伐他汀組r=0.483,P㩳0.05。以上結(jié)果說(shuō)明,他汀類藥物能夠降低T2DM患者IMT、EMP及LDL-C,其抗As作用除與降脂作用有關(guān),可能還與抑制EMP釋放有關(guān)。阿托伐他汀不僅在降低LDL-C上優(yōu)于辛伐他汀,而且在降低EMP上同樣優(yōu)于辛伐他汀,由此推測(cè)阿托伐他汀的抗As作用強(qiáng)于辛伐他汀可能與此相關(guān)。
[Abstract]:Diabetes mellitus is an important risk factor to accelerate atherosclerosis and related complications are the main cause of disability and death. Endothelial dysfunction is the key link to promote the occurrence and development of as in diabetic patients. Therefore, early improvement of endothelial dysfunction is the key to prevent and treat as. Endothelial microparticle (EMP) is a kind of microparticles released by endothelial cells during activation or apoptosis. It contains the unique cellular membrane, nucleus and cytoplasmic structure of precursor cells, thus carrying its unique biological information. Current studies have confirmed that EMP is significantly increased in diabetes mellitus, autoimmune diseases, inflammatory diseases and other diseases closely related to vascular endothelial dysfunction. At home and abroad, the mechanism of EMP affecting the occurrence and development of diabetic vascular lesions and the treatment targeting EMP are still in the exploratory stage, and there are still arguments on the changes of EMP after the use of statins. Intima-media thickness of carotid artery is an early indication of as, and can be used as a reliable index to evaluate the curative effect of as. The purpose of this study was to evaluate the changes of type, low density lipoprotein cholesterol (LDL-C) and IMT in patients with type 2 diabetes mellitus (type 2 diabetes mellitusus T2DM) before and after statin administration. Atto vastatin and simvastatin were compared. Ninety T2DM inpatients aged 45 to 75 years were randomly divided into Atto vastatin group and simvastatin group. All patients were treated with oral hypoglycemic drugs and / or insulin in conjunction with lifestyle interventions. Enteric aspirin 0.1 g QD, Atto vastatin group 20 mg / night, simvastatin group 20 mg / night, total course of treatment 24 weeks. The changes of LDL-CIMT before and after treatment were observed and the correlation between them was analyzed. The results showed that the levels of IMT EMP and LDL-C were significantly decreased in Atto vastatin group and simvastatin group compared with before treatment (P0.05). The effect of Atto vastatin on IMT EMP and LDL-C was stronger than simvastatin (P0.05). There was a significant difference between the two groups (P0.05). Linear correlation analysis showed that there was a positive correlation between the changes of EMP and IMT in the two groups at the end of the experiment, the changes of LDL-C were positively correlated with the changes of IMT in the Atto vastatin group and simvastatin group, and in Atto vastatin group and simvastatin group, respectively. Atto vastatin group was 0.512 P0. 05, simvastatin group was 0. 483% P0. 05. These results suggest that statins can reduce the levels of IMT EMP and LDL-Cin in patients with T2DM. The anti-as effect may be related not only to the lipid-lowering effect but also to the inhibition of EMP release. Atto vastatin was not only superior to simvastatin in reducing LDL-C but also superior to simvastatin in decreasing EMP. It is suggested that Atto vastatin has stronger antiarsenic effect than simvastatin.
【學(xué)位授予單位】：河北北方學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R587.2
本文編號(hào)：2175417
[Abstract]:Diabetes mellitus is an important risk factor to accelerate atherosclerosis and related complications are the main cause of disability and death. Endothelial dysfunction is the key link to promote the occurrence and development of as in diabetic patients. Therefore, early improvement of endothelial dysfunction is the key to prevent and treat as. Endothelial microparticle (EMP) is a kind of microparticles released by endothelial cells during activation or apoptosis. It contains the unique cellular membrane, nucleus and cytoplasmic structure of precursor cells, thus carrying its unique biological information. Current studies have confirmed that EMP is significantly increased in diabetes mellitus, autoimmune diseases, inflammatory diseases and other diseases closely related to vascular endothelial dysfunction. At home and abroad, the mechanism of EMP affecting the occurrence and development of diabetic vascular lesions and the treatment targeting EMP are still in the exploratory stage, and there are still arguments on the changes of EMP after the use of statins. Intima-media thickness of carotid artery is an early indication of as, and can be used as a reliable index to evaluate the curative effect of as. The purpose of this study was to evaluate the changes of type, low density lipoprotein cholesterol (LDL-C) and IMT in patients with type 2 diabetes mellitus (type 2 diabetes mellitusus T2DM) before and after statin administration. Atto vastatin and simvastatin were compared. Ninety T2DM inpatients aged 45 to 75 years were randomly divided into Atto vastatin group and simvastatin group. All patients were treated with oral hypoglycemic drugs and / or insulin in conjunction with lifestyle interventions. Enteric aspirin 0.1 g QD, Atto vastatin group 20 mg / night, simvastatin group 20 mg / night, total course of treatment 24 weeks. The changes of LDL-CIMT before and after treatment were observed and the correlation between them was analyzed. The results showed that the levels of IMT EMP and LDL-C were significantly decreased in Atto vastatin group and simvastatin group compared with before treatment (P0.05). The effect of Atto vastatin on IMT EMP and LDL-C was stronger than simvastatin (P0.05). There was a significant difference between the two groups (P0.05). Linear correlation analysis showed that there was a positive correlation between the changes of EMP and IMT in the two groups at the end of the experiment, the changes of LDL-C were positively correlated with the changes of IMT in the Atto vastatin group and simvastatin group, and in Atto vastatin group and simvastatin group, respectively. Atto vastatin group was 0.512 P0. 05, simvastatin group was 0. 483% P0. 05. These results suggest that statins can reduce the levels of IMT EMP and LDL-Cin in patients with T2DM. The anti-as effect may be related not only to the lipid-lowering effect but also to the inhibition of EMP release. Atto vastatin was not only superior to simvastatin in reducing LDL-C but also superior to simvastatin in decreasing EMP. It is suggested that Atto vastatin has stronger antiarsenic effect than simvastatin.
【學(xué)位授予單位】：河北北方學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R587.2
【參考文獻(xiàn)】
相關(guān)期刊論文 前5條
1 戴蘭;朱明清;薛壽儒;李旺俊;阮長(zhǎng)耿;;內(nèi)皮細(xì)胞微顆粒在阿爾茨海默病患者血漿中的水平及其臨床意義[J];國(guó)際檢驗(yàn)醫(yī)學(xué)雜志;2011年15期
2 姚輕舟;雷和平;余細(xì)勇;;內(nèi)皮細(xì)胞微粒與糖尿病心肌病[J];國(guó)際病理科學(xué)與臨床雜志;2012年02期
3 范曉紅;王春;;頸動(dòng)脈粥樣硬化的發(fā)病情況及其影響因素的調(diào)查與相關(guān)分析[J];中華心血管病雜志;2006年02期
4 董亞琳,董衛(wèi)華;他汀類藥物的研究進(jìn)展[J];中國(guó)新藥雜志;2003年03期
5 楊輝;馮躍明;;2型糖尿病患者發(fā)生動(dòng)脈粥樣硬化的相關(guān)危險(xiǎn)因素[J];中國(guó)老年學(xué)雜志;2013年08期
，本文編號(hào)：2175417
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