不同他汀类调脂药物对冠心病患者血清脂联素的影响

目的:探讨不同他汀类调脂药物对冠心病患者血清脂联素的影响。方法:选取明确诊断为冠心病伴高TC血症患者87例,随机分为2组,A组口服阿托伐他汀20mg/d,B组口服普伐他汀20mg/d,其他治疗相同。检测治疗前后血脂和血清脂联素水平。结果:2组治疗后血脂水平明显下降,血清脂联素水平和HDL-C显著高于治疗前,A组优于B组,且起效时间短。结论:2种他汀类调脂药物都可以明显升高冠心病患者的血清脂联素水平,阿托伐他汀在调脂治疗达标时间和治疗达标后血清脂联素升高的程度上优于普伐他汀。     

大剂量阿托伐他汀对急性冠脉综合征患者冠脉支架置入治疗后炎症因子和血脂的影响

目的探讨大剂量阿托伐他汀治疗对急性冠脉综合征(ACS)冠脉介入(PCI)治疗后患者的调脂疗效及炎症因子的影响。方法 88例成功进行PCI治疗的ACS患者,随机分为A组46例和B组42例。在常规治疗基础上,A组加用阿托伐他汀40 mg/d,B组加用阿托伐他汀20 mg/d。分别随访和检测两组患者在治疗后4、12和24周的血脂、血浆MMP-9、hs-CRP水平及药物不良反应。结果治疗后A组血脂和炎症因子水平的改善情况均优于B组(P<0.05),治疗后12、24周LDL-C达标(≤1.86 mmol/L)率A组高于B组(P均<0.05),两组均无严重的药物不良反应发生。结论大剂量阿托伐他汀对PCI治疗后的ACS患者抗炎和调脂疗效更优,且无严重的不良反应。     

阿托伐他汀和普伐他汀对高脂血症患者血糖的影响

目的 S探讨阿托伐他汀和普伐他汀对原发性高脂血症患者血糖的影响。方法 400例原发性高脂血症患者随机分为阿托伐他汀组和普伐他汀组各200例。阿托伐他汀组患者口服阿托伐他汀10 mg治疗,1次/d;普伐他汀组患者则口服普伐他汀40 mg治疗。于治疗前和治疗6、12、18个月分别检测患者血脂和血糖水平,观察新发糖尿病的情况。结果阿托伐他汀组患者治疗12、18个月后FPG和Hb A1c水平显著高于对照组(P0.05)。阿托伐他汀组患者新发糖尿病率为11.00%,显著高于普伐他汀组的5.50%(P0.05)。结论长期服用阿托伐他汀新发糖尿病率可能高于普伐他汀。     

40 mg与10 mg阿托伐他汀对缺血性心肌病患者血清前列环素及血小板活化影响的比较

目的比较40 mg与10 mg阿托伐他汀对缺血性心肌病患者血清前列环素及血小板活化的影响。方法选择2008年3月至2010年6月在我院心内科住院确诊的缺血性心肌病患者77例,患者随机分为两组:阿托伐他汀10 mg/d治疗组38例和40 mg/d治疗组39例。随访期1年,所有研究对象在初始及随访结束时两次行肌酶、谷丙转氨酶、血脂、血小板、血清血小板活化因子、6-酮-前列素F1α及血栓素B2水平检测,并记录两组患者药物不良反应的发生率。结果研究结束时,与阿托伐他汀10 mg/d治疗组比较,阿托伐他汀40 mg/d治疗组血清总胆固醇、低密度脂蛋白胆固醇、血清血小板活化因子及血栓素B2水平水平明显降低,6-酮-前列素F1α水平明显升高(P<0.05);两组间血小板、血清肌酸激酶、谷丙转氨酶水平及药物不良反应比较差异无显著性(P>0.05)。结论与10 mg/d阿托伐他汀治疗比较,40 mg/d阿托伐他汀可能明显升高缺血性心肌病患者血清前列环素水平,降低患者血小板活化水平。     

阿托伐他汀对不稳定性心绞痛患者介入治疗后血清hs-CRP的影响

目的研究不同剂量阿托伐他汀对不稳定性心绞痛患者经皮冠状动脉介入(PCI)治疗术后炎症因子、调脂疗效的影响。方法对80例不稳定心绞痛患者行冠状动脉介入术,随机分为阿托伐他汀10mg/d组(A组)和20mg/d组(B组)各40例,手术当天、术后24h、术后2周空腹采血,测定血清高敏C-反应蛋白(hs-CRP)和肌钙蛋白的Ⅰ(CTnI)浓度以及血脂水平。结果阿托伐他汀20mg组较10mg组PCI术后血清hs-CRP和CTnI浓度降低更明显(P<0.05)。两组术后血脂水平较术前略有降低,但无统计学意义(P>0.05)。结论冠脉介入术后患者血清hs-CRP和CTnI水平升高;阿托伐他汀能降低冠脉介入术后患者血清hs-CRP和CTnI水平;20mg阿托伐他汀治疗较10mg阿托伐他汀疗效更好。     

阿托伐他汀对急性冠脉综合征病人脂联素浓度的影响

目的观察急性冠脉综合征（ACS）病人使用不同剂量阿托伐他汀治疗后血清脂联素（APN）的变化,比较并分析其相关关系,以探讨APN在ACS发病机制中的作用及他汀类药物的抗炎作用。方法将住院确诊为ACS40例病人随机分为两组,每组20例,均在常规治疗基础上加服阿托伐他汀。A组口服阿托伐他汀20mg/d,B组口服阿托伐他汀40mg/d,两组均治疗2周,测定治疗前后APN的变化。同时设健康对照组,不做治疗。结果干预前ACS组APN水平为4.45mg/L±2.12mg/L,低于健康对照组的9.64mg/L±3.84mg/L（P〈0.01）;阿托伐他汀治疗后A组、B组总胆固醇（TC）、低密度脂蛋白（LDL-C）均较治疗前明显下降（P〈0.01）,血清APN升高（P〈0.01）;B组与A组比较,TC及APN的浓度变化幅度更大（P〈0.01）。结论ACS病人APN水平明显低于健康人,低APN参与了ACS发病过程且与ACS中的炎症反应关系密切,阿托伐他汀短期内不仅可降低血脂水平,而且可升高APN水平。     

不同剂量阿托伐他汀对不稳定性心绞痛患者血清C-反应蛋白、肌钙蛋白及LDL-C的影响

目的研究不同剂量阿托伐他汀对不稳定性心绞痛患者治疗后炎症因子、调脂疗效的影响。方法对50例不稳定性心绞痛患者,随机分为阿托伐他汀10mg组(A组)24例,20mg组(B组)26例,分别于治疗前和治疗3个月后空腹采血测定血清高敏C-反应蛋白(hs-CRP)和肌钙蛋白I(CTnI)浓度以及血脂水平。结果阿托伐他汀20mg组较10mg组治疗后hs-CRP和CTnI浓度降低更明显(P0.01)。两组服药后血脂水平较服药前均有降低,但阿托伐他汀20mg组较10mg组治疗后血清低密度脂蛋白(LDL-C)浓度降低更明显(P0.05)。结论不稳定性心绞痛患者血清hs-CRP和CTnI水平较正常人升高;阿托伐他汀能降低不稳定性心绞痛患者血清hs-CRP和CTnI、LDL-C水平;20mg阿托伐他汀治疗较10mg阿托伐他汀治疗疗效更好。     

不同剂量阿托伐他汀在急性冠状动脉综合征的早期应用

目的探讨阿托伐他汀在急性冠状动脉综合征早期治疗的意义。方法将66例患者随机分为3组各22例。治疗组A用阿托伐他汀10mg/d;治疗组B用阿托伐他汀20mg/d;对照组未服用调脂药物。观察用药前后血脂,缺血事件发生情况。结果3个月后治疗组A血清胆固醇(TC)下降24%,低密度脂蛋白(LDL-C)下降30%,甘油三酯(TG)下降20%。治疗组B分别下降30%、38%、28%,与对照组比较差异均有统计学意义(P均<0.05)。两治疗组缺血事件与对照组相比明显下降(P<0.05)。结论阿托伐他汀在急性冠脉综合征早期应用可降低心脏事件发生率。     

阿托伐他汀对急性脑梗死患者血清脂联素水平的影响

目的观察急性脑梗死（ACI）患者服用HMG—CoA还原酶抑制剂阿托伐他汀后血清脂联素水平的变化。方法将54例ACI患者随机分为对照组29例和治疗组25例,并以26例非脑血管病患者作为正常组。ACI患者均给予常规治疗14d;治疗组在常规治疗的基础上加用阿托伐他汀10mg,1次／d,治疗14d。所有研究对象均测定治疗前后的血清血脂全项、高敏C反应蛋白（hsCRP）和脂联素水平,并进行神经功能缺损程度（NDS）评分。结果与正常组比较,ACI患者治疗前TG、TC、LDL和hsCRP水平均升高,而脂联素水平降低（P〈0．05）。与治疗前和对照组治疗后比较,治疗组治疗后TG、TC、LDL、hsCRP均下降,脂联素水平升高,NDS改善明显。结论阿托伐他汀除降低ACI患者的血脂水平外,还能降低hsCRP和升高脂联素水平,减轻神经功能缺损程度。     

大剂量阿托伐他汀治疗冠心病并发高脂血症的有效性与安全性

目的比较阿托伐他汀80 mg/d与阿托伐他汀20 mg/d在冠心病并发高脂血症患者中调脂的疗效与安全性。方法将血脂未达标的84例冠心病患者随机分成两组。80 mg组:阿托伐他汀80 mg/d;20 mg组:阿托伐他汀20 mg/d。治疗前、治疗后4周、12周检查血清总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、三酰甘油（TG）、谷丙转氨酶（ALT）、肌酸磷酸激酶（CK）。结果阿托伐他汀20 mg/d与80 mg/d均能显著降低TC（P<0.01）、LDL-C（P<0.01）,阿托伐他汀80 mg/d作用强于20 mg/d（P<0.05）。结论阿托伐他汀80 mg/d与20 mg/d均能显著降低TC、LDL-C水平,80 mg组明显优于20 mg组,两种剂量均有好的安全性。     

水飞蓟宾对代谢综合征患者葡萄糖代谢率与脂肪因子的影响

目的探讨代谢综合征(MS)患者葡萄糖代谢率(M)与血浆抵抗素(resistin)、脂联素(adiponectin)、瘦素(leptin)水平变化及水飞蓟宾(Silibinin)的治疗作用。方法筛选15例MS病例和20例健康对照组。采用高胰岛素-正常血糖钳夹技术检测M,评估胰岛素抵抗(IR)程度;采用EILSA法检测血浆resistin、adiponectin与leptin浓度;检测空腹胰岛素(FINS)、血糖、血脂等生化指标;MS患者给予水飞蓟宾70mg口服,一日3次,治疗12 w,于治疗结束后重复检测M、血浆resistin、adiponectin与leptin浓度。结果①MS组腰围(WC)、体重指数(BMI)、空腹血糖(FPG)、2 h血糖(2 h PG)、FINS及甘油三酯(TG)等均显著高于对照组,高密度脂蛋白-胆固醇(HDL-C)明显低于对照组(P均<0.05)。高胰岛素正常血糖钳夹试验稳态时(120～150 min),MS组M显著低于对照组(P<0.01)。两组血浆resistin水平无显著差异(P>0.05);MS组血浆leptin水平显著高于对照组,adiponectin水平显著低于对照组(P...     

Pravastatin does not affect insulin sensitivity and adipocytokines levels in healthy nondiabetic patients

BACKGROUND: The effect of statins on insulin resistance is controversial and poorly studied in nondiabetic subjects. In addition, the effect of statins on leptin and adiponectin has never been studied. METHODS: Forty healthy nondiabetic volunteers (22 men and 18 women) aged 28 to 72 were randomized either to placebo or pravastatin 40 mg daily for a 12-week period. Insulin resistance, assessed using the Quantitative Insulin Sensitivity Check Index (QUICKI), as well as serum leptin and adiponectin levels, was measured at baseline and at the end of therapy. RESULTS: Pravastatin treatment decreased total cholesterol, low-density lipoprotein cholesterol, and triglycerides levels by 24%, 32%, and 14%, respectively ( P < .05 for all), but did not affect glucose and insulin levels, the (QUICKI) index, and adiponectin and leptin levels. When stratification was performed according to QUICKI index or sex, no significant differences were observed in the prevalues and postvalues of leptin, adiponectin, or QUICKI index in the pravastatin group. Adiponectin, leptin, and QUICKI index were statistically higher in women than in men ( P < .001 for both variables). Adiponectin was negatively correlated with body mass index (BMI; r = -0.39, P < .05) and positively correlated with the QUICKI index ( r = 0.54, P < .001) and with high-density lipoprotein cholesterol ( r = 0.50, P < .01). The relation between adiponectin and QUICKI index remained significant after adjustment for sex and BMI ( P = .005 and P = .007, respectively). Leptin was only related to BMI ( r = 0.57, P < .001) and to sex ( P < .001) with no significant correlations with lipid parameters or QUICKI index. Both sex and BMI are independent predictors of leptin ( P < .001 and P < .001). CONCLUSION: A 12-week treatment with pravastatin 40 mg/d does not change the QUICKI index and leptin and adiponectin levels in healthy volunteers. In addition, our results emphasize the importance of sex and BMI in the determination of both adiponectin and leptin. Adiponectin was also related to QUICKI index, whereas this relation was not found with leptin.     

Decreased plasma adiponectin concentrations in women with low-grade C-reactive protein elevation

OBJECTIVE: Inflammation has been suggested as a risk factor for the development of atherosclerosis, while some components of metabolic syndrome X have been related to inflammatory markers. We hypothesized that adipocyte secreting protein, adiponectin and leptin, for which have been demonstrated an association with metabolic syndrome X and coronary artery disease, may be associated with inflammatory markers in nondiabetic humans. DESIGN AND METHODS: We measured high-sensitivity C-reactive protein (hs-CRP), as an inflammatory marker, and adiponectin and leptin concentrations in 384 nondiabetic Japanese women (mean+/-s.e.m. age 53.6+/-0.8 Years, body mass index (BMI) 23.0+/-0.2 kg/m(2)) undergoing measurement of markers of metabolic syndrome X. RESULTS: The women who had a low-grade hs-CRP elevation (>2.0 mg/l) were significantly older and had higher BMI, body fat mass (BFM), total cholesterol (TC), triglyceride (TG), atherogenic index (AI=(TC-HDLC)/HDLC), where HDLC is high-density lipoproten-cholesterol), fasting blood glucose and leptin concentrations before and after adjustment for BMI or BFM, while lower HDLC and adiponectin concentrations before and after adjustment compared with women with normal CRP levels (<0.5 mg/l). BMI, BFM, TG, AI and leptin before and after adjustment were found to be correlated with hs-CRP levels, while HDLC and adiponectin before and after adjustment were inversely correlated (all P<0.0001). hs-CRP was independently associated with white blood cell count, blood urea nitrogen and AI and inversely with adiponectin/BFM in the stepwise regression analysis model. CONCLUSIONS: These data demonstrate a significant decrease in plasma adiponectin in low-grade chronic inflammation, and suggest that there is an important linkage between inflammation/adipose tIssue/atherosclerosis.     

Leptin: Adiponectin ratio discriminated the risk of metabolic syndrome better than adiponectin and leptin in Southwest Nigeria

AimTo assess the ability of leptin, adiponectin and leptin: adiponectin ratio (LAR) to discriminate apparently healthy subjects with metabolic syndrome in Southwest Nigeria.MethodsOne hundred and twenty three subjects with metabolic syndrome (cases) were age matched with 123 subjects without metabolic syndrome. The serum adiponectin and leptin levels were measured using standard procedures. The ability of serum adiponectin, leptin and LAR to discriminate metabolic syndrome and its components were determined using the receiver operating curve and linear regression.ResultsThe median age of the cases (49 IQR 42, 56 years) was not significantly different from the controls (48 IQR 39, 56 years) p = 0.252. The adiponectin levels was reduced with increasing number of the components of metabolic syndrome from 11.6 (IQR 9.6, 13.5) among subjects without any component of metabolic syndrome to 6.5 (IQR 5.7, 7.7) in subjects with more than three components of metabolic syndrome. For leptin and LAR, the values increased with increasing components (p < 0.001). LAR (AUC 0.960) discriminated metabolic syndrome better than adiponectin (AUC 0.865) and leptin (AUC = 0.918) in males and females (LAR AUC = 0.966, adiponectin AUC = 0.888, leptin AUC = 0.929).ConclusionLAR had better ability to discriminate the risk of metabolic syndrome than adiponectin and leptin alone in males and females among apparently healthy subjects from Southwest Nigeria.     

普伐他汀、阿托伐他汀对心绞痛患者C反应蛋白及血脂的影响

目的:探讨普伐他汀、阿托伐他汀对不稳定型心绞痛(UA)患者C反应蛋白和血脂的影响。方法:106例不稳定型心绞痛患者被随机分为普伐他汀组(53例)及阿托伐他汀组(53例),测定治疗前,治疗8周后C反应蛋白和血脂的变化。结果:两组治疗前后C反应蛋白(CRP)和血脂均有显著下降(P<0.05),且阿托伐他汀组较普伐他汀组血脂下降更显著(P<0.05)。结论:普伐他汀、阿托伐他汀均可降低UA患者CRP及血脂水平,同剂量阿托伐他汀较普伐他汀降脂效果更显著,其抗炎作用不依赖降脂作用。     

Orlistat for obesity: benefits beyond weight loss

Orlistat lowers lipids and improves insulin sensitivity, but its effect on other metabolic syndrome related parameters is not known. To assess its influence on adiponectin, high sensitive C-reactive protein (hs-CRP) and other metabolic syndrome related parameters, this study enrolled 106 participants in a weight-reduction program and categorized them into a group of 51 who had been treated with orlistat 360 mg/day for one year and a group of 55 age and sex and body mass index (BMI) matched controls. The orlistat group had greater changes in BMI, % body fat (% BF), waist circumference, and insulin resistance, hs-CRP, leptin and adiponectin levels after one year on the program than the controls. After adjusting for % BF and waist circumference, change of serum leptin and adiponectin levels remained significantly different. It was found that orlistat could effectively manage obesity related co-morbidities, especially insulin resistance and atherosclerosis risk. It decreases leptin and increases adiponectin independent of % BF and waist circumference. Therefore, orlistat appears to have anti-diabetic and anti-atherogenic properties and may help prevent metabolic syndrome in the overweight people.     

Association of the leptin to high-molecular-weight adiponectin ratio with metabolic syndrome

Recent studies have reported that leptin and adiponectin are associated with metabolic syndrome. The leptin/adiponectin ratio has been suggested as an atherosclerotic index. The objective of this study was to compare the degree of association of metabolic syndrome with adiponectin levels, leptin levels, leptin/adiponectin ratio, and leptin/high-molecular-weight (HMW) adiponectin ratio. The study population included 3272 Koreans (men: 1915, women: 1357; age, 30-84 years), who had visited the Health Examination Center. Adipokines were divided into quartiles, and metabolic syndrome was defined by the National Cholesterol Education Program Adult Treatment Panel-III (NCEP ATP III). A logistic regression model was fitted to establish the association between adipokines and metabolic syndrome. Adipokines, such as adiponectin, HMW adiponectin, and leptin, were found to be statistically related to metabolic syndrome. Compared to the lowest quartile, the leptin/HMW adiponectin ratio in the highest quartile was associated with a 5-fold increase in the probability of prevalent metabolic syndrome, which was independent of age, smoking status, exercise, low-density lipoprotein (LDL) cholesterol, and body mass index. There was a linear increase in the leptin/HMW adiponectin ratio as the number of metabolic syndrome components increased. The leptin/HMW adiponectin ratio had the highest odds ratio in women. In addition, compared to adiponectin or leptin alone, the AUC of the leptin/adiponectin ratio and leptin/HMW adiponectin ratio was higher for metabolic syndrome. We may suggest that the leptin/HMW adiponectin ratio is not superior to other adipokine markers, but is as effective as the leptin/total adiponectin ratio.     

脂联素瘦素比值在老年男性代谢综合征患者中的诊断价值

目的 研究血脂联素瘦素比值与老年男性代谢综合征的相关性. 方法 选择老年男性患者256例,分为代谢综合征组109例和非代谢综合征组(对照组)147例,代谢综合征的诊断采用2004年中国糖尿病学会制定的标准;采用LINCO放射免疫试剂盒测定空腹血脂联素、瘦素水平.结果 (1)老年男性代谢综合征组与对照组瘦素水平分别为(10.3±7.0)μg/L和(6.8±4.9)μg/L,脂联素分别为(7.8±5.6)g/L和(9.5±5.9)g/L,脂联素瘦素比值分别为0.94±0.78和2.15±2.13;(2)脂联素瘦素比值与体质指数、血三酰甘油、血尿酸水平均呈负相关,而与高密度脂蛋白水平显著正相关(P<0.001);(3)随着脂联素瘦素比值升高,代谢综合征发生的可能性减小,当比值在5以上,代谢综合征的患病率降至O(X2=34.891,P<0.001);(4)代谢异常组分数越多.脂联素瘦素比值越低(F=10.876,P<0.001). 结论 血脂联素瘦素比值可用于评价老年男性患者代谢紊乱程度,对老年男性代谢综合征的诊断有辅助作用.     

Low-grade systemic inflammation, hypoadiponectinemia and a high concentration of leptin are present in very young obese children, and correlate with metabolic syndrome

OBJECTIVE: To determine the concentration levels of C-reactive protein (CRP), leptin and adiponectin in obese pre-pubertal children, and their possible relation with metabolic syndrome, fibrinogen and plasminogen activator inhibitor-1. METHODS: A study was carried out in 51 obese children (aged 6 to 9 years) and the same number of non-obese children (control group), matched by age and sex. (Cross-sectional study of obese children). Body mass index (BMI), waist/hip ratio (WHR) and blood pressure were determined for each child. Serum CRP, leptin, adiponectin, glucose, insulin, lipid profile, plasminogen activator inhibitor-1 (PAI-1) and fibrinogen were all measured. RESULTS: The levels of CRP serum (1.67+/-0.222 vs 0.92+/-0.16 mg/l) and leptin (15.56+/-1.27 vs 4.68+/-0.62 ng/ml) were significantly higher in obese children. The adiponectin level was significantly higher in non-obese children (11.58+/-0.63 vs 9.64+/-0.49 microg/dl). In the obese group, log. CRP showed a positive correlation with BMI, insulin, homeostasis model assessment (HOMA), triglycerides, alanine aminotransferase (ALT), uric acid, PAI-1, fibrinogen and interleukin 6 (IL-6), and correlated negatively with apolipoprotein A-I and high-density lipoprotein cholesterol (HDL-C). The leptin was positively correlated with BMI, insulin, HOMA, triglycerides and PAI-1 and negatively with Apo A-I and HDL-C. Adiponectin correlated negatively with BMI, insulin, HOMA, and triglycerides. CONCLUSIONS: Low-grade systemic inflammation, elevated leptin concentration and low adiponectin level are described in very young obese children, correlating with a range of variables of metabolic syndrome. Inflammation and adipocytokines can play an important role in the etiopathogeny of metabolic syndrome.