阿托伐他汀对2型糖尿病患者内皮微粒和颈动脉内膜中层厚度的影响
发布时间：2018-08-10 07:43
【摘要】：糖尿病是加速动脉粥样硬化(atherosclerosis,As)的重要危险因素,相关的并发症是患者致残和致死的主要原因,而内皮功能障碍是促进糖尿病患者As发生、发展的关键环节。因而早期改善内皮功能障碍是防治As的关键途径。内皮细胞微粒(endothelial microparticle,EMP)是内皮细胞在活化或凋亡时释放的一种微粒,包含了前体细胞特有的细胞膜、细胞核和细胞质结构,因而携带着其特有的生物信息。目前的研究证实EMP在糖尿病、As、自身免疫性疾病、炎症性疾病等与血管内皮功能障碍密切相关的疾病中显著升高。国内外对EMP影响糖尿病血管病变的发生、发展的机制及以EMP为靶点的治疗尚处于探索阶段,在应用他汀类药物后EMP的变化方面仍存在争论。颈动脉内膜中层厚度(intima-media thickness,IMT)增厚是As的早期指征,可作为评价药物疗效的可靠指标。本实验旨在评价2型糖尿病(type 2 diabetes mellitus,T2DM)患者应用他汀类药物前后EMP、低密度脂蛋白胆固醇(low density lipoprotein cholester,LDL-C)与IMT的变化及三者之间是否具有相关性做一探讨,并将阿托伐他汀与辛伐他汀进行比较。选取T2DM住院患者90例,年龄45-75岁,随机分为阿托伐他汀组和辛伐他汀组。所有患者均在生活方式干预的同时给予口服降糖药和(或)胰岛素治疗,肠溶阿司匹林0.1g qd,阿托伐他汀组给予每晚加服阿托伐他汀片20mg,辛伐他汀组给予每晚加服辛伐他汀片20mg,总疗程24周,观察治疗前后EMP、LDL-C、IMT的变化,并分析它们之间的相关性。实验结果显示,与治疗前相比,阿托伐他汀组和辛伐他汀组IMT、EMP及LDL-C水平均明显下降(P0.05),阿托伐他汀降低IMT、EMP及LDL-C的作用强于辛伐他汀(P0.05),两组降低幅度差异有统计学意义(P0.05)。直线相关分析表明,实验结束时两组治疗前后EMP变化值与IMT变化值呈正相关,阿托伐他汀组r=0.483,P㩳0.05,辛伐他汀组r=0.423,P㩳0.05;两组治疗前后LDL-C变化值与IMT变化值呈正相关,阿托伐他汀组r=0.512,P㩳0.05,辛伐他汀组r=0.483,P㩳0.05。以上结果说明,他汀类药物能够降低T2DM患者IMT、EMP及LDL-C,其抗As作用除与降脂作用有关,可能还与抑制EMP释放有关。阿托伐他汀不仅在降低LDL-C上优于辛伐他汀,而且在降低EMP上同样优于辛伐他汀,由此推测阿托伐他汀的抗As作用强于辛伐他汀可能与此相关。
[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.
【学位授予单位】：河北北方学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.2
本文编号：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.
【学位授予单位】：河北北方学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.2
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