Bulcão Caroline, Ribeiro-Filho Fernando Flexa, Sañudo Adriana, Roberta Ferreira Sandra G
Division of Endocrinology, Department of Internal Medicine, Federal University of São Paulo, São Paulo, Brazil.
Am J Cardiovasc Drugs. 2007;7(3):219-24. doi: 10.2165/00129784-200707030-00007.
In addition to lipid-lowering and insulin-sensitizing actions, statins (HMG-CoA reductase inhibitors) and metformin may have pleiotropic effects.
To study the effect of simvastatin and metformin on insulin sensitivity and inflammatory markers.
Forty-one subjects with body mass index (BMI) 25-39.9 kg/m(2) and impaired glucose tolerance were randomized to receive simvastatin or metformin for 16 weeks. Blood samples were obtained for measurement of metabolic and inflammatory parameters before and after each treatment.
As expected, when compared with simvastatin, metformin therapy resulted in significant reductions in mean BMI, fasting plasma glucose, and homeostasis model assessment-insulin resistance (HOMA-IR), whereas simvastatin treatment resulted in significantly reduced total cholesterol, low-density lipoprotein-cholesterol (LDL-C), and apolipoprotein B levels. Independently of the medication used, significant decreases in C-reactive protein (CRP) and interleukin (IL)-6 were detected from baseline to treatment end. CRP showed a mean reduction of 0.12 +/- 0.04 mg/dL (p = 0.002) over the 16-week intervention period and IL-6 a mean reduction was 0.35 +/- 0.17 pg/mL (p = 0.046). No change was observed in the tumor necrosis factor-alpha levels. Baseline values of CRP and IL-6 and their percentage declines were correlated (r = 0.71 and r = 0.67, respectively; p < 0.001). In simvastatin recipients, no correlation was detected between reductions in CRP or IL-6 and lipids, whereas in metformin recipients, reductions in inflammatory markers were not correlated to BMI and HOMA-IR.
Our findings suggest that both metformin and simvastatin have similar beneficial effects on low-grade inflammation, in addition to their classical effects on glucose and lipid metabolism. Moreover, they confirm the importance of treating at-risk individuals even before the precipitation of overt diabetes mellitus or full-blown metabolic syndrome.
除降脂和胰岛素增敏作用外，他汀类药物（HMG-CoA还原酶抑制剂）和二甲双胍可能具有多效性。
研究辛伐他汀和二甲双胍对胰岛素敏感性和炎症标志物的影响。
将41名体重指数（BMI）为25-39.9kg/m²且糖耐量受损的受试者随机分为两组，分别接受辛伐他汀或二甲双胍治疗16周。在每次治疗前后采集血样，以测定代谢和炎症参数。
正如预期的那样，与辛伐他汀相比，二甲双胍治疗使平均BMI、空腹血糖和稳态模型评估胰岛素抵抗（HOMA-IR）显著降低，而辛伐他汀治疗使总胆固醇、低密度脂蛋白胆固醇（LDL-C）和载脂蛋白B水平显著降低。无论使用何种药物，从基线到治疗结束时，C反应蛋白（CRP）和白细胞介素（IL）-6均显著降低。在16周的干预期内，CRP平均降低0.12±0.04mg/dL（p=0.002），IL-6平均降低0.35±0.17pg/mL（p=0.046）。肿瘤坏死因子-α水平未观察到变化。CRP和IL-6的基线值及其下降百分比具有相关性（分别为r=0.71和r=0.67；p<0.001）。在接受辛伐他汀治疗的患者中，未检测到CRP或IL-6的降低与血脂之间的相关性，而在接受二甲双胍治疗的患者中，炎症标志物的降低与BMI和HOMA-IR无关。
我们的研究结果表明，除了对糖脂代谢的经典作用外，二甲双胍和辛伐他汀对轻度炎症均具有相似的有益作用。此外，这些结果证实了在高危个体出现明显糖尿病或全面代谢综合征之前进行治疗的重要性。
