CAJ | 학술논문

目的：探讨阿托伐他汀联合非诺贝特治疗冠心病合并糖尿病患者的调脂疗效与安全性。方法：选择100例确诊冠心病合并糖尿病的患者为研究对象，在常规治疗基础上按1∶1随机分为两组：（1）他汀组（50例，给予阿托伐他汀20mg，每晚1次）；（2）联合治疗组（50例，给予阿托伐他汀20mg 每晚1次，非诺贝特200mg 每日1次治疗）。分别于治疗前、治疗6周和12周后检测血清总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）和高密度脂蛋白胆固醇（HDL-C）水平，观察治疗前后上述血脂水平的变化、达标率，并记录不良反应及临床事件。结果：治疗6周后，两组血清 TC、TG、LDL-C 水平均明显低于用药前，治疗12周后降低更为明显（P ＜0.05～＜0.01），且12周后与他汀组比较，联合治疗组 TC [（4.35±0.71）mmol/L 比（4.09±0.56）mmol/L]，TG [（2.35±0.62）mmol/L 比（1.65±0.49）mmol/L]和 LDL-C 水平[（2.01±0.39）mmol/L 比（1.85±0.22）mmol/L]降低更显著（P＜0.05或＜0.01）；两组治疗后 HDL-C 水平均升高，12周后升高更明显但两组比较无统计学差异（P ＞0.05）。治疗12周后，联合治疗组 LDL-C、TG、HDL-C 各项指标达标率、3项血脂指标均达标和非 HDL-C 的达标率（分别为70％、68％、80％、58％、70％）均明显高于他汀组（分别为50％、46％、48％、10％、48％）（P ＜0.05或＜0.01）。治疗期间两组均未观察到严重不良反应。结论：阿托伐他汀联合非诺贝特治疗冠心病合并糖尿病患者较单用阿托伐他汀更有效，能更全面地改善各项血脂水平，有助于血脂的全面达标，且具有更良好的安全性和耐受性。
목적：탐토아탁벌타정연합비낙패특치료관심병합병당뇨병환자적조지료효여안전성。방법：선택100례학진관심병합병당뇨병적환자위연구대상，재상규치료기출상안1∶1수궤분위량조：（1）타정조（50례，급여아탁벌타정20mg，매만1차）；（2）연합치료조（50례，급여아탁벌타정20mg 매만1차，비낙패특200mg 매일1차치료）。분별우치료전、치료6주화12주후검측혈청총담고순（TC）、감유삼지（TG）、저밀도지단백담고순（LDL-C）화고밀도지단백담고순（HDL-C）수평，관찰치료전후상술혈지수평적변화、체표솔，병기록불량반응급림상사건。결과：치료6주후，량조혈청 TC、TG、LDL-C 수평균명현저우용약전，치료12주후강저경위명현（P ＜0.05～＜0.01），차12주후여타정조비교，연합치료조 TC [（4.35±0.71）mmol/L 비（4.09±0.56）mmol/L]，TG [（2.35±0.62）mmol/L 비（1.65±0.49）mmol/L]화 LDL-C 수평[（2.01±0.39）mmol/L 비（1.85±0.22）mmol/L]강저경현저（P＜0.05혹＜0.01）；량조치료후 HDL-C 수평균승고，12주후승고경명현단량조비교무통계학차이（P ＞0.05）。치료12주후，연합치료조 LDL-C、TG、HDL-C 각항지표체표솔、3항혈지지표균체표화비 HDL-C 적체표솔（분별위70％、68％、80％、58％、70％）균명현고우타정조（분별위50％、46％、48％、10％、48％）（P ＜0.05혹＜0.01）。치료기간량조균미관찰도엄중불량반응。결론：아탁벌타정연합비낙패특치료관심병합병당뇨병환자교단용아탁벌타정경유효，능경전면지개선각항혈지수평，유조우혈지적전면체표，차구유경량호적안전성화내수성。
Objective:To explore the lipid-regulating effect and safety of atorvastatin combined fenofibrate therapy in patients with coronary heart disease (CHD)complicated diabetes mellitus (DM).Methods:A total of 100 pa-tients with CHD complicated DM were enrolled.Based on routine treatment,patients were randomly and equally di-vided into statin group (n=50,received 20mg atorvastatin,once/night)and combined treatment group (n=50,re-ceived 20mg atrovastatin once/night,combined fenofibrate 200mg once/d).Serum levels of total cholesterol (TC), triglyceride (TG),low density lipoprotein cholesterol (LDL-C)and high density lipoprotein cholesterol (HDL-C) were measured before,six and 12 weeks after treatment,levels and standard-reaching rates of above blood lipid were observed before and after treatment;adverse reactions and clinical events were recorded.Results:Compared with before treatment after six-week treatment,there were significant reductions in serum levels of TC,TG and LDL-C in both groups,and they further decreased after 12-week treatment (P <0.05~ <0.01),compared with statin group after 12-week treatment,there were significant reductions in levels of TC [(4.35±0.71)mmol/L vs. (4.09±0.56)mmol/L],TG [(2.35±0.62)mmol/L vs.(1.65±0.49)mmol/L]and LDL-C [(2.01 ±0.39) mmol/L vs.(1.85±0.22)mmol/L]in combined treatment group,P <0.05 or <0.01;HDL-C level significantly rose in both groups after treatment,and it′s more significant after 12 weeks,but there was no significant difference between statin group and combined treatment group (P >0.05).After 12-week treatment,standard-reaching rates of LDL-C,TG,HDL-C,all standard-reaching of above three indexes and non HDL-C (70%,68%,80%,58% and 70%)in combined treatment group were significantly higher than those of statin group (50%,46%,48%,10% and 48%)respectively,P <0.05 or <0.01. No severe adverse reactions were observed in two groups during treatment. Conclusion:Atorvastatin combined fenofibrate treatment is more effective than atorvastatin monotherapy in patients with coronary heart disease complicated diabetes mellitus.It can improve blood lipid level more comprehensively, contribute to comprehensive standard-reaching of blood lipids,and possess better safety and tolerance.