冠状动脉粥样硬化性心脏病合并糖尿病患者调脂治疗中胆固醇代谢标志物变化的研究被引量：5

The variation of cholesterol metabolism markers in antilipemic therapy treating coronary atherosclerotic heart disease and diabetes

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摘要目的探讨冠状动脉粥样硬化性心脏病（冠心病）合并糖尿病患者调脂治疗中胆固醇代谢标志物变化情况。方法选择2013年5月至2015年5月在首都医科大学附属北京安贞医院住院并接受冠状动脉造影检查诊断为冠心病合并糖尿病的患者76例。所有患者入院前至少4周内均未接受调脂药物治疗。根据糖化血红蛋白（HbA1c）水平的不同分为5．2％～〈7．0％组（37例）、7．0％～〈9．0％组（24例）和9．0％-11．3％组（15例）。所有患者均接受瑞舒伐他汀10mg／d治疗4周，根据患者血脂水平是否达标分为血脂达标组42例[低密度脂蛋白胆固醇（LDL—C）〈2．07mmol／L]和血脂未达标组34例（LDL-C≥2．07mmol／L），血脂达标组继续瑞舒伐他汀10mg／d治疗至第12周，血脂未达标组联合依折麦布10mg／d治疗至第12周。比较3组不同HbAlc水平患者治疗前以及血脂达标组与未达标组治疗前及治疗4、12周时的血脂指标和胆固醇代谢标志物的水平情况。结果治疗前，9．0％-11．3％组总胆固醇、LDL—C水平、胆固醇吸收标志物菜油固醇含量明显高于5．2％-〈7．0％组[（4．7±1．4）mmol／L比（4．4±0．9）mmol／L、（2．9±0．7）mmol／L比（2．8±0．7）mmo]／L、（7．7±1．9）mmol／L比（7．1±1．0）mmol／L]；3组患者中，高HbAlc水平组的谷固醇含量明显高于低HbAlc水平组[（13．6±1．9）mg／L、（12．6±1．3）mg／L比（11．3±1．5）mg／L]，差异均有统计学意义（均P〈0．05）。治疗4周时，血脂达标组42例（55．3％），血脂未达标组34例（44．7％）；2组患者的总胆固醇含量、LDL．C及胆固醇合成标志物7-烯胆甾烷醇含量明显低于治疗前，吸收标志物谷固醇明显高于治疗前[血脂未达标组：（3．8±1．0）mmol／L比（4．6±1．1）mmol／L，（2．3±0．5）mmo]／L比（3．0±0．9）mmo]／L，（6．4±1．0）mg／L比（7．0±0．9）mg／L，（14．1±2．1）mg／L比（12．5±2．0）mg／L；血脂达标组：（3．4±1．0）mmol／L比（4．5±0．8）mmol／L，（1．9±0．6）mmol／L比（2．8±0．6）mmol／L，（6．2±0．7）mg／L比（7．4±0．9）mg／L，（13．8±2．1）mg／L比（11．0±0．9）mg／L]，差异均有统计学意义（均P〈0．05）。治疗12周时，血脂达标组的总胆固醇、LDL—C水平及胆固醇代谢标志物含量与治疗4周时比较，差异均无统计学意义（均P〉0．05）；血脂未达标组血脂达标者25例（73．5％），血脂未达标组的总胆固醇、LDL—C水平及胆固醇吸收标志物菜油固醇、谷固醇的含量明显低于治疗4周时[（3．4±0．6）mmo]／L比（3．8±1．0）mmol／L，（2．0±0．7）mmo]／L比（2．3±0．5）mmo]／L，（5．5±1．7）mg／L比（7．4±1．8）mg／L，（9．3±1．8）mg／L比（14．1±2．1）mg／L]，差异均有统计学意义（均P〈0．05）。结论瑞舒伐他汀联合依折麦布调脂治疗能够明显降低冠心病合并糖尿病患者的总胆固醇、LDL-C水平和胆固醇吸收标志物菜油固醇、谷固醇的含量，提高血脂达标率。 Objective To analyze the variation of cholesterol matabolism markers in antilipemic therapy treating coronary atherosclerotic heart disease （CHD） complicated with diabetes. Methods Totally 76 patients with CHD complicated with diabetes who had not taken antilipemic drugs in 4 weeks before admission from May 2013 to May 2015 in Beijing Anzhen Hospital, Capital Medical University were enrolled. All patients were divided into 3 groups according to the level of glycosylated hemoglobin （ HbAlc ）： group A （ HbAlc 5.2% - 〈 7.0%, 51 cases）, group B （ HbAlc 7.0%- 〈 9. 0%, 33 cases）, group C （ HbA1c 9.0%-11.3%, 20 cases）. All patients were treated with rosuvastatin 10 mg/d for 4 weeks, and they were divided into 2 groups according to the level of low-density lipoprotein cholesterol （LDL-C）： group D （ LDL-C 〈 2. 07 retool/L, 42 cases） and group E （LDL-C≥2. 07 mmol/L, 34 cases）. Group D was treated with rosuvastatin 10 mg/d for 8 weeks; group E was treated with rosuvastatin 10 mg/d combined with ezetimibe 10 mg/d for 8 weeks. Levels of blood lipid indexes and cholesterol matabolism markers were analyzed. Results Before treatment, total cholesterol （TC）, LDL-C and campesterol（ a marker of cholesterol absorption） in group C were significantly higher than those in group A [（4.7±1.4）mmol/L vs （4.4 ±0.9）mmol/L, （2.9 ±0.7）mmol/L vs （2.8 ±0.7）mmol/L, （7.7 ± 1.9） mmol/L vs （7.1 ± 1.0） mmol/L ] （ all P 〈 0. 05 ） ; sitosterol （ a marker of cholesterol absorption） levels in group B, C were significantly higher than that in group A[ （13.6 ± 1.9）mmol/L, （12. 6 ± 1.3）mmol/L vs （ 11.3 ± 1.5 ） mmol/L 1 （ all P 〈 0. 05 ）. After 4 weeks of treatment, there were 42 cases （55.3 % ） in group D and 34 cases（44.7% ） in group E; TC, LDL-C and lathosterol（ a marker of cholesterol synthesis） were significantly lower than those before treatment in group D and group E, sitosterol levels were significantly higher than those before treatment in both groups [ group D：（3.8 ± 1.0） mmol/L vs （4. 6 ± 1.1 ） mmol/L, （ 2. 3 ± 0. 5 ） mmol/L vs （3.0±0.9）mmol/L, （6.4±1.0）mg/L vs （7.0±0.9）mg/L, （14.1 ±2.1）mg/L vs （12.5 ±2.0）mg/L; group E：（3.4 ±1.0）mmol/L vs （4.5 ±0. 8）mmol/L, （1.9 ±0. 6） mmol/L vs （2.8 ±0. 6）mmol/L, （6.2 ± 0. 7 ） mg/L vs （7.4 ± 0. 9） mg/L, （ 13.8 ± 2. 1 ） mg/L vs （ 11.0 ± 0. 9） mg/Ll （ all P 〈 0. 05 ）. After 12 weeks of treatment, TC, LDL-C and cholesterol matabolism markers did not significantly decreased compared to those after 4 weeks of treatment in group D （ P 〉 0. 05 ） ; in group E [ 25 cases （ 73.5% ） ], TC, LDL-C, campesterol and sitosterol were significantly lower than those after 4 weeks of treatment [ （ 3.4 ± 0. 6 ） mmol/L vs （ 3.8 ± 1. 0） mmol/L, （2. 0 ± 0. 7） mmol/L vs （2. 3 ± 0. 5 ） mmol/L, （5.5 ± 1.7 ） mmol/L vs （7.4 ± 1.8 ） mmol/L, （9.3 ± 1.8）mmol/L vs （ 14. 1 ±2. 1 ）mmol/L] （all P 〈0. 05）. Conclusion Rosuvastatin combined with ezetimibe can significantly lower levels of TC, LDL-C, campesterol and sitosterol in patients with CHD and diabetes.