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目的观察吉非罗齐调脂效果及对代谢综合征患者胰岛素抵抗(IR)的影响;探讨血压或血脂变化与IR变化的关系。方法将60例代谢综合征(MS)患者按随机、对照、单盲方法分为尼群地平加吉非罗齐治疗组(n=40)和尼群地平加安慰剂对照组(n=20)。两组服尼群地平将血压控制到正常;同时分别服用吉非罗齐胶囊0.6 g,2次/d,或安慰剂2粒,2次/d,共12周。服药前后分别测定BMI,WHR,SBP,DBP,FBS,FINS,FFAs,TG,TC,LDL-C和HDL-C。研究各指标变化与IR变化的相关性。运用多因素逐步回归分析筛选对改善IR有显著贡献的变量。结果①12周后,在吉非罗齐治疗组中,与治疗前比较,SBP,DBP,FBS,FINS,TG,TC和FFAs显著降低(P<0.05),ISI显著增高(P<0.05);FINS,TG,TC,HDL-C,LDL-C,FFAs和ISI的变化值与安慰剂对照组各指标变化值比较具有显著差异性(P<0.05);②吉非罗齐治疗组ISI上升值与FFAs的下降值呈显著正相关(P<0.05,r=0.353,Y=166.804X+30.769);亦与TG的下降值显著正相关(P<0.05,r=0.329,Y=0.776X+0.67)。多因素逐步回归分析发现仅TG的降低对ISI的上升有显著贡献。结论尼群地平控制MS患者血压后并不能改善其IR状态;常规剂量的吉非罗齐可以有效地降低血TG,TC,LDL-C,FFAs,升高HDL-C,并可能通过降低TG及FFAs改善了MS患者的IR。
Objective To observe the effects of gemfibrozil on lipid metabolism and insulin resistance (IR) in patients with metabolic syndrome. To investigate the relationship between the changes of blood pressure and blood lipids and the changes of IR. Methods Sixty patients with metabolic syndrome (MS) were randomly divided into two groups: nimodipine plus gemfibrozil group (n = 40) and nitrendipine plus placebo group (n = 20) . Two groups of clothes nitrendipine control of blood pressure to normal; while taking gemfibrozil 0.6g, 2 times / d, or placebo 2, 2 times / d, a total of 12 weeks. BMI, WHR, SBP, DBP, FBS, FINS, FFAs, TG, TC, LDL-C and HDL-C were measured before and after treatment. To study the correlation between changes of each index and IR changes. Multi-factor regression analysis was used to screen for variables that significantly contributed to improving IR. RESULTS: After 12 weeks, the levels of SBP, DBP, FBS, FINS, TG, TC and FFAs in the gemfibrozil group were significantly lower (P <0.05) and ISI was significantly higher (P <0.05) , TG, TC, HDL-C, LDL-C, FFAs and ISI were significantly different from those in placebo control group (P <0.05) FFAs decreased significantly (P <0.05, r = 0.353, Y = 166.804X + 30.769), but also positively correlated with the decrease of TG (P <0.05, r = 0.329, Y = 0.776X + 0.67) . Multi-factorial stepwise regression analysis found that only the reduction of TG has a significant contribution to the rise of ISI. CONCLUSION Nitrendipine can not improve the IR state of blood pressure in MS patients. Gemfibrozil can effectively decrease TG, TC, LDL-C, FFAs and increase HDL-C in MS patients, FFAs improve IR in MS patients.