糖尿病心血管自主神经病变:辛伐他汀和Omega-3多不饱和脂肪酸对胰岛素抵抗和血脂参数的影响

V. Serhiyenko, M. Hotsko, S. Azhmi, O. Serhiyenko
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引用次数: 0

摘要

介绍。2型糖尿病(T2DM)患者心脏自主神经病变(CAN)目前尚无统一的治疗方案。本研究的目的是探讨辛伐他汀(SIM)和-3多不饱和脂肪酸(-3 PUFAs)对2型糖尿病合并明确心脏自主神经病变患者血脂和胰岛素抵抗(IR)的影响。材料和方法。该研究涉及72例T2DM和明确的CAN患者。患者分为四组:第一组接受标准降糖治疗-控制(n = 15);第二组(n = 22) -另外辛伐他汀20.0 mg/q.d;第3次(n = 18) -每天增加1粒胶囊。ω-3 pufa;第4 (n = 17) -添加SIM 10.0 mg/q。D和1胶囊/q。ω-3 pufa的d值为3个月。测定血中葡萄糖、糖化血红蛋白A1c、免疫反应性胰岛素(IRI)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)的浓度。计算稳态模型评价IR (HOMA-IR)、动脉粥样硬化系数(AC)、TG/LDL-C、TG/TC、TG/LDL-C及TG与葡萄糖指数(TyG)。结果。处方SIM可显著降低TC、LDL-C、TG浓度。同时,SIM诱导AC、TG/HDL-C降低,HDL-C升高,而IRI、HOMA-IR、TG/LDL-C、TG/TC、TC/LDL-C/HDL-C、TyG不受影响。ω-3 PUFAs的使用显著降低了TG、AC、TG/LDL-C、TG/TC、TG/HDL-C、TyG指数,增加了HDL-C,而IRI含量、HOMA-IR、TC、LDL-C和TC/LDL-C/HDL-C没有变化。SIM和-3 PUFAs联合用药后,血脂谱变化更明显,具有统计学意义,IRI和HOMA-IR下降。结论。本研究结果验证了辛伐他汀联合-3多不饱和脂肪酸处方治疗2型糖尿病合并明确心脏自主神经病变的适宜性。关键词:糖尿病,心脏自主神经病变,治疗。
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Diabetic Cardiovascular Autonomic Neuropathy: Effects of Simvastatin and Omega-3 Polyunsaturated Fatty Acids on Insulin Resistance and Lipid Profile Parameters
Introduction. Currently, there is no unified treatment algorithm of cardiac autonomic neuropathy (CAN) in patients with type 2 diabetes mellitus (T2DM). The aim of the study was to investigate the effects of simvastatin (SIM) and -3 polyunsaturated fatty acids (-3 PUFAs) on blood lipid profile and insulin resistance (IR) in patients with type 2 diabetes mellitus and definite cardiac autonomic neuropathy. Materials and methods. The study involved 72 patients with T2DM and definite CAN. Patients were divided into four groups: 1st - received standard hypoglycemic therapy - control (n = 15); 2nd (n = 22) – in addition simvastatin (SIM) 20.0 mg/q.d.; 3rd (n = 18) - in addition 1 capsule/q.d. of the ω-3 PUFAs; 4th (n = 17) - in addition SIM 10.0 mg/q.d and 1 capsule/q.d of the ω-3 PUFAs for three months. The concentration of glucose, glycated hemoglobin A1c, immunoreactive insulin (IRI), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG) in the blood were determined. Homeostasis model assessment IR (HOMA-IR), atherogenic coefficient (AC), TG/LDL-C, TG/TC, TG/LDL-C and TG and glucose index (TyG) were calculated. Results. Prescription of SIM was accompanied by a statistically significant decrease in TC, LDL-C, TG concentrations. In parallel, SIM induced a decrease of AC, TG/HDL-C, increase in HDL-C, and does not affect the IRI, HOMA-IR, TG/LDL-C, TG/TC, TC/LDL-C/HDL-C, TyG. The use of ω-3 PUFAs has contributed to a significant reduction in TG, AC, TG/LDL-C, TG/TC, TG/HDL-C, TyG index, increase in HDL-C, and was not accompanied by changes in IRI content, HOMA-IR, TC, LDL-C, and TC/LDL-C/HDL-C. The combined prescription of SIM and -3 PUFAs was accompanied by more pronounced, statistically significant changes in the blood lipid spectrum, as well as a decrease in the IRI and HOMA-IR. Conclusions. Obtained results justify the appropriateness of combined simvastatin and -3 polyunsaturated fatty acids prescription to patients with type 2 diabetes mellitus and definite cardiac autonomic neuropathy. Keywords: diabetes mellitus, cardiac autonomic neuropathy, treatment.
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