Hung Y J, Pei D, Wu D A, Kuo S W, Fuh M M, Jeng C
Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
J Formos Med Assoc. 1999 Feb;98(2):104-10.
Insulin resistance is associated with hypertriglyceridemia, low serum high-density lipoprotein cholesterol (HDL-C) concentrations and high serum total cholesterol (TC) to HDL-C ratios. Several reports have demonstrated that either lovastatin or gemfibrozil may favorably lower serum lipid concentrations. However, their effects on insulin sensitivity are unknown. The primary aim of this study was to compare the effects of lovastatin and gemfibrozil on insulin sensitivity and serum leptin concentrations in subjects with high TC/HDL-C ratios. We enrolled 25 nondiabetic patients, similar in terms of age and weight with TC/HDL-C ratios greater than 5. Thirteen subjects were treated with lovastatin 20 mg per day, and 12 received gemfibrozil 300 mg twice per day. Plasma lipids, glucose, and leptin were measured, and a 75-g oral glucose tolerance test (OGTT) and a modified insulin suppression test were performed before and after 3 months of treatment. The study showed the mean plasma TC, low-density lipoprotein cholesterol (LDL-C) concentrations, and TC/HDL-C ratio were significantly reduced in the lovastatin-treated group, but no obvious effects on plasma triglyceride (TG) and HDL-C were noted. In the gemfibrozil group, plasma TG and HDL-C were markedly lowered, but no significantly different effects in other plasma lipids were found. Gemfibrozil did not affect steady-state plasma glucose (SSPG) concentrations, whereas lovastatin significantly increased SSPG concentrations. Neither drug affected the serum leptin concentration during the OGTT. We conclude that lovastatin significantly lowers plasma TC and LDL-C ratio, and TC/HDL-C concentrations and adversely affects insulin sensitivity, while gemfibrozil markedly reduces plasma TG concentrations without altering insulin sensitivity in subjects with high TC/HDL-C ratios.
胰岛素抵抗与高甘油三酯血症、血清高密度脂蛋白胆固醇（HDL-C）浓度降低以及血清总胆固醇（TC）与HDL-C比值升高有关。多项报告表明，洛伐他汀或吉非贝齐均可有效降低血脂浓度。然而，它们对胰岛素敏感性的影响尚不清楚。本研究的主要目的是比较洛伐他汀和吉非贝齐对高TC/HDL-C比值受试者胰岛素敏感性和血清瘦素浓度的影响。我们招募了25名非糖尿病患者，他们在年龄和体重方面相似，TC/HDL-C比值大于5。13名受试者每天接受20mg洛伐他汀治疗，12名受试者每天两次接受300mg吉非贝齐治疗。在治疗3个月前后测量血浆脂质、葡萄糖和瘦素，并进行75g口服葡萄糖耐量试验（OGTT）和改良胰岛素抑制试验。研究表明，洛伐他汀治疗组的平均血浆TC、低密度脂蛋白胆固醇（LDL-C）浓度和TC/HDL-C比值显著降低，但对血浆甘油三酯（TG）和HDL-C无明显影响。在吉非贝齐组中，血浆TG和HDL-C明显降低，但在其他血浆脂质方面未发现显著差异。吉非贝齐不影响稳态血浆葡萄糖（SSPG）浓度，而洛伐他汀显著提高SSPG浓度。在OGTT期间，两种药物均未影响血清瘦素浓度。我们得出结论，洛伐他汀显著降低血浆TC和LDL-C比值以及TC/HDL-C浓度，并对胰岛素敏感性产生不利影响，而吉非贝齐在高TC/HDL-C比值受试者中显著降低血浆TG浓度，且不改变胰岛素敏感性。
