摘要
目的探讨新诊断T2DM合并颈动脉粥样硬化(CAS)患者血清对氧磷酶3(pon3)的水平及阿托伐他汀对血清pon3水平的影响。方法选择新诊断T2DM合并CAS患者87例,随机分为阿托伐他汀治疗组(43例)和非诺贝特治疗组(44例)。另选择健康体检者为对照组(NGT组,45名)。采用ELISA测定血清pon3水平,分析FPG、FIns、HbA1c、BMI、稳态模型评估法计算胰岛素抵抗指数(HOMA-IR)、同型半胱氨酸(Hcy)、纤维蛋白原(FIB)、高敏C反应蛋白(hsC-RP)、超氧化物歧化酶(SOD)、颈动脉内-中膜厚度(CIMT)与血清pon3水平的关系。观察T2DM合并CAS患者经阿托伐他汀、非诺贝特治疗前后血清pon3水平变化。结果 (1)阿托伐他汀和非诺贝特组血清pon3水平[(3.55±0.54)和(3.61±0.51)ng/ml]均高于NGT组[(2.27±0.46)ng/ml](P<0.01);(2)血清pon3水平与BMI、FIns、LDL-C、HOMA-IR、hsC-RP、FPG、HbA1c、Hcy、FIB、CIMT呈正相关(r分别为0.545、0.547、0.520、0.529、0.572、0.635、0.624、0.542、0.517、0.525,P<0.05或P<0.01),与HDL-C、SOD呈负相关(r=-0.565、-0.566);(3)治疗24周后,阿托伐他汀组TC、TG、LDL-C、CIMT、Hcy、FIB、hsC-RP较治疗前下降(P<0.05),SOD、HDL-C、血清pon3水平较治疗前增高(P<0.05),非诺贝特组血脂变化与阿托伐他汀组差异无统计学意义,CIMT、Hcy、FIB、SOD、血清pon3水平较治疗前无明显差异;(4)多元逐步回归分析显示,CIMT、HOMA-IR、Hcy、FIB是影响T2DM患者血清pon3水平的独立相关因素。HOMAIR、FIB、Hcy、血清pon3水平是影响T2DM患者CIMT的独立相关因素。结论阿托伐他汀能够降低新诊断T2DM合并CAS患者CIMT,这与其升高血清pon3水平有关,不依赖其降脂作用。
Objective To investigate the effect of atorvastatin on serum paraoxonase-3 （pon3） level in newly diagnosed T2DM patients with carotid atherosclerosis（CAS）.Methods 87 newly diagnosed T2DM patients with CAS were divided into atorvastatin treated group （n=43） and fenofibrate treated group （n=44）.45 healthy individuals with normal glucose tolerance were selected as the control （NGT group）.Serum pon3 level was measured by ELISA method.The association between serum pon3 levels and FPG,FIns,HbA1 c,BMI,HOMA-IR,homocysteine （Hcy）,fibrinogen （FIB）,hsC-RP,superoxide dismutase（SOD） and carotid intima-media thickness（CIMT） were also analyzed.Serum pon3 levels were observed in newly diagnosed T2DM patients with CAS before and after treatment.Results （1） Atorvasta-tin and fenofibrate group had significantly higher serum pon3 levels than NGT group（3.55 ± 0.54） ng/ml,（3.61 ± 0.51） ng/ml vs （2.27 ± 0.46） ng/ml,（P 〈 0.01）,respectively.（2） Pearson correlation analysis showed that serum pon3 level was positively correlated with BMI,FIns,LDL-C,HOMA-IR,hsC-RP,FPG,HbA1 c,Hcy,FIB and CIMT （r =0.545,0.547,0.520,0.529,0.572,0.635,0.624,0.542,0.517,0.525,P〈0.05 or P〈0.01,respectively） ;And was negatively correlated with HDL-C,SOD（r=-0.565,-0.566,P 〈 0.05）.（3） After 24 weeks treatment,serum pon3,SOD and HDL-C levels were significantly increased（P〈0.05）,while TC,TG,LDL-C,CIMT,Hcy,FIB,hsC-RP levels were significantly decreased in atorvastatin group（P〈0.05）,and fenofibrate group had no significant difference of lipid profiles compared with atorvastatin group,while CIMT,Hcy,FIB,SOD,serum pon3 and hsC-RP levels have no significant difference.（4）Multiple stepwise regression analysis showed that CIMT,HOMAIR,Hcy and FIB were the independent related factors influencing the serum pon3 level of T2DM patients,and HOMA-IR,FIB,Hcy,pon3 were the independent related factors influencing CIMT of the newly diagnosed T2DM patients with CAS.Conclusion Atorvastatin
出处
《中国糖尿病杂志》
CAS
CSCD
北大核心
2014年第11期978-983,共6页
Chinese Journal of Diabetes
关键词
对氧磷酶3
糖尿病
2型
颈动脉粥样硬化
阿托伐他汀
Paraoxonase-3 （pon3）
Diabetes mellitus,type 2
Carotid atherosclerosis（CAS）
Atorvastatin
