盾叶冠心宁片联合氟伐他汀治疗高脂血症的临床研究

目的探讨盾叶冠心宁片联合氟伐他汀钠胶囊治疗高脂血症的临床疗效。方法选取2018年2月—2019年2月在西宁市第三人民医院治疗的高脂血症患者102例,将患者根据药品应用的差别分为治疗组与对照组(每组51例)。对照组睡前口服氟伐他汀钠胶囊,20 mg/次,1次/d,必要时可40 mg/次,1次/d;治疗组除了给予氟伐他汀钠胶囊外还给予盾叶冠心宁片,0.32g/次,3次/d,口服。两组均经4周治疗。观察两组患者临床疗效,同时比较治疗前后两组患者血脂水平、血清超敏C反应蛋白(hs-CRP)、摄食抑制因子-1(NSF-1)、P选择素(CD62P)、干扰素-γ(IFN-γ)、白细胞介素-1β(IL-1β)和脂联素(ADP)水平及肥胖指标体质量(W)、肥胖度(A)、体质量指数(BMI)和体脂率(F)。结果治疗后,在有效率上对照组为80.39%,远低于治疗组(96.08%,P0.05)。经治疗,两组TC、TG、LDL-C表达均降低,HDL-C表达均增高,但治疗组最明显(P0.05)。经治疗,两组血清hs-CRP、NSF-1、CD62P、IFN-γ、IL-1β表达均下降,ADP表达均增高,且以治疗组最为显著(P0.05)。治疗后,两组W、A、BMI、F水平均降低,且以治疗组最为显著(P0.05)。结论高脂血症采用盾叶冠心宁片与氟伐他汀钠胶囊共同治疗能够明显改善患者血脂,促进机体细胞因子的改善,有利于肥胖指标的恢复,有着很好应用价值。     

Effect of statins on platelet function in patients with hyperlipidemia

Introduction

It is generally assumed that cholesterol reduction by statins is the predominant therapeutic result underlying their beneficial effects in cardiovascular disease. However, the action of statins may be partially independent of their effects on plasma cholesterol levels, as they combine lipid lowering with positive effects on hemorheological conditions and endothelial function. We evaluated the impact of statin treatment on platelet adhesion to fibrinogen (spontaneous and ADP-activated), along with ADP, collagen or ristocetin-induced aggregation in type II hyperlipidemic patients.

Material and methods

The study group included 70 persons: 50 patients affected by type II hyperlipidemia without concomitant diseases and 20 healthy volunteers. The effects of 8-week statin treatment (atorvastatin 10 mg/day, simvastatin 20 mg/day, or pravastatin 20 mg/day) on platelet activation were evaluated.

Results

Regardless of the type of statin, a significant decrease in ADP-induced platelet aggregation was observed: for atorvastatin 50.6 ±12.8% vs. 41.1 ±15.8% (p < 0.05), for simvastatin 57.2 ±18.0% vs. 44.7 ±22.1% (p = 0.05), and for pravastatin 55.8 ±19.5% vs. 38.8 ±23.3% (p < 0.05). There was no significant effect of statins on collagen or ristocetin-induced platelet aggregation and adhesion.

Conclusions

Therapy with statins beneficially modifies ADP-induced platelet aggregation in patients with hyperlipidemia and does not affect spontaneous or ADP-induced platelet adhesion to fibrinogen and platelet aggregation induced by collagen or ristocetin.     

Simple Renal Cyst Prevalence in Internal Medicine Department and Concomitant Diseases

A total of 684 patients who had not been diagnosed with renal cyst but had undergone abdominal ultrasonography for various reasons were evaluated. Patients with and without renal cyst were classified into two groups and were compared in terms of hypertension (HT), hyperlipidemia (HL), diabetes mellitus (DM) and obesity (body mass index: ≥30 kg/m²) prevalence. Although 94 patients (13.7%) were established with a renal cyst, 590 patients (86.3%) did not have a renal cyst. The mean age of the patients established with a simple renal cyst was 67.3 ± 12.1 years (range: 28–82 years); 54 (57.4%) of them were women and 40 (42.6%) were men. Of the patients established with a simple renal cyst, 64 (68.1%) had HT, 40 (42.6%) had DM, 20 (21.3%) had HL, 42 (44.7%) were obese, 18 (19.1%) had nephrolithiasis, and 6 (6.4%) had urinary tract infection. Of the patients without a cyst, 272 (46.1%) had DM, 212 (35.9%) had HT, 122 (20.7%) had HL, and 96 (16.3%) were obese. HT and obesity were significantly higher in patients with a renal cyst when compared with those without a cyst. However, although HL incidence was higher in patients with a cyst, the difference was not significant statistically. HT, HL, and obesity are more prevalent in patients with a renal cyst when compared with patients without. Consequently, patients with a simple renal cyst should be evaluated and followed up in terms of atherosclerotic risk factors.     

不同剂量阿托伐他汀对高脂血症合并2型糖尿病患者的调脂效果

目的 对比不同剂量阿托伐他汀对高脂血症合并2型糖尿病患者的调脂效果。方法 选择2014年1月-2016年12月在青海省心脑血管病专科医院诊治的高脂血症合并2型糖尿病患者140例作为研究对象,根据随机原则分为观察组与对照组各70例,对照组给予小剂量阿托伐他汀治疗,观察组给予大剂量阿托伐他汀治疗,都治疗观察4周。比较两组糖脂代谢指标,血脂指标及并发症情况。结果 观察组与对照组治疗后的血糖与糖化血红蛋白明显低于治疗前,差异有统计学意义（P<0.05）;两组治疗后的血糖与糖化血红蛋白值对比无明显差异。观察组与对照组治疗后的三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白（LDL-C）低于治疗前,高密度脂蛋白（HDL-C）高于治疗前,对比差异明显（P<0.05）;同时治疗后观察组的TG、TC、LDL-C明显低于对照组,HDL-C明显高于对照组,差异有统计学意义（P<0.05）。治疗后观察组与对照组的总有效率分别为95.7%和97.1%,两组对比差异无统计学意义;治疗后随访调查6个月,观察组的心律失常、心衰、心源性休克等并发症发生率为8.6%,对照组为27.1%,观察组明显少于对照组,差异有统计学意义（P<0.05）。结论 阿托伐他汀治疗高脂血症合并2型糖尿病患者具有很好的效果,特别是大剂量阿托伐他汀的应用具有更好的调脂效果,从而减少随访心血管并发症的发生,有很好的应用价值。     

The Effects of High Dose Pravastatin and Low Dose Pravastatin and Ezetimibe Combination Therapy on Lipid,Glucose Metabolism and Inflammation

Objective Coronary artery disease (CAD) is presently the major cause of mortality and morbidity. Anti-hyperlipidemic treatment is one of the main treatment steps in the management of CAD. Statins are the cornerstones in this treatment. Ezetimibe can be reliably used, when statins prove ineffective in treatment, or to reduce their side effects. In the present study we examined the effects of high-dose pravastatin (40 mg) and low-dose pravastatin (10 mg) + ezetimibe (10 mg) combination therapy on lipid and glucose mechanism, as well as inflammation. Methods This study registered 100 cases. Of the cases, 50 [57.1 ± 11.1 years (24 (48%) females and 26 (52%) males)] were administered 40 mg/day pravastatin (group 1) and 50 [53.2 ± 12.2 years (27 (54%) females and 23 (46%) males)] were administered 10 mg pravastatin + 10 mg ezetimibe (group 2). Results In group 1, total cholesterol fell from 231.1 ± 83.5 mg/dl to 211.3 ± 37.2 mg/dl (p = 0.03), triglyceride from 243.5 ± 96.8 mg/dl to 190.9 ± 55.2 mg/dl (p = 0.003), and LDL cholesterol from 165.7 ± 29.7 mg/dl to 133.4 ± 26.6 mg/dl (p = 0.02). In group 2, total cholesterol dropped from 250.9 ± 51.8 mg/dl to 187.9 ± 34.9 mg/dl (p = 0.001), triglyceride from 270.3 ± 158.9 mg/dl to 154.6 ± 60.7 mg/dl (p = 0.001), and LDL cholesterol from 158.1 ± 47.5 mg/dl to 116.9 ± 26.4 mg/dl (p = 0.001). Insulin resistance decreased from 4.05 ± 2.31 to 3.16 ± 1.90 (p = 0.07) in group 1 and from 2.96 ± 1.50 to 2.05 ± 0.55 (p = 0.009) in group 2. High sensitive C-reactive protein fell from 6.69 ± 6.11 mg/l to 3.02 ± 1.70 mg/l (p = 0.01) in group 1 and from 6.36 ± 2.06 mg/l to 2.68 ± 1.69 mg/l (p = 0.001) in group 2. Conclusion Both therapy regimes are effective. However, we found that low-dose pravastatin and ezetimibe combination therapy is more effective than high-dose pravastatin therapy on lipid metabolism, glucose metabolism and inflammation.     

雷公藤多苷片对高脂小鼠血脂的影响

目的 研究雷公藤多苷片对高脂小鼠血脂的影响。方法 采用高血脂小鼠模型,通过小鼠尾静脉注射不同剂量（0.5,1.0,1.5 mg·kg^-1·d^-1）雷公藤多苷,测定不同时间段小鼠体质量和血清总胆固醇（total cholesterol,TC）、甘油三酯（totaltriglyceride,TG）、高密度脂蛋白胆固醇（high density lipoprotein cholesterol,HDL-C）、低密度脂蛋白胆固醇（low densitylipoprotein cholesterol,LDL-C）的含量及卵磷脂胆固醇酰基转移酶（lecithin cholesterol acyltransferase,LCAT）、肝脂酶（hepatic lipase,HL）和脂蛋白脂酶（lipoprotein lipase,LPL）的活性,研究雷公藤多苷对小鼠体质量、血脂代谢、动脉粥样硬化指数、肝脏LCAT水平等的影响。结果 给予高脂饲料后小鼠体质量和血脂显著升高（P<0.01）,动脉粥样硬化指数显著升高（P<0.01）,抗动脉粥样硬化指数显著下降（P<0.01）。注射雷公藤多苷能显著降低高血脂模型小鼠血清TC、TG和LDL-C,同时显著降低高脂饮食所导致的动脉粥样硬化指数升高。此外,雷公藤多苷片能显著提高血清LCAT水平和HL、LPL的活性。结论 雷公藤多苷片具有一定的降血脂功能,并能有效降低动脉粥样硬化的发生几率。     

小蘖碱对高脂血症鼠脂联素的调控作用及其对血脂指标和斑块形成的影响

目的 研究小蘖碱对高脂血症鼠脂联素的调控作用及其对血脂指标和斑块形成的影响。 方法 在40只Wistar雄性鼠随机选取30只并喂养高脂饲料饮食进行高血脂(HLP)造模,对照组(n=10)则喂养正常食物并自由摄取水。10周后,将HLP模型随机分为3组: HLP组(n=10)、HLP+LBB组(n=10)和HLP+HBB组(n=10)。对HLP+LBB组鼠进行低剂量小檗碱(berberine, BB)灌胃(150 mg/(kg·d)), HLP+HBB组高剂量小檗碱灌胃(300 mg/(kg·d)),对照组和HLP组则以生理盐水代替。连续喂养10周后测定并比较4组鼠血清甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、血清总脂联素和高分子量脂联素含量,以及心肌梗死斑块面积。 结果 造模后,与对照组相比,HLP组大鼠TG、TC和LDL-C显著升高,HDL-C水平显著下降(P<0.05)。提示HLP大鼠造模成功。与HLP组相比,HLP+LBB组、HLP+HBB组TG、TC和LDL-C显著降低(P<0.001),HLP+LBB组HDL-C水平显著升高(P<0.05)。四组大鼠血清总脂联素含量差异无统计学意义(P>0.05),但HLP组中高分子量脂联素与总脂联素的比值显著低于对照组, 而HLP+HBB组显著高于HLP组(P<0.05)。与对照组比较,AdipoR1在HLP组中表达下调(P<0.05), 而HLP+HBB组显著高于HLP组,差异有统计学意义(P<0.05)。AdipoR2在HLP组中的表达无明显变化,但HLP+HBB组显著高于对照组(P<0.05)。HLP+HBB组梗塞面积[(11.4±1.0)%)]显著低于HLP组[(52.2±0.9)%]和HLP+LBB组[(33.1±1.1)%](均P<0.05)。 结论 小蘖碱可对抗高脂血症鼠血中脂联素的下调,这一干预可能在血脂指标和斑块形成方面起到改善作用。     

祛浊胶囊联合阿托伐他汀钙治疗高脂血症的临床研究

目的探讨祛浊胶囊联合阿托伐他汀钙治疗高脂血症的临床疗效。方法选取2015年7月—2017年7月在石家庄市第三医院治疗的高脂血症患者108例,随机分为对照组(54例)和治疗组(54例)。对照组口服阿托伐他汀钙片,20 mg/次,1次/d。治疗组在对照组基础上口服祛浊胶囊,3 g/次,3次/d。两组患者均治疗4周。观察两组患者临床疗效,比较治疗前后两组患者血脂水平、血清一氧化氮(NO)和内皮素(ET)水平。结果治疗后,对照组和治疗组临床有效率分别为81.48%和96.30%,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者三酰甘油(TG)、胆固醇(TC)和低密度脂蛋白胆固醇(LDL-C)显著降低,高密度脂蛋白胆固醇(HDL-C)显著升高,同组比较差异具有统计学意义(P0.05);且治疗组患者的血脂水平明显优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者血清NO水平显著升高,ET水平显著降低,同组比较差异具有统计学意义(P0.05);且治疗组患者NO和ET水平明显优于对照组,两组比较差异具有统计学意义(P0.05)。结论祛浊胶囊联合阿托伐他汀钙治疗高脂血症效果显著,可有效降低机体血脂水平,改善机体血管内皮功能。     

羟基红花黄色素A和三七总皂苷对高脂血症的影响与机制研究

目的: 研究比较羟基红花黄色素A(HSYA)和三七总皂苷(PNS)对高脂血症大鼠的血脂及动脉粥样硬化相关炎症因子的作用和机制。方法：以高脂血症大鼠为模型,辛伐他汀为阳性对照药品,分别给予实验组大鼠不同剂量的HSYA和PNS,给药期满后取血测定大鼠血脂及CRP、IL-10和IL-6。结果：HSYA高剂量组可显著降低TC、TG,升高HDL-C,但大鼠死亡率最高;低剂量组则可显著降低CRP、IL-6,升高IL-10;PNS高、中剂量组可显著降低TC、TG和LDL-C,各剂量组对IL-6、IL-10和CRP的作用不明显,大鼠死亡率低。结论：HSYA低剂量给药具有抗炎作用,同时安全性高,临床应用建议以低剂量抗炎作用为主。治疗剂量下PNS的降血脂与抗炎作用均不优于辛伐他汀和HSYA,可认为其用于动脉粥样硬化的作用位点与HSYA不同,在临床应用时也应当考虑其适应症区别。