不同剂量阿托伐他汀对老年2型糖尿病患者维生素D和骨密度的影响

摘要

目的 探讨不同剂量阿托伐他汀对老年2型糖尿病患者维生素D和骨密度(BMD)的影响.方法 将87例老年2型糖尿病患者随机分为A、B两组,分别给予阿托伐他汀钙片(立普妥)10 mg/d和20 mg/d,连续口服6个月,于服药前后分别测定总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、25-羟维生素D3(25-OH-VD3)、BMD、胰岛素抵抗指数(HOMA-IR).结果 (1)治疗前两组间血脂、25-OH-VD3、HOMA-IR、BMD间差异均无统计学意义(P＞0.05).阿托伐他汀治疗6个月后,两组的TC、LDL、HOMA-IR均明显降低,与治疗前比较差异有统计学意义(P＜0.01);HDL、25-OH-VD3、BMD均明显增高,与治疗前比较差异有统计学意义(P＜0.05).治疗6个月后两组间比较,B组TC、LDL、HOMA-IR明显降低,HDL、BMD明显增高,与A组比较差异有统计学意义(P＜0.01);两组25-OH-VD3间比较,差异无统计学意义(P＞0.05).(2)治疗前后25-OH-VD3与BMD、HOMA-IR均呈正相关(P＜0.01),与BMI呈负相关(P＜0.05);治疗前25-OH-VD3与TC、LDL呈负相关(P＜0.05),但治疗后却与两者均不相关;治疗前后25-OH-VD3与HDL均不相关.治疗前后BMD与25-OH-VD3、BMI均呈正相关(P＜0.01),与HOMA-IR呈负相关(P＜0.01),与TC、LDL、HDL均不相关.结论 阿托伐他汀在降低胆固醇的同时,可以减轻患者的胰岛素抵抗、提高维生素D水平、增高BMD.%Objective To investigate the effects of different doses of Atorvastatin on Vitamin D and bone mineral density in older patients with type 2 diabetes.Methods The patients ( n = 87 ) with type 2 diabetes were randomly divided into two groups.The patients were given Atorvastatin ( 10 mg/d ) in group A and Atorvastatin ( 20 mg/d ) in group B group for six months, total cholesterol ( TC ), low density lipoprotein ( LDL ), high density lipoprotein ( HDL ), 25 ( OH ) vitamin D3 ( 25 - OH - VD3 ), bone minal density ( BMD ) and HOMA insulin resistance index ( HOMA -IR ) were measured before and after the course of treatment.Results ( 1 ) There was no significant difference before the treatment in blood lipid, 25- OH - VD3 , HOMA - IR and BMD between the two groups ( P ＞0.05 ).After six months treatment, the levels of TC, LDL and HOMA - IR were reduced ( P ＜ 0.01 ) and the levels of HDL, 25 - OH - VD3 an BMD were increased in both groups ( P ＜ 0.05 ); and compared with group A, the levels of TC, LDL and HOMA - IR were observably reduced and the levels of HDL and BMD were obviously increased in group B ( P ＜ 0.01 ).There was no significant difference in 25 - OH - VD3 between the two groups ( P ＞ 0.05 ).( 2 ) Before or after the treatment, the serum 25 - OH - VD3 was positively correlated with BMD and HOMA - IR ( P ＜ 0.01 ) and negatively correlated with BMI ( P ＜ 0.05 ).Before the treatment 25 - OH - VD3 was negatively correlated with TC and LDL ( P ＜ 0.05 ), but after the treatment no correlation was found.Both before and after the treatment 25 鈥?OH 鈥?VD3 was not correlated with HDL.Before and after the treatment BMD was positively correlated with 25 - OH - VD3 and BMI ( P ＜ 0.01 ), and negatively correlated with HOMA - IR ( P ＜ 0.01 ).However it was not correlated with TC, LDL, and HDL.Conclusion Atorvastatin can reduce cholesterol, relieve patients insulin resistance, improve VD level, and increased BMD in patients with type 2 diabetes.