不同品种他汀类药物对非糖尿病冠状动脉粥样硬化性心脏病患者糖代谢的影响
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摘要
目的研究不同品种他汀类药物对非糖尿病冠状动脉粥样硬化性心脏病(冠心病)患者糖代谢的影响,为临床合理应用提供参考。方法收集黑龙江省医院2013年1月至2017年6月诊治的非糖尿病冠心病患者的临床资料,按照服用药物的不同分为阿托伐他汀组(服用阿托伐他汀钙片,20 mg/d)、瑞舒伐他汀组(服用瑞舒伐他汀钙片,10 mg/d)和匹伐他汀组(服用匹伐他汀钙片,2 mg/d),各60例。分析各组研究对象治疗前及治疗后4周及治疗后12周血脂及糖代谢指标的变化情况。结果与治疗前比较,治疗后4周及12周3组三酰甘油、总胆固醇及低密度脂蛋白胆固醇水平均明显降低,而高密度脂蛋白胆固醇水平均明显升高,差异均有统计学意义(均P <0. 05)。与治疗前比较,治疗后12周阿托伐他汀组、瑞舒伐他汀组空腹血糖、糖化血红蛋白水平升高,空腹胰岛素水平降低[阿托伐他汀组:(5. 9±0. 9) mmol/L比(5. 4±0. 9) mmol/L、(6. 7±0. 8)%比(6. 4±0. 5)%、(8. 1±0. 8) mIU/L比(8. 6±0. 9) mIU/L;瑞舒伐他汀组:(5. 8±0. 9) mmol/L比(5. 4±1. 0) mmol/L、(6. 7±0. 8)%比(6. 4±0. 9)%、(8. 1±0. 8) mIU/L比(8. 5±0. 8) mIU/L],差异均有统计学意义(均P <0. 05)。结论匹伐他汀对非糖尿病冠心病患者糖代谢影响较小,不增加冠心病患者新发糖尿病风险。
Objective To investigate the effect of different statins on glycometabolism in patients with non-diabetic coronary atherosclerotic heart disease( CHD). Methods Clinical data of patients with non-diabetic CHD admitted to Heilongjiang Provincial Hospital from January 2013 to June 2017 were retrospectively analyzed.The patients were divided into atorvastatin group( 20 mg/d),rosuvastatin group( 10 mg/d) and pitavastatin group( 2 mg/d),with 60 cases in each group. Changes of blood lipids and glycometabolism indexes were analyzed before,4 and 12 weeks after treatment. Results Levels of serum triglyceride,total cholesterol and low density lipoprotein cholesterol in the three group significantly decreased and high density lipoprotein cholesterol level significantly increased 4 and 12 weeks after treatment( all P < 0. 05); there was no significant difference among the three groups( P > 0. 05). After 12 weeks of treatment,serum levels of fasting blood glucose and glycosylated hemoglobin significantly increased and fasting insulin significantly decreased compared to those before treatment in the atorvastatin group and rosuvastatin group[atorvastatin group:( 5. 9 ± 0. 9) mmol/L vs( 5. 4 ± 0. 9) mmol/L,( 6. 7 ± 0. 8) % vs( 6. 4 ± 0. 5) %,( 8. 1 ± 0. 8) mI U/L vs( 8. 6 ± 0. 9) mI U/L; rosuvastatin group:( 5. 8 ±0. 9) mmol/L vs( 5. 4 ± 1. 0) mmol/L,( 6. 7 ± 0. 8) % vs( 6. 4 ± 0. 9) %,( 8. 1 ± 0. 8) mI U/L vs( 8. 2 ±0. 8) mI U/L]( all P < 0. 05). Conclusion Pitavastatin shows no obvious effect on glycometabolism in patients with non-diabetic CHD and does not increase the risk of newly onset diabetes in patients with CHD.
Objective To investigate the effect of different statins on glycometabolism in patients with non-diabetic coronary atherosclerotic heart disease( CHD). Methods Clinical data of patients with non-diabetic CHD admitted to Heilongjiang Provincial Hospital from January 2013 to June 2017 were retrospectively analyzed.The patients were divided into atorvastatin group( 20 mg/d),rosuvastatin group( 10 mg/d) and pitavastatin group( 2 mg/d),with 60 cases in each group. Changes of blood lipids and glycometabolism indexes were analyzed before,4 and 12 weeks after treatment. Results Levels of serum triglyceride,total cholesterol and low density lipoprotein cholesterol in the three group significantly decreased and high density lipoprotein cholesterol level significantly increased 4 and 12 weeks after treatment( all P < 0. 05); there was no significant difference among the three groups( P > 0. 05). After 12 weeks of treatment,serum levels of fasting blood glucose and glycosylated hemoglobin significantly increased and fasting insulin significantly decreased compared to those before treatment in the atorvastatin group and rosuvastatin group[atorvastatin group:( 5. 9 ± 0. 9) mmol/L vs( 5. 4 ± 0. 9) mmol/L,( 6. 7 ± 0. 8) % vs( 6. 4 ± 0. 5) %,( 8. 1 ± 0. 8) mI U/L vs( 8. 6 ± 0. 9) mI U/L; rosuvastatin group:( 5. 8 ±0. 9) mmol/L vs( 5. 4 ± 1. 0) mmol/L,( 6. 7 ± 0. 8) % vs( 6. 4 ± 0. 9) %,( 8. 1 ± 0. 8) mI U/L vs( 8. 2 ±0. 8) mI U/L]( all P < 0. 05). Conclusion Pitavastatin shows no obvious effect on glycometabolism in patients with non-diabetic CHD and does not increase the risk of newly onset diabetes in patients with CHD.
引文
[1]李辉,赵凯.氨氯地平阿托伐他汀钙片治疗高血压合并冠心病的临床研究[J].实用药物与临床,2017,20(1):56-59.DOI:10.14053/j.cnki.ppcr.201701016.Li H,Zhao K.Clinical research of amlodipine besylate atorvastatin calcium in patients with hypertension combined with coronary heart disease[J].Practical Pharmacy and Clinical Remedies,2017,20(1):56-59.DOI:10.14053/j.cnki.ppcr.201701016.
[2]李欢,王稳,闫谊,等.阿托伐他汀联合曲美他嗪对冠心病患者心功能和hs-CRP、IL-6、Fib的影响[J].药物评价研究,2017,40(1):108-111.DOI:10.7501/j.issn.1674-6376.2017.01.021.Li H,Wang W,Yan Y,et al.Effect of trimetazidine combined with atorvastatin on cardiac function andlevel of hs-CRP,IL-6,and Fib in patients with coronary heart disease[J].Drug Evaluation Research,2017,40(1):108-111.DOI:10.7501/j.issn.1674-6376.2017.01.021.
[3]刘晓玲,曾朝阳,黄文蓉.二甲双胍联合阿托伐他汀对老年2型糖尿病肾病患者脂代谢及微炎症状态的影响[J].临床内科杂志,2017,34(11):785-786.DOI:10.3969/j.issn.1001-9057.2017.11.022.Liu XL,Zeng CY,Huang WR.Effects of metformin combined with atorvastatin on lipid metabolism and microinflammation in elderly patients with type 2 diabetic nephropathy[J].Journal of Clinical Internal Medicine,2017,34(11):785-786.DOI:10.3969/j.issn.1001-9057.2017.11.022.
[4]郝佳,姜淑萍,赵君,等.不同剂量阿托伐他汀对急性心肌梗死患者餐后4h血脂及心肌血运重建的影响[J].中国医药,2018,13(2):186-190.DOI:10.3760/cma.j.issn.1673-4777.2018.02.007.Hao J,Jiang SP,Zhao J,et al.Effects of different doses of atorvastatin on postprandial 4 h blood lipid and myocardial revascularization in patients with acute myocardial infarction[J].China Medicine,2018,13(2):186-190.DOI:10.3760/cma.j.issn.1673-4777.2018.02.007.
[5]周雷,杨宁.中西医结合治疗对代谢综合征患者血脂及血糖水平的影响分析[J].世界中医药,2018,13(3):648-650,654.DOI:10.3969/j.issn.1673-7202.2018.03.025.Zhou L,Yang N.Effects of combination of traditional Chinese and western medicine on blood lipid and blood glucose level in patients with metabolic syndrome[J].World Chinese Medicine,2018,13(3):648-650,654.DOI:10.3969/j.issn.1673-7202.2018.03.025.
[6]黄占强,吴悦陶,杨阳.他汀类药物的多效性及对糖代谢的影响[J].安徽医药,2013,17(1):11-14.DOI:10.3969/j.issn.1009-6469.2013.01.005.Huang ZQ,Wu YT,Yang Y.The pleiotropic effects and impact on glucose metabolism of statins[J].Anhui Medical and Pharmaceutical Journal,2013,17(1):11-14.DOI:10.3969/j.issn.1009-6469.2013.01.005.
[7]刘虹宏,张京梅,李志忠,等.经皮冠状动脉介入术后大剂量阿托伐他汀对冠状动脉多支病变合并2型糖尿病患者黏附分子和炎性指标及颈动脉斑块面积的影响[J].中国医药,2017,12(11):1609-1613.DOI:10.3760/cma.j.issn.1673-4777.2017.11.003.Liu HH,Zhang JM,Li ZZ,et al.Effect of high dose atorvastatin on adhesion molecules,inflammatory markers and carotid plaque area in patients with multivessel coronary heart disease complicated with type 2 diabetes after percutaneous coronary intervention[J].China Medicine,2017,12(11):1609-1613.DOI:10.3760/cma.j.issn.1673-4777.2017.11.003.
[8]陈慧敏,许逸飞.曲美他嗪联合阿托伐他汀钙治疗冠心病心绞痛伴血脂异常的临床研究[J].中国临床药理学杂志,2016,32(11):966-968.DOI:10.13699/j.cnki.1001-6821.2016.11.002.Chen HM,Xu YF.Clinical trial of trimetazidine combined with atorvastatin calcium in the treatment of coronary heart disease and angina pectoris with dyslipidemia[J].The Chinese Journal of Clinical Pharmacology,2016,32(11):966-968.DOI:10.13699/j.cnki.1001-6821.2016.11.002.
[9]戴敬,孟康,吕树铮.他汀类药物对急性心肌梗死患者应激性高血糖的影响[J].中国循证心血管医学杂志,2014,6(2):160-161,165.DOI:10.3969/j.1674-4055.2014.02.10.Dai J,Meng K,Lyu SZ.Influence of statins on stress hyperglycemia in patients with acute myocardial infarction[J].Chinese Journal of Evidence-Bases Cardiovascular Medicine,2014,6(2):160-161,165.DOI:10.3969/j.1674-4055.2014.02.10.
[10]刘劲松,曾小莉,李娟.他汀类药物治疗心血管获益与糖尿病风险[J].中国循证心血管医学杂志,2016,8(12):1534-1536.DOI:10.3969/j.issn.1674-4055.2016.12.38.Liu JS,Zeng XL,Li J.Cardiovascular benefits of statins and diabetes risk[J].Chinese Journal of Evidence-Bases Cardiovascular Medicine,2016,8(12):1534-1536.DOI:10.3969/j.issn.1674-4055.2016.12.38.
[11]选择性胆固醇吸收抑制剂临床应用中国专家共识(2013版)[J].中国医刊,2014,49(3):103-106.DOI:10.3969/j.issn.1008-1070.2014.03.042.Chinese expert consensus on the clinical application of selective cholesterol absorption inhibitors(2013 edition)[J].Chinese Journal of Medicine,2014,49(3):103-106.DOI:10.3969/j.issn.1008-1070.2014.03.042.
[12]路海平,蔡松,唐明明,等.老年非糖尿病患者应用小剂量普伐他汀的疗效及对糖代谢的影响[J].实用药物与临床,2017,20(9):1030-1032.DOI:10.14053/j.cnki.ppcr.201709011.Lu HP,Cai S,Tang MM,et al.Effect of low-dose pravastatin on glucose metabolism and its therapeutic effect in elderly non-diabetic patients[J].Practical Pharmacy and Clinical Remedies,2017,20(9):1030-1032.DOI:10.14053/j.cnki.ppcr.201709011.
[13]李婉媚,许卓帆,孙燕,等.辛伐他汀对血脂异常人群糖代谢的影响[J].广东医学,2017,38(10):1600-1603.DOI:10.3969/j.issn.1001-9448.2017.10.036.Li WM,Xu ZF,Sun Y,et al.Effects of simvastatin on glucose metabolism in patients with dyslipidemia[J].Guangdong Medical Journal,2017,38(10):1600-1603.DOI:10.3969/j.issn.1001-9448.2017.10.036.
[14]许卓帆,吕敏清,李婉媚.不同剂量辛伐他汀对血脂异常患者糖代谢的影响[J].海南医学,2015,26(15):2202-2204.DOI:10.3969/j.issn.1003-6350.2015.15.0796.Xu ZF,Lyu MQ,Li WM.Impact of different doses of simvastatin on glucose metabolism in the treatment of patients with dyslipidemia[J].Hainan Medical Journal,2015,26(15):2202-2204.DOI:10.3969/j.issn.1003-6350.2015.15.0796.
[15]杨涛,陈磊,宋冬林,等.普伐他汀与瑞舒伐他汀对急性冠脉综合征患者糖代谢的影响[J].武警后勤学院学报:医学版,2015,24(10):779-782.Yang T,Chen L,Song DL,et al.Effect of pravastatin and rosuvastatin on glucose metabolism in patients with acute coronary syndrome[J].Journal of Logistics University of CAPF,2015,24(10):779-782.
[16]李飞.依折麦布联合小剂量阿托伐他汀钙对急性冠脉综合征患者糖代谢水平的影响[D].延安:延安大学,2015.Li F.Effect of ezetimibe combined with low-dose atorvastatin calcium on glucose metabolism in patients with acute coronary syndrome[D].Yan'an:Yan'an University,2015.
[17]蔡淇冰,李三潭,陈晨,等.辛伐他汀联合依折麦布对男性冠心病患者睾酮水平及糖代谢影响的研究[J].重庆医科大学学报,2015,40(4):488-492.DOI:10.13406/j.cnki.cyxb.000613.Cai QB,Li ST,Chen C,et al.Effects of simvastatin combined with ezetimibe on testosterone and blood glucose in male patients with stable coronary artery disease[J].Journal of Chongqing Medical University,2015,40(4):488-492.DOI:10.13406/j.cnki.cyxb.000613.
[2]李欢,王稳,闫谊,等.阿托伐他汀联合曲美他嗪对冠心病患者心功能和hs-CRP、IL-6、Fib的影响[J].药物评价研究,2017,40(1):108-111.DOI:10.7501/j.issn.1674-6376.2017.01.021.Li H,Wang W,Yan Y,et al.Effect of trimetazidine combined with atorvastatin on cardiac function andlevel of hs-CRP,IL-6,and Fib in patients with coronary heart disease[J].Drug Evaluation Research,2017,40(1):108-111.DOI:10.7501/j.issn.1674-6376.2017.01.021.
[3]刘晓玲,曾朝阳,黄文蓉.二甲双胍联合阿托伐他汀对老年2型糖尿病肾病患者脂代谢及微炎症状态的影响[J].临床内科杂志,2017,34(11):785-786.DOI:10.3969/j.issn.1001-9057.2017.11.022.Liu XL,Zeng CY,Huang WR.Effects of metformin combined with atorvastatin on lipid metabolism and microinflammation in elderly patients with type 2 diabetic nephropathy[J].Journal of Clinical Internal Medicine,2017,34(11):785-786.DOI:10.3969/j.issn.1001-9057.2017.11.022.
[4]郝佳,姜淑萍,赵君,等.不同剂量阿托伐他汀对急性心肌梗死患者餐后4h血脂及心肌血运重建的影响[J].中国医药,2018,13(2):186-190.DOI:10.3760/cma.j.issn.1673-4777.2018.02.007.Hao J,Jiang SP,Zhao J,et al.Effects of different doses of atorvastatin on postprandial 4 h blood lipid and myocardial revascularization in patients with acute myocardial infarction[J].China Medicine,2018,13(2):186-190.DOI:10.3760/cma.j.issn.1673-4777.2018.02.007.
[5]周雷,杨宁.中西医结合治疗对代谢综合征患者血脂及血糖水平的影响分析[J].世界中医药,2018,13(3):648-650,654.DOI:10.3969/j.issn.1673-7202.2018.03.025.Zhou L,Yang N.Effects of combination of traditional Chinese and western medicine on blood lipid and blood glucose level in patients with metabolic syndrome[J].World Chinese Medicine,2018,13(3):648-650,654.DOI:10.3969/j.issn.1673-7202.2018.03.025.
[6]黄占强,吴悦陶,杨阳.他汀类药物的多效性及对糖代谢的影响[J].安徽医药,2013,17(1):11-14.DOI:10.3969/j.issn.1009-6469.2013.01.005.Huang ZQ,Wu YT,Yang Y.The pleiotropic effects and impact on glucose metabolism of statins[J].Anhui Medical and Pharmaceutical Journal,2013,17(1):11-14.DOI:10.3969/j.issn.1009-6469.2013.01.005.
[7]刘虹宏,张京梅,李志忠,等.经皮冠状动脉介入术后大剂量阿托伐他汀对冠状动脉多支病变合并2型糖尿病患者黏附分子和炎性指标及颈动脉斑块面积的影响[J].中国医药,2017,12(11):1609-1613.DOI:10.3760/cma.j.issn.1673-4777.2017.11.003.Liu HH,Zhang JM,Li ZZ,et al.Effect of high dose atorvastatin on adhesion molecules,inflammatory markers and carotid plaque area in patients with multivessel coronary heart disease complicated with type 2 diabetes after percutaneous coronary intervention[J].China Medicine,2017,12(11):1609-1613.DOI:10.3760/cma.j.issn.1673-4777.2017.11.003.
[8]陈慧敏,许逸飞.曲美他嗪联合阿托伐他汀钙治疗冠心病心绞痛伴血脂异常的临床研究[J].中国临床药理学杂志,2016,32(11):966-968.DOI:10.13699/j.cnki.1001-6821.2016.11.002.Chen HM,Xu YF.Clinical trial of trimetazidine combined with atorvastatin calcium in the treatment of coronary heart disease and angina pectoris with dyslipidemia[J].The Chinese Journal of Clinical Pharmacology,2016,32(11):966-968.DOI:10.13699/j.cnki.1001-6821.2016.11.002.
[9]戴敬,孟康,吕树铮.他汀类药物对急性心肌梗死患者应激性高血糖的影响[J].中国循证心血管医学杂志,2014,6(2):160-161,165.DOI:10.3969/j.1674-4055.2014.02.10.Dai J,Meng K,Lyu SZ.Influence of statins on stress hyperglycemia in patients with acute myocardial infarction[J].Chinese Journal of Evidence-Bases Cardiovascular Medicine,2014,6(2):160-161,165.DOI:10.3969/j.1674-4055.2014.02.10.
[10]刘劲松,曾小莉,李娟.他汀类药物治疗心血管获益与糖尿病风险[J].中国循证心血管医学杂志,2016,8(12):1534-1536.DOI:10.3969/j.issn.1674-4055.2016.12.38.Liu JS,Zeng XL,Li J.Cardiovascular benefits of statins and diabetes risk[J].Chinese Journal of Evidence-Bases Cardiovascular Medicine,2016,8(12):1534-1536.DOI:10.3969/j.issn.1674-4055.2016.12.38.
[11]选择性胆固醇吸收抑制剂临床应用中国专家共识(2013版)[J].中国医刊,2014,49(3):103-106.DOI:10.3969/j.issn.1008-1070.2014.03.042.Chinese expert consensus on the clinical application of selective cholesterol absorption inhibitors(2013 edition)[J].Chinese Journal of Medicine,2014,49(3):103-106.DOI:10.3969/j.issn.1008-1070.2014.03.042.
[12]路海平,蔡松,唐明明,等.老年非糖尿病患者应用小剂量普伐他汀的疗效及对糖代谢的影响[J].实用药物与临床,2017,20(9):1030-1032.DOI:10.14053/j.cnki.ppcr.201709011.Lu HP,Cai S,Tang MM,et al.Effect of low-dose pravastatin on glucose metabolism and its therapeutic effect in elderly non-diabetic patients[J].Practical Pharmacy and Clinical Remedies,2017,20(9):1030-1032.DOI:10.14053/j.cnki.ppcr.201709011.
[13]李婉媚,许卓帆,孙燕,等.辛伐他汀对血脂异常人群糖代谢的影响[J].广东医学,2017,38(10):1600-1603.DOI:10.3969/j.issn.1001-9448.2017.10.036.Li WM,Xu ZF,Sun Y,et al.Effects of simvastatin on glucose metabolism in patients with dyslipidemia[J].Guangdong Medical Journal,2017,38(10):1600-1603.DOI:10.3969/j.issn.1001-9448.2017.10.036.
[14]许卓帆,吕敏清,李婉媚.不同剂量辛伐他汀对血脂异常患者糖代谢的影响[J].海南医学,2015,26(15):2202-2204.DOI:10.3969/j.issn.1003-6350.2015.15.0796.Xu ZF,Lyu MQ,Li WM.Impact of different doses of simvastatin on glucose metabolism in the treatment of patients with dyslipidemia[J].Hainan Medical Journal,2015,26(15):2202-2204.DOI:10.3969/j.issn.1003-6350.2015.15.0796.
[15]杨涛,陈磊,宋冬林,等.普伐他汀与瑞舒伐他汀对急性冠脉综合征患者糖代谢的影响[J].武警后勤学院学报:医学版,2015,24(10):779-782.Yang T,Chen L,Song DL,et al.Effect of pravastatin and rosuvastatin on glucose metabolism in patients with acute coronary syndrome[J].Journal of Logistics University of CAPF,2015,24(10):779-782.
[16]李飞.依折麦布联合小剂量阿托伐他汀钙对急性冠脉综合征患者糖代谢水平的影响[D].延安:延安大学,2015.Li F.Effect of ezetimibe combined with low-dose atorvastatin calcium on glucose metabolism in patients with acute coronary syndrome[D].Yan'an:Yan'an University,2015.
[17]蔡淇冰,李三潭,陈晨,等.辛伐他汀联合依折麦布对男性冠心病患者睾酮水平及糖代谢影响的研究[J].重庆医科大学学报,2015,40(4):488-492.DOI:10.13406/j.cnki.cyxb.000613.Cai QB,Li ST,Chen C,et al.Effects of simvastatin combined with ezetimibe on testosterone and blood glucose in male patients with stable coronary artery disease[J].Journal of Chongqing Medical University,2015,40(4):488-492.DOI:10.13406/j.cnki.cyxb.000613.