Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Korea, 120-752.
Cardiovasc Drugs Ther. 2012 Dec;26(6):501-9. doi: 10.1007/s10557-012-6412-2.
Insulin resistance is associated with the progression of atherosclerosis and is reported to predict cardiovascular mortality in patients with end-stage renal disease (ESRD). Although statins exert pleiotropic effects, it is uncertain whether statin therapy improves insulin resistance in these patients. In this prospective randomized controlled trial, we aimed to evaluate the effects of statin on insulin resistance among 70 patients undergoing peritoneal dialysis (PD).
Patients were randomized into a statin group (n = 35) or a control group (n = 35). The statin group received 10 mg per day of rosuvastatin for 6 months. We determined insulin resistance by homeostatic model assessment of insulin resistance (HOMA-IR) index. Serum concentrations of adipokines such as adiponectin, leptin, and resistin were measured using enzyme-linked immunosorbent (ELISA) assay. As inflammatory markers, high sensitive C-reactive protein (hsCRP) and interleukin-6 were also measured.
There were no significant differences in baseline characteristics between the two groups. Compared to baseline value, statin treatment significantly decreased HOMA-IR index from 2.37 ± 1.08 to 2.05 ± 0.82 (P = 0.014). There was a concordant decrease in hsCRP levels in the statin group (2.05 ± 1.57 to 1.21 ± 0.84 mg/L, P < 0.001), but such improvements were not observed in the control group. When between-group differences in these parameters were compared, hsCRP levels were more decreased in the statin group than in the control group (P = 0.021 for between-group difference), whereas HOMA-IR index was not (P = 0.189 for between-group difference). During this period, statin treatment did not result in the improved adipokine profiles.
This study showed that statin therapy failed to improve insulin resistance in PD patients despite a significant decline in hsCRP levels after statin treatment. Our finding suggests that reducing inflammation by statin is of limited help to fully attenuate insulin resistance in these patients.
胰岛素抵抗与动脉粥样硬化的进展有关，并据报道可预测终末期肾病（ESRD）患者的心血管死亡率。尽管他汀类药物具有多种作用，但尚不确定他汀类药物治疗是否能改善这些患者的胰岛素抵抗。在这项前瞻性随机对照试验中，我们旨在评估他汀类药物对 70 名接受腹膜透析（PD）的患者胰岛素抵抗的影响。
患者被随机分为他汀组（n = 35）或对照组（n = 35）。他汀组每天服用 10 mg 瑞舒伐他汀，持续 6 个月。我们通过稳态模型评估的胰岛素抵抗（HOMA-IR）指数来确定胰岛素抵抗。使用酶联免疫吸附（ELISA）测定法测量脂联素、瘦素和抵抗素等脂肪因子的血清浓度。作为炎症标志物，还测量了高敏 C 反应蛋白（hsCRP）和白细胞介素-6。
两组患者的基线特征无显著差异。与基线值相比，他汀治疗可使 HOMA-IR 指数从 2.37 ± 1.08 降至 2.05 ± 0.82（P = 0.014）。他汀组的 hsCRP 水平也呈一致下降（从 2.05 ± 1.57 降至 1.21 ± 0.84 mg/L，P < 0.001），但对照组则未观察到这种改善。当比较这些参数的组间差异时，他汀组的 hsCRP 水平下降更为明显（组间差异 P = 0.021），而 HOMA-IR 指数则无明显差异（组间差异 P = 0.189）。在此期间，他汀治疗并未改善脂肪因子谱。
本研究表明，尽管他汀类药物治疗后 hsCRP 水平显著下降，但在 PD 患者中，他汀类药物治疗并未改善胰岛素抵抗。我们的发现表明，通过他汀类药物减少炎症对充分减轻这些患者的胰岛素抵抗帮助有限。
