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目的探讨阿司匹林、阿托伐他汀、普罗布考联合应用(PAS疗法)对糖尿病动脉粥样硬化患者的干预作用。方法入选糖尿病患者92例,随访1年,最后资料完全者78例,其中对照组(阿司匹林100 mg/d、阿托伐他汀10 mg/d)38例,PAS组(普罗布考0.25 g/d、阿司匹林100 mg/d、阿托伐他汀10 mg/d)40例。测定治疗前后空腹血糖(FBG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1c)、血脂、血清氧化型低密度脂蛋白(ox-LDL)、丙二醛水平。计算出胰岛素抵抗指数(HOMA-IRI)、胰岛素敏感指数(ISI),超声检测治疗前、后颈动脉内膜厚度及斑块厚度。结果对照组治疗前后HOMA-IRI、ISI、ox-LDL、丙二醛水平无明显变化(P>0.05);PAS组治疗后FBG、FINS、HbA1c、HOMA-IRI较治疗前明显下降,差异有统计学意义(P<0.05),总胆固醇(CHOL)、三酰甘油(TG)及低密度脂蛋白(LDL-C)较治疗前明显下降,差异有统计学意义(P<0.05)。ox-LDL较治疗前下降了33.7%[(14.91±0.02)mmol/L比(22.49±0.01)mmol/L,P<0.05],丙二醛较治疗前下降了22.3%[(1.81±0.79)mmol/L比(2.33±1.23)mmol/L,P<0.05],ISI较治疗前明显升高(P<0.05)。PAS组治疗后颈动脉内膜厚度[(0.095±0.001)cm比(0.113±0.001)cm]、斑块厚度[(0.201±0.002)cm比(0.249±0.002)cm],较治疗前均有明显下降,差异有统计学意义(P<0.001)。对照组治疗后颈动脉内膜厚度及斑块厚度较治疗前下降,差异有统计学意义(P<0.05)。PAS组与对照组组间比较颈动脉内膜厚度及斑块厚度下降更明显,差异有统计学意义(P<0.001)。结论 PAS联合治疗在调节血脂、降低血糖及改善胰岛素抵抗的同时,可使糖尿病患者血清ox-LDL及丙二醛水平明显下降,对动脉粥样硬化的形成具有明显的干预作用。
Objective To investigate the intervention effects of aspirin, atorvastatin and probucol on the patients with diabetic atherosclerosis. Methods Ninety-two diabetic patients were enrolled in this study. One year follow-up was performed and 78 patients were finally completed. Among them, 38 patients in the control group (aspirin 100 mg / d, atorvastatin 10 mg / d), PAS group (probucol 0.25 g / d , Aspirin 100 mg / d, atorvastatin 10 mg / d) in 40 cases. The levels of fasting blood glucose (FBG), fasting insulin (FINS), HbA1c, serum lipids, serum ox-LDL and malondialdehyde were measured before and after treatment. The insulin resistance index (HOMA-IRI) and insulin sensitivity index (ISI) were calculated. The carotid intima-media thickness and plaque thickness were measured by ultrasound before and after treatment. Results The levels of HOMA-IRI, ISI, ox-LDL and MDA did not change significantly in the control group before treatment (P> 0.05). The FBG, FINS, HbA1c and HOMA-IRI in the PAS group were significantly lower than those before treatment (P <0.05). The levels of total cholesterol (CHOL), triglyceride (TG) and low density lipoprotein (LDL-C) were significantly lower than those before treatment (P <0.05). ox-LDL decreased by 33.7% [(14.91 ± 0.02) mmol / L (22.49 ± 0.01) mmol / L, P <0.05] and decreased by 22.3% [(1.81 ± 0.79) mmol / L (2.33 ± 1.23) mmol / L, P <0.05]. ISI was significantly higher than that before treatment (P <0.05). The carotid intima thickness in the PAS group was significantly higher than that before treatment [(0.095 ± 0.001) cm (0.113 ± 0.001) cm] and plaque thickness (0.201 ± 0.002) cm (0.249 ± 0.002) cm Decreased, the difference was statistically significant (P <0.001). The carotid intima-media thickness and plaque thickness decreased in the control group after treatment, with significant difference (P <0.05). PAS group and control group compared between the carotid intima-media thickness and plaque thickness decreased more significantly, the difference was statistically significant (P <0.001). Conclusions PAS combined therapy can significantly decrease serum ox-LDL and malondialdehyde levels in diabetes patients while regulating blood lipids, lowering blood glucose and improving insulin resistance. It has a significant intervention on the formation of atherosclerosis.