阿托伐他汀对经皮冠状动脉介入治疗后患者血脂及胰岛素抵抗的影响

摘要

Objective To observe the effect of atorvastatin on blood lipid and glucose in acute myocardial infarction (AMI) patients underwent emergent percutaneous coronary intervention (PCI) with normal fasting and postprandial blood glucose,and to explore its mechanism .Methods Sixty AMI patients with normal blood glucose underwnt emergent PCI were randomly divided into groups A , B, with 30 cases in each group .Two groups were both given the same secondary prevention against coronary heart disease .Group A took atorvastatin 20 mg/d,and group B atorvastatin 80 mg/d.The treatment lasted for 8 weeks.The levels of total cholesterol (TC),triglyceride(TG),serum low density lipoprotein (LDL), fasting plasma glucose(FPG),glycosylated hemoglobin (HbA1c) and fasting insulin(FINS) were detected before and 8 weeks after treatment .HOMA index was used to calculate the insulin sensitivity and B cell function .Results Eight weeks after the treatment of atorvastatin ,the levels of TG,TC,LDL-C in both groups were significantly lower than those before treatment(P<0.05),and the decrease in group B was more significant than that in group A (P<0.05).The PINS level in group B was higher than that in group A (P <0.05).The FPG and HbA1c changes before and after treatment showed no significant difference between two groups ( P>0 .05 ) .The results of HOMA-IR showed that both groups had insulin resistance and group B had higher insulin resistance compared with group A (P<0.01).HOMA-B suggested that insulin function imrpoved and insulin release increased in group B .Conclusion Atorvastatin can decrease the levels of TG ,TC and LDL-C in patients undergoing emergent PCI .However ,the PINS and HOMA-B index increase with a dose-dependent manner .%目的：观察空腹及餐后血糖正常急性心肌梗死患者行急诊经皮冠状动脉介入治疗（ PCI ）后，使用阿托伐他汀对血脂、血糖的影响并探讨其机制。方法对血糖正常、行急诊PCI的60例急性心肌梗死患者，按随机数字表法分为A、B两组，每组30例。两组均给予相同的冠心病二级预防药物治疗方案， A组口服阿托伐他汀20 mg/d，B组口服阿托伐他汀80 mg/d，共治疗8周，检测治疗前及治疗8周后的总胆固醇（ TC）、甘油三酯（ TG）、血清低密度脂蛋白（ LDL）、空腹血糖（ FPG）、糖化血红蛋白（ HbA1 c）、空腹胰岛素（ FINS）水平，使用HOMA指数计算胰岛素敏感性和B细胞功能。结果阿托伐他汀治疗8周后，两组患者的TG、TC、LDL-C均较治疗前明显降低（P＜0．05），且B组降低幅度较A组明显（P＜0．05），FINS B组比A组高（P＜0．05），两组在治疗前后FPG和HbA 1 c的改变差异无统计学意义（ P＞0．05）。 HOMA-IR结果提示两组均存在胰岛素抵抗，且B组高于A组（P＜0．01），HOMA-B提示B组胰岛功能增强，胰岛素释放量增加。结论阿托伐他汀可以降低急诊PCI术后患者的TG、TC及LDL-C水平，但FINS及HOMA-B指数增加，并呈剂量依耐性。