摘要
目的探讨阿司匹林、阿托伐他汀、普罗布考联合应用(PAS疗法)对糖尿病动脉粥样硬化患者的干预作用。方法入选糖尿病患者92例,随访1年,最后资料完全者78例,其中对照组(阿司匹林100 mg/d、阿托伐他汀10 mg/d)38例,PAS组(普罗布考0.25 g/d、阿司匹林100 mg/d、阿托伐他汀10 mg/d)40例。测定治疗前后空腹血糖(FBG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1c)、血脂、血清氧化型低密度脂蛋白(ox-LDL)、丙二醛水平。计算出胰岛素抵抗指数(HOMA-IRI)、胰岛素敏感指数(ISI),超声检测治疗前、后颈动脉内膜厚度及斑块厚度。结果对照组治疗前后HOMA-IRI、ISI、ox-LDL、丙二醛水平无明显变化(P>0.05);PAS组治疗后FBG、FINS、HbA1c、HOMA-IRI较治疗前明显下降,差异有统计学意义(P<0.05),总胆固醇(CHOL)、三酰甘油(TG)及低密度脂蛋白(LDL-C)较治疗前明显下降,差异有统计学意义(P<0.05)。ox-LDL较治疗前下降了33.7%[(14.91±0.02)mmol/L比(22.49±0.01)mmol/L,P<0.05],丙二醛较治疗前下降了22.3%[(1.81±0.79)mmol/L比(2.33±1.23)mmol/L,P<0.05],ISI较治疗前明显升高(P<0.05)。PAS组治疗后颈动脉内膜厚度[(0.095±0.001)cm比(0.113±0.001)cm]、斑块厚度[(0.201±0.002)cm比(0.249±0.002)cm],较治疗前均有明显下降,差异有统计学意义(P<0.001)。对照组治疗后颈动脉内膜厚度及斑块厚度较治疗前下降,差异有统计学意义(P<0.05)。PAS组与对照组组间比较颈动脉内膜厚度及斑块厚度下降更明显,差异有统计学意义(P<0.001)。结论 PAS联合治疗在调节血脂、降低血糖及改善胰岛素抵抗的同时,可使糖尿病患者血清ox-LDL及丙二醛水平明显下降,对动脉粥样硬化的形成具有明显的干预作用。
Objective To investigate the effects of probucol, aspirin and atorvastatin （PAS） combination therapy up on atherosclerosis in patients with diabetes mellitus. Methods A total of 92 diabetic patients with atherosclerosis were selected and were given the treatment for one year. Finally the eligible patients with complete data were 78, including control group （ n = 38, aspirin 100 mg and atorvastatinlO mg daily） and PAS group （ n =40, aspirin 100 mg, atorvastatinlO mg and probucol 0. 25 g daily）. Before and after treatment, the serum levels of fasting glucose, fasting insulin, hemoglycoglobulin （ HbAlc ）, serum lipids, serum oxidized low - density lipoproteins （ ox - LDL） and malondialdehyde （MDA） levels were detected ; the insulin re- sistance index （HOMA -IRI） and insulin sensitivity index （ISI） were calculated; and the carotid intima thickness and plaque thickness were examined by ultrosonography. Results In the control group, the post - treatment levels of HOMA - IRI, ISI, ox -LDL and MDA were not statistically different from the pre -treatment levels （P 〉0. 05）. In the PAS group, the post -treat- ment levels of PAS FBG, FINS, HbA^c, and HOMA - IRI were statistically different from the pre - treatment levels （ P 〈 0. 05 ） ; the post- treatment levels of total cholesterol （TC）, triglyceride （TG） and lower density lipoprotein -cholesterol （LDL - C） were statistically decreased as compared with the pre - treatment levels （ P 〈 0. 05 ） ; ox - LDL level decreased by 33.7% [ （14.91±0.02） mmol/Lvs （22.49±0.01） mmol/L, P〈0.05], MDA level decreased by 22. 3% [ （1.81±0.79） mmol/L vs （2. 33 ± 1.23 ） mmol/L, P 〈 0. 05 ] ; ISI level increased with statistical significance （ P 〈 0. 05 ） ; the carotid intima thickness [ （0.095±0.001） cm vs （0. 113 ±0.001） cm, P〈0 001] and plaque thickness [ （0.201 _＋0.002） em vs （0. 249 ±0. 002） cm, P 〈 0. 001 ] were all significantly decreased. The carotid intima thickness and plaque thickness in the control group were also significantly decreased （ P 〈 0.05 ） ; however the decreases in the PAS group were more evident （ P 〈 0. 001 ）. Conclusion PAS combination therapy can modulate the serum lipids, reduce the blood sugar level and ameliorate the insulin resistance, at the same time it can reduce ox - LDL and MDA significantly, and can evidently intervene the atherosclero- sis in diabetic patients.
出处
《中国全科医学》
CAS
CSCD
北大核心
2010年第34期3855-3858,共4页
Chinese General Practice
