Polenova N V, Vaulin N A, Masenko V P, Iavelov I S, Gratsianskiĭ N A
Kardiologiia. 2009;49(2):9-14.
To compare lipid lowering profile and effects on markers of inflammation of rosuvastatin and fenofibrate in patients with type 2 diabetes with low high density lipoprotein (HDL) cholesterol (CH).
We enrolled into randomized open comparative study 30 pts (20 women) aged 62.5 +/- 7.2 (47-74) years with type 2 diabetes and low HDLCH level (below 1.0 mmol/l for men and 1.2 mmol/l for women). All patients had arterial hypertension, 25--coronary heart disease, 4--peripheral arterial disease. Baseline BMI was > 25 kg/m2 in all patients (above 30 kg/m2 in 70%). Median waist circumference was 105.5 cm. Patients were assigned to receive either rosuvastatin 10 mg/day (n=17) or fenobibrate 200 mg/day (n=13). Serum lipids, high sensitivity C reactive protein (CPR), interleukin 6 (IL-6) and fibrinogen levels were measured at baseline and after 3 months.
Median fasting glucose and HbA1c were 9.14 mmol/l and 6.8%, 8.78 mmol/l and 7.0% at baseline and study end respectively, without significant differences between groups. Mean baseline levels of low density lipoprotein (LDL) CH, HDLCH and triglycerides (TG) were 3.9, 0.93, and 2.39 mmol/l, respectively. Median baseline CRP was relatively low (1.5, interquartile range 0.78-3.08 mg/l). Both rosuvastatin and fenofibrate decreased total CH, LDLCH and TG and increased HDLCH. Tendencies to more pronounced effect of rosuvastatin on total and LDL CH and fenofibrate on TG and HDLCH were not statistically significant. CPR, IL-6, and fibrinogen levels did not significantly change in either group. There were no associations between changes of lipid levels and those of CRP or IL-6 when all patients were taken together.
In this relatively small group of overweight diabetics with low HDLCH rosuvastatin and fenofibrate exerted expected effects on lipid profile. However 3 months administration of both starting dose of rosuvastatin (10 mg) and standard dose of fenofibrate was similarly neutral relative to CPR, IL-6 and fibrinogen levels. This can reflect true absence of marked effect or be a consequence of low baseline values of these markers of inflammation.
比较瑞舒伐他汀和非诺贝特对2型糖尿病且高密度脂蛋白（HDL）胆固醇（CH）水平低的患者的降脂情况及对炎症标志物的影响。
我们纳入了30例患者（20名女性）进行随机开放对照研究，患者年龄为62.5±7.2（47 - 74）岁，患有2型糖尿病且HDL - CH水平低（男性低于1.0 mmol/l，女性低于1.2 mmol/l）。所有患者均患有动脉高血压，25例患有冠心病，4例患有外周动脉疾病。所有患者的基线体重指数（BMI）均>25 kg/m²（70%的患者BMI高于30 kg/m²）。腰围中位数为105.5 cm。患者被分配接受瑞舒伐他汀10 mg/天（n = 17）或非诺贝特200 mg/天（n = 13）治疗。在基线和3个月后测量血脂、高敏C反应蛋白（CPR）、白细胞介素6（IL - 6）和纤维蛋白原水平。
空腹血糖和糖化血红蛋白（HbA1c）的中位数在基线时分别为9.14 mmol/l和6.8%，在研究结束时分别为8.78 mmol/l和7.0%，两组之间无显著差异。低密度脂蛋白（LDL）- CH、HDL - CH和甘油三酯（TG）的平均基线水平分别为3.9、0.93和2.39 mmol/l。基线CRP中位数相对较低（1.5，四分位间距0.78 - 3.08 mg/l）。瑞舒伐他汀和非诺贝特均降低了总CH、LDL - CH和TG，并升高了HDL - CH。瑞舒伐他汀对总CH和LDL - CH的作用以及非诺贝特对TG和HDL - CH的作用更显著的趋势无统计学意义。两组中CPR、IL - 6和纤维蛋白原水平均无显著变化。当将所有患者一起考虑时，血脂水平的变化与CRP或IL - 6的变化之间无关联。
在这一相对较小的HDL - CH水平低的超重糖尿病患者群体中，瑞舒伐他汀和非诺贝特对血脂谱产生了预期的影响。然而，给予起始剂量的瑞舒伐他汀（10 mg）和标准剂量的非诺贝特3个月，相对于CPR、IL - 6和纤维蛋白原水平同样无明显作用。这可能反映了真正不存在显著影响，或者是这些炎症标志物基线值较低的结果。
