阿托伐他汀对肢端肥大症患者血清脂蛋白的影响。

The effect of atorvastatin on serum lipoproteins in acromegaly.

作者信息

Mishra Manoj, Durrington Paul, Mackness Mike, Siddals Kirk W, Kaushal Kalpana, Davies Rob, Gibson Martin, Ray David W

机构信息

Cardiovascular, Medicine and Surgery Central Clinical Academic Group, University of Manchester, M13 9PT, UK.

出版信息

Clin Endocrinol (Oxf). 2005 Jun;62(6):650-5. doi: 10.1111/j.1365-2265.2005.02273.x.

DOI:10.1111/j.1365-2265.2005.02273.x

PMID:15943824

Abstract

OBJECTIVE

Acromegaly is associated with long-term adverse effects on cardiovascular mortality and morbidity. Reducing growth hormone secretion improves well-being and symptoms, but may not significantly improve the lipoprotein profile. An additional approach to cardiovascular risk reduction in acromegaly may therefore be to target lipoprotein metabolism directly. In this study we investigated the effect of statin treatment.

DESIGN

Double blind, placebo-controlled, crossover study of the effects on circulating lipoproteins of atorvastatin 10 mg daily vs. placebo. Each treatment was given for 3 months in random order.

SUBJECTS

Eleven patients with acromegaly.

MEASUREMENTS

Lipids, lipoproteins, apolipoproteins, enzyme activity and calculated cardiovascular risk.

RESULTS

Atorvastatin treatment compared to placebo resulted in a significant decrease in serum cholesterol (5.85 +/- 1.04 mmol/l vs. 4.22 +/- 0.69 mmol/l; mean +/- SD; P < 0.001), low-density lipoprotein (LDL) cholesterol (2.95 +/- 1.07 mmol/l vs. 1.82 +/- 0.92 mmol/l; P < 0.001), very low-density lipoprotein (VLDL) cholesterol (0.31 (0.21-0.47) mmol vs. 0.23 (0.13-0.30) mmol/l median (interquartile range); P < 0.05), apolipoprotein B (111 +/- 28 mg/dl vs. 80 +/- 18 mg/dl; P < 0.001), and calculated coronary heart disease risk (6.8 (3.3-17.9) vs. 2.8 (1.5-5.7)% over next 10 years; P < 0.01). Serum triglyceride was 1.34 (1.06-1.71) mmol/l on placebo and 1.14 (0.88-1.48) mmol/l on atorvastatin (ns). HDL cholesterol, apolipoprotein A1 and Lp(a) concentrations and cholesteryl ester transfer protein and lecithin: cholesterol acyl transferase activities were also not significantly altered.

CONCLUSION

Atorvastatin treatment was safe, well tolerated and effective in improving the atherogenic lipoprotein profile in acromegaly.

摘要

目的

肢端肥大症与心血管疾病的长期不良影响相关，包括死亡率和发病率。降低生长激素分泌可改善健康状况和症状，但可能不会显著改善脂蛋白谱。因此，在肢端肥大症中降低心血管风险的另一种方法可能是直接针对脂蛋白代谢。在本研究中，我们调查了他汀类药物治疗的效果。

设计

每日服用10mg阿托伐他汀与安慰剂对循环脂蛋白影响的双盲、安慰剂对照、交叉研究。每种治疗随机给药3个月。

研究对象

11例肢端肥大症患者。

测量指标

血脂、脂蛋白、载脂蛋白、酶活性及计算得出的心血管风险。

结果

与安慰剂相比，阿托伐他汀治疗使血清胆固醇显著降低（5.85±1.04mmol/L对4.22±0.69mmol/L；均值±标准差；P<0.001），低密度脂蛋白（LDL）胆固醇（2.95±1.07mmol/L对1.82±0.92mmol/L；P<0.001），极低密度脂蛋白（VLDL）胆固醇（中位数（四分位间距）：0.31（0.21 - 0.47）mmol对0.23（0.13 - 0.30）mmol/L；P<0.05），载脂蛋白B（111±28mg/dl对80±18mg/dl；P<0.001），以及计算得出的冠心病风险（未来10年：6.8（3.3 - 17.9）%对2.8（1.5 - 5.7）%；P<0.01）。安慰剂组血清甘油三酯为1.34（1.06 - 1.71）mmol/L，阿托伐他汀组为1.14（0.88 - 1.48）mmol/L（无显著差异）。高密度脂蛋白胆固醇、载脂蛋白A1和Lp(a)浓度以及胆固醇酯转运蛋白和卵磷脂胆固醇酰基转移酶活性也无显著改变。