Objective To investigate the efficacy of combination of ezetimibe and atorvastatin in treatment of patients with nonalcoholic fatty liver disease(NAFLD)complicated by coronary heart disease(CHD). Methods 114 patients with NAFLD and CHD were recruited in our hospital between February 2014 and February 2016,and were randomly divided into the observation group and the control group with 57 cases in each group by a computer-generated numbers. The patients in the control group were given atorvastatin calcium,and those in the observation group were given combination of ezetimibe and atorvastatin therapy for six months. The left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVVED)and left ventricular posterior wall depth(LVPWd)were obtained by echocardiography,and serum interleukin -6(IL-6)and interleukin-10(IL-10)were assayed by ELISA. Results At the end of six month observation,serum TC,TG and LDL-C levels were(4.3±1.6)mmol/L,(2.4±0.9)mmol/L and(2.8±1.1)mmol/L,respectively in the observation group,significantly lower than(5.1±1.7)mmol/L,(2.9±0.9)mmol/L and(3.3±1.2)mmol/L(P<0.05)in the control group,while serum HDL-C level was(1.3 ± 0.5)mmol/L,significantly higher than(1.0±0.4)mmol/L(P<0.05)in the control group;serum ALT,AST and GGT levels decreased significantly in the observation (P<0.05);the LVEF was(47.2 ±6.4)%,significantly higher than(42.8 ±5.8)%(P<0.05),while LEVDD and LVPWd were(52.5 ±7.3)mm and(10.1 ±0.9)mm, significantly lower than(58.2±7.6)mm and(11.4±1.1)mm,respectively(P<0.05)in the control;serum levels of ADMA,hs-CRP and IL-6 were(2.8±0.4)μmol/L, (3.4±0.7)mg/L and(39.3±6.9)ng/L,significantly lower than(3.0±0.4)μmol/L,(3.9±0.7)mg/L and(45.9±8.4) ng/L(P<0.05)in the control and serum level of IL-10 was(28.7±8.6)ng/L,significantly higher than(22.3±5.4) ng/L(P<0.05)in the control group. Conclusions Ezetimibe combined with atorvastatin could significantly decrease the serum lipid levels and improve liver functions in patients with NAFLD complicated by CHD,which might be related to the regulation of lipid metabolism and reduced levels of ADMA and serum inflammatory factors.%目的 探讨依泽替米贝联合阿托伐他汀治疗非酒精性脂肪性肝病(NAFLD )合并冠心病患者的疗效.方法2014年2月~2016年2月我院收治的NAFLD合并冠心病患者114例,被随机分为观察组和对照组,每组57例,分别接受依泽替米贝联合阿托伐他汀钙片或阿托伐他汀治疗6 m.使用Philips HD 6型彩色多普勒超声诊断仪检测左心室射血分数(LVEF)、左心室舒张末期直径(LVVED)和 左心室后壁厚度(LVPWd);采用高效液相色谱法检测血清非对称性二甲基精氨酸(ADMA)水平,采用ELISA 法检测血清白介素-6(IL-6)和白介素-10 (IL-10)水平.结果 在治疗6 m末,观察组血清TC、TG、LDL-C水平分别为(4.3±1.6)mmol/L、(2.4±0.9)mmol/L和(2.8±1.1)mmol/L,显著低于对照组的(5.1±1.7)mmol/L、(2.9±0.9)mmol/L和(3.3±1.2)mmol/L(P<0.05),血清HDL-C水平为(1.3±0.5)mmol/L,显著高于对照组的(1.0±0.4)mmol/L(P<0.05);观察组血清肝功能指标改善显著优于对照组(P<0.05);观察组LVEF为(47.2±6.4)%,显著高于对照组的(42.8±5.8)%(P<0.05),LEVDD和LVPWd分别为(52.5±7.3)mm和(10.1±0.9)mm,显著低于对照组的(58.2±7.6)mm和(11.4±1.1)mm(P<0.05);观察组血清ADMA、hs-CRP和IL-6水平分别为(2.8±0.4)μmol/L、(3.4±0.7)mg/L和(39.3±6.9)ng/L,显著低于对照组的(3.0±0.4)μmol/L、(3.9±0.7)mg/L和(45.9±8.4)ng/L(P<0.05),血清IL-10水平为(28.7±8.6) ng/L,显著高于对照组的(22.3±5.4)ng/L(P<0.05).结论 依泽替米贝联合阿托伐他汀治疗NAFLD合并冠心病患者可明显降低血脂,改善肝功能,可能与其调控脂质代谢,降低血清ADMA和炎性因子水平有关.
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