阿托伐他汀和瑞舒伐他汀对非糖尿病脑梗死二级预防患者血糖的影响
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摘要
目的观察非糖尿病脑梗死二级预防患者服用不同剂量阿托伐他汀和瑞舒伐他汀调控血脂时血糖相关指标的变化。方法将150例患者随机分为5组各30例,分别给予阿托伐他汀钙片10mg、20mg、40mg和瑞舒伐他汀钙片10mg、20mg,口服,每晚1次。疗程均为24周。观察治疗前后空腹三酰甘油(triglyceride,TG)、总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、空腹血糖(fasting blood glucose,FBG)、糖化血红蛋白(glycosylated hemoglobin,HbA1c)的变化。结果治疗后,阿托伐他汀10mg组、20mg组、40mg组和瑞舒伐他汀10mg组、20mg组TG、TC、LDL-C较治疗前明显下降,阿托伐他汀20mg组HbA1c较治疗前升高,阿托伐他汀40mg组FBG和HbA1c较治疗前升高(P<0.05);治疗后,阿托伐他汀20mg组、40mg组和瑞舒伐他汀10mg组、20mg组TG、TC、LDL-C低于阿托伐他汀10mg组,阿托伐他汀40mg组TG、TC、LDL-C又低于20mg组和瑞舒伐他汀10mg组,瑞舒伐他汀20mg组低于10mg组(P<0.05),阿托伐他汀40mg组HbA1c高于阿托伐他汀10mg组、20mg组和瑞舒伐他汀10mg组、20mg组(P<0.05)。结论瑞舒伐他汀降脂效果与阿托伐他汀相同时对FBG和HbA1c影响较小。
Objective To observe the level changes of blood glucose related indexes in patients with non-diabetes but with cerebral infarction secondary prevention,when they took different doses of atorvastatin or rosuvastatin to regulate blood lipids.Methods One hundred and fifty patients were randomly divided into 5 groups,30 patients in each group.They were respectively treated with 10 mg atorvastatin,20 mg atorvastatin,40 mg atorvastatin,10 mg rosuvastatin or 20 mg rosuvastatin by oral administration once a night.The course of treatment was 24 weeks.The level changes of fasting triglyceride(TG),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),fasting blood glucose(FBG)and glycosylated hemoglobin(HbA1c)in those patients were observed before and after treatment.Results After treatment,the level of TG,TC and LDL-C of each group were significantly decreased,HbA1c level of 20 mg atorvastatin group was significantly increased and the level of FBG and HbA1 c of 40 mg atorvastatin group were significantly increased(P<0.05).Pairwise comparison among groups after treatment:the level of TG,TC and LDL-C of 10 mg atorvastatin group were significantly higher than those of other four groups,those of 40 mg atorvastatin group were significantly lower than those of 20 mg atorvastatin group and two rosuvastatin groups.Those of 20 mg rosuvastatin group were significantly lower than those of 10 mg rosuvastatin group(P<0.05).HbA1c level of40 mg atorvastatin group were significantly higher than that of other four groups(P<0.05).Conclusion The effect of rosuvastatin on FBG and HbA1c is less than that of atorvastatin when the lipid-lowering effect of rosuvastatin is the same as that of atorvastatin.
Objective To observe the level changes of blood glucose related indexes in patients with non-diabetes but with cerebral infarction secondary prevention,when they took different doses of atorvastatin or rosuvastatin to regulate blood lipids.Methods One hundred and fifty patients were randomly divided into 5 groups,30 patients in each group.They were respectively treated with 10 mg atorvastatin,20 mg atorvastatin,40 mg atorvastatin,10 mg rosuvastatin or 20 mg rosuvastatin by oral administration once a night.The course of treatment was 24 weeks.The level changes of fasting triglyceride(TG),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),fasting blood glucose(FBG)and glycosylated hemoglobin(HbA1c)in those patients were observed before and after treatment.Results After treatment,the level of TG,TC and LDL-C of each group were significantly decreased,HbA1c level of 20 mg atorvastatin group was significantly increased and the level of FBG and HbA1 c of 40 mg atorvastatin group were significantly increased(P<0.05).Pairwise comparison among groups after treatment:the level of TG,TC and LDL-C of 10 mg atorvastatin group were significantly higher than those of other four groups,those of 40 mg atorvastatin group were significantly lower than those of 20 mg atorvastatin group and two rosuvastatin groups.Those of 20 mg rosuvastatin group were significantly lower than those of 10 mg rosuvastatin group(P<0.05).HbA1c level of40 mg atorvastatin group were significantly higher than that of other four groups(P<0.05).Conclusion The effect of rosuvastatin on FBG and HbA1c is less than that of atorvastatin when the lipid-lowering effect of rosuvastatin is the same as that of atorvastatin.
引文
[1]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[2]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2014[J].中华神经科杂志,2015,48(4):258-273.
[3]李荣华,韦世友,管萍,等.氯吡格雷联合阿托伐他汀或瑞舒伐他汀用于脑梗死二级预防效果比较[J].山东医药,2017,57(12):83-85.
[4]血脂异常老年人使用他汀类药物中国专家共识组.血脂异常老年人使用他汀类药物中国专家共识[J].中华内科杂志,2015,54(5):467-477.
[5] Waters DD,Ho JE,Boekholdt SM,et al.Cardiovascular event reduction versus new-onset diabetes during atorvastatin therapy:effect of baseline risk factors for diabetes[J].J Am Coll Cardiol,2013,61(2):148-152.
[6]中国成人血脂异常防治指南修订联合委员会.中国成人血脂异常防治指南(2016年修订版)[J].中国循环杂志,2016,31(10):937-950.
[7]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中华糖尿病杂志,2014,6(7):447-498.
[8]李真,李伟,陈琦,等.不同剂量瑞舒伐他汀治疗急性脑梗死的临床观察[J].中国药房,2017,28(14):1948-1951.
[9]陈梅,郭明升.脂康颗粒联合不同剂量阿托伐他汀用于脑梗死二级预防效果观察及析因分析[J].药物流行病学杂志,2017,26(5):309-313.
[10]杨文,刘洁云,秦雷.瑞舒伐他汀与阿托伐他汀治疗冠心病的疗效对比研究[J].中国全科医学,2013,16(6):621-623.
[11] Bener A,Dogan M,Barakat L,et al.Comparison of costeffectiveness,safety,and efficacy of rosuvastatin versus atorvastatin,pravastatin,and simvastatin in dyslipidemic diabetic patients with or without metabolic syndrome[J].J Prim Care Community Health,2014,5(3):180-187.
[12]梁祥文,李平,甘剑挺,等.瑞舒伐他汀对急性ST段抬高型心肌梗死患者冠状动脉支架术后再狭窄的影响[J].中国临床药理学杂志,2015,31(17):1703-1705.
[13]王鹏,严妍,于文君,等.阿托伐他汀与瑞舒伐他汀对冠心病患者的疗效与安全性对比观察[J].中国医院药学杂志,2018,38(2):169-172,202.
[14] Li L,Wang Y,Xu Y,et al.Atorvastatin inhibits CD68expression in aortic root through a GRP78-involved pathway[J].Cardiovasc Drugs Ther,2014,28(6):523-532.
[15]高海燕,崔岭,韦洪艳,等.阿托伐他汀在冠心病治疗中IL-6、APN水平动态变化观察[J].河北医科大学学报,2013,34(9):1051-1053.
[16]宋梅,田玉和.瑞舒伐他汀治疗对颈动脉斑块以及炎性因子的影响[J].中国地方病防治杂志,2017,32(2):182-183.
[17]刘爱宁,杨文刚,鞠树红,等.不同剂量瑞舒伐他汀对实验性动脉粥样硬化大鼠过氧化及血管平滑肌增生的影响[J].河北医科大学学报,2015,36(2):133-136.
[18]侯慧清,苗军,孙大宝,等.阿托伐他汀治疗急性脑梗死39例[J].医药导报,2013,32(8):1033-1035.
[19] Delgado-Len TG,Slas-Pacheco JM,Vazquez-Alaniz F,et al.Apoptosis in pancreaticβ-cells is induced by arsenic and atorvastatin in Wistar rats with diabetes mellitus type 2[J].J Trace Elem Med Biol,2018,46:144-149.
[20] Sun B,Zhong Z,Wang F,et al.Atorvastatin impaired glucose metabolism in C2C12 cells partly via inhibiting cholesterol-dependent glucose transporter 4 translocation[J].Biochem Pharmacol,2018,150:108-119.
[21] Ling Z,Shu N,Xu P,et al.Involvement of pregnane X receptor in the impaired glucose utilization induced by atorvastatin in hepatocytes[J].Biochem Pharmacol,2016,100:98-111.
[22]边亚,牛素贞,籍子英,等.阿托伐他汀对高血压合并早期肾损害患者血糖及糖化血红蛋白的影响[J].河北医药,2014,36(14):2101-2104.
[23]周莉,刘翠平,武霞,等.瑞舒伐他汀对伴有2型糖尿病的冠心病患者空腹血糖和糖化血红蛋白的影响[J].临床合理用药杂志,2014,7(7):83.
[24]张海娜,戴歌心,徐慧,等.瑞舒伐他汀与阿托伐他汀对高脂血症患者血糖影响的Meta分析[J].药物流行病学杂志,2017,26(9):604-606,626.
[25]Maki KC,Ridker PM,Brown WV,et al.An assessment by the statin diabetes safety task force:2014update[J].J Clin Lipidol,2014,8(3Suppl):S17-29.
[2]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2014[J].中华神经科杂志,2015,48(4):258-273.
[3]李荣华,韦世友,管萍,等.氯吡格雷联合阿托伐他汀或瑞舒伐他汀用于脑梗死二级预防效果比较[J].山东医药,2017,57(12):83-85.
[4]血脂异常老年人使用他汀类药物中国专家共识组.血脂异常老年人使用他汀类药物中国专家共识[J].中华内科杂志,2015,54(5):467-477.
[5] Waters DD,Ho JE,Boekholdt SM,et al.Cardiovascular event reduction versus new-onset diabetes during atorvastatin therapy:effect of baseline risk factors for diabetes[J].J Am Coll Cardiol,2013,61(2):148-152.
[6]中国成人血脂异常防治指南修订联合委员会.中国成人血脂异常防治指南(2016年修订版)[J].中国循环杂志,2016,31(10):937-950.
[7]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中华糖尿病杂志,2014,6(7):447-498.
[8]李真,李伟,陈琦,等.不同剂量瑞舒伐他汀治疗急性脑梗死的临床观察[J].中国药房,2017,28(14):1948-1951.
[9]陈梅,郭明升.脂康颗粒联合不同剂量阿托伐他汀用于脑梗死二级预防效果观察及析因分析[J].药物流行病学杂志,2017,26(5):309-313.
[10]杨文,刘洁云,秦雷.瑞舒伐他汀与阿托伐他汀治疗冠心病的疗效对比研究[J].中国全科医学,2013,16(6):621-623.
[11] Bener A,Dogan M,Barakat L,et al.Comparison of costeffectiveness,safety,and efficacy of rosuvastatin versus atorvastatin,pravastatin,and simvastatin in dyslipidemic diabetic patients with or without metabolic syndrome[J].J Prim Care Community Health,2014,5(3):180-187.
[12]梁祥文,李平,甘剑挺,等.瑞舒伐他汀对急性ST段抬高型心肌梗死患者冠状动脉支架术后再狭窄的影响[J].中国临床药理学杂志,2015,31(17):1703-1705.
[13]王鹏,严妍,于文君,等.阿托伐他汀与瑞舒伐他汀对冠心病患者的疗效与安全性对比观察[J].中国医院药学杂志,2018,38(2):169-172,202.
[14] Li L,Wang Y,Xu Y,et al.Atorvastatin inhibits CD68expression in aortic root through a GRP78-involved pathway[J].Cardiovasc Drugs Ther,2014,28(6):523-532.
[15]高海燕,崔岭,韦洪艳,等.阿托伐他汀在冠心病治疗中IL-6、APN水平动态变化观察[J].河北医科大学学报,2013,34(9):1051-1053.
[16]宋梅,田玉和.瑞舒伐他汀治疗对颈动脉斑块以及炎性因子的影响[J].中国地方病防治杂志,2017,32(2):182-183.
[17]刘爱宁,杨文刚,鞠树红,等.不同剂量瑞舒伐他汀对实验性动脉粥样硬化大鼠过氧化及血管平滑肌增生的影响[J].河北医科大学学报,2015,36(2):133-136.
[18]侯慧清,苗军,孙大宝,等.阿托伐他汀治疗急性脑梗死39例[J].医药导报,2013,32(8):1033-1035.
[19] Delgado-Len TG,Slas-Pacheco JM,Vazquez-Alaniz F,et al.Apoptosis in pancreaticβ-cells is induced by arsenic and atorvastatin in Wistar rats with diabetes mellitus type 2[J].J Trace Elem Med Biol,2018,46:144-149.
[20] Sun B,Zhong Z,Wang F,et al.Atorvastatin impaired glucose metabolism in C2C12 cells partly via inhibiting cholesterol-dependent glucose transporter 4 translocation[J].Biochem Pharmacol,2018,150:108-119.
[21] Ling Z,Shu N,Xu P,et al.Involvement of pregnane X receptor in the impaired glucose utilization induced by atorvastatin in hepatocytes[J].Biochem Pharmacol,2016,100:98-111.
[22]边亚,牛素贞,籍子英,等.阿托伐他汀对高血压合并早期肾损害患者血糖及糖化血红蛋白的影响[J].河北医药,2014,36(14):2101-2104.
[23]周莉,刘翠平,武霞,等.瑞舒伐他汀对伴有2型糖尿病的冠心病患者空腹血糖和糖化血红蛋白的影响[J].临床合理用药杂志,2014,7(7):83.
[24]张海娜,戴歌心,徐慧,等.瑞舒伐他汀与阿托伐他汀对高脂血症患者血糖影响的Meta分析[J].药物流行病学杂志,2017,26(9):604-606,626.
[25]Maki KC,Ridker PM,Brown WV,et al.An assessment by the statin diabetes safety task force:2014update[J].J Clin Lipidol,2014,8(3Suppl):S17-29.