辛伐他汀和血脂康对新发老年2型糖尿病患者的调脂效果和安全性分析

摘要

目的 了解新发老年2型糖尿病患者血脂异常的发生率和知晓情况,比较辛伐他汀和血脂康的降脂效果,并分析其安全性. 方法 回顾性分析中国糖尿病并发症防治研究(CDCPS)中255例年龄在60～75岁,诊断1年之内2型糖尿病患者的血脂异常分布情况.在生活方式干预和血糖、血压控制的前提下,比较仅用生活方式干预不用药、辛伐他汀(20 mg/d)与血脂康(0.6～1.2 g/d)后血脂异常患者随访20个月的血脂水平及对肝、肾功能的变化. 结果 255例新发老年2型糖尿病患者中血脂异常的发生率为62.0％,知晓率为55.7％.血脂异常中高三酰甘油血症的发生率最高,为29.7％.在88例已知血脂异常的患者中仅有25例(28.4％)在研究进行前使用过降脂药物,其中有8例(32％)血脂降到正常水平,只有3例(12％)达到强化控制标准.与基线水平相比,随访末三酰甘油、总胆固醇和低密度脂蛋白胆固醇(LDL-C)水平较基线水平在辛伐他汀组分别降低了1.8％、10.5％和20.0％,血脂康组分别降低5.5％、15.0％和15.7％,未用药组分别降低2.7％、8.7％和4.5％.血脂异常的患者中,与仅用生活方式干预组比较,辛伐他汀和血脂康对LDL-C有降低作用(P=0.0047、0.0433).辛伐他汀与血脂康间的降脂作用并没有统计学差别.药物干预前后肝、肾脏功能无明显差异(P＞0.05). 结论 针对新发老年2型糖尿病患者应检查血脂并早期实施药物干预.应用降脂药物比单纯生活方式干预能更有效降低血脂,但是血脂康和辛伐他汀的降脂作用并没有统计学差别.同时两种药物均具有良好的安全性.%Objective To observe the incidence and awareness of dyslipidemia in newly diagnosed elderly type 2 diabetic patients,and to determine the efficacy and safety of simvastatin and Xuezhikang in the treatment of dyslipidemia.Methods Totally 255 newly diagnosed type 2 diabetic patients aged 60 to 75 years in CDCPS research were included and the incidence of dyslipidemia were retrospectively analyzed.Patients were divided into 3 groups:the group 1 was given simvastatin (20 mg/d); the group 2 was given Xuezhikang (0.6～ 1.2 g/d); the group 3 was given no lipid-lowering drugs.All the three groups were given lifestyle intervention and blood pressure and blood sugar control.All patients were followed up monthly and TG,TC,LDL-C,BUN,ALT and creatinine were examined at 7th,14th,and 20th months.Results The incidence of dyslipidemia and the rate of awareness in the study cohort was 62％ and 55.7％.Hypertriglyceridemia was the most common type of dyslipidemia (29％).Among 88 patients with dyslipidemia,25 (28.4％) patients had been treated with lipid-lowering drugs before our study,in whom,8(32％) patients had normal serum lipid levels and only 3 (12％)patients reached to the control standards.20 months after the treatment,the decrement scales of TG,TC and LDL-C were 1.8％,10.5 ％ and 20 ％ respectively in group 1;5.5 ％,15.0％ and 15.7％ respectively in group 2;2.7％,8.7％ and 4.5％ respectively in group 3.The long-term lifestyle intervention and blood pressure and blood sugar control reduced serum lipid to some degree.In the patients with dyslipidemia,lipid-lowering drugs had a better effect on serum lipid reduction than did the lifestyle intervention (P=0.0047,0.0433).There was no significant difference between simvastatin and Xuezhikang.The function changes of liver and kidney had no difference before and after drug intervention (P＞0.05).Conclusions Serum lipid should be monitored and early medicine intervention should be taken in newly diagnosed elderly type 2 diabetic patients.Medicine intervention has a better effect on serum lipid reduction than lifestyle intervention,and there are no significant differences in efficacy and safety between simvastatin and Xuezhikang.