阿托伐他汀联合非诺贝特对冠心病并糖尿病患者的疗效与安全性

目的：探讨阿托伐他汀联合非诺贝特治疗冠心病合并糖尿病患者的调脂疗效与安全性。方法：选择100例确诊冠心病合并糖尿病的患者为研究对象，在常规治疗基础上按1∶1随机分为两组：（1）他汀组（50例，给予阿托伐他汀20mg，每晚1次）；（2）联合治疗组（50例，给予阿托伐他汀20mg 每晚1次，非诺贝特200mg 每日1次治疗）。分别于治疗前、治疗6周和12周后检测血清总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）和高密度脂蛋白胆固醇（HDL-C）水平，观察治疗前后上述血脂水平的变化、达标率，并记录不良反应及临床事件。结果：治疗6周后，两组血清 TC、TG、LDL-C 水平均明显低于用药前，治疗12周后降低更为明显（P ＜0.05～＜0.01），且12周后与他汀组比较，联合治疗组 TC （4.35±0.71）mmol/L 比（4.09±0.56）mmol/L]，TG （2.35±0.62）mmol/L 比（1.65±0.49）mmol/L]和 LDL-C 水平（2.01±0.39）mmol/L 比（1.85±0.22）mmol/L]降低更显著（P＜0.05或＜0.01）；两组治疗后 HDL-C 水平均升高，12周后升高更明显但两组比较无统计学差异（P ＞0.05）。治疗12周后，联合治疗组 LDL-C、TG、HDL-C 各项指标达标率、3项血脂指标均达标和非 HDL-C 的达标率（分别为70％、68％、80％、58％、70％）均明显高于他汀组（分别为50％、46％、48％、10％、48％）（P ＜0.05或＜0.01）。治疗期间两组均未观察到严重不良反应。结论：阿托伐他汀联合非诺贝特治疗冠心病合并糖尿病患者较单用阿托伐他汀更有效，能更全面地改善各项血脂水平，有助于血脂的全面达标，且具有更良好的安全性和耐受性。

Lipid-regulating effect and safety of atorvastatin combined fenofibrate therapy in patients with coro- nary heart disease complicated diabetes mellitus

Objective：To explore the lipid-regulating effect and safety of atorvastatin combined fenofibrate therapy in patients with coronary heart disease （CHD）complicated diabetes mellitus （DM）.Methods：A total of 100 pa-tients with CHD complicated DM were enrolled.Based on routine treatment,patients were randomly and equally di-vided into statin group （n=50,received 20mg atorvastatin,once/night）and combined treatment group （n=50,re-ceived 20mg atrovastatin once/night,combined fenofibrate 200mg once/d）.Serum levels of total cholesterol （TC）, triglyceride （TG）,low density lipoprotein cholesterol （LDL-C）and high density lipoprotein cholesterol （HDL-C） were measured before,six and 12 weeks after treatment,levels and standard-reaching rates of above blood lipid were observed before and after treatment;adverse reactions and clinical events were recorded.Results：Compared with before treatment after six-week treatment,there were significant reductions in serum levels of TC,TG and LDL-C in both groups,and they further decreased after 12-week treatment （P 〈0.05~ 〈0.01）,compared with statin group after 12-week treatment,there were significant reductions in levels of TC （4.35±0.71）mmol/L vs. （4.09±0.56）mmol/L],TG （2.35±0.62）mmol/L vs.（1.65±0.49）mmol/L]and LDL-C （2.01 ±0.39） mmol/L vs.（1.85±0.22）mmol/L]in combined treatment group,P 〈0.05 or 〈0.01;HDL-C level significantly rose in both groups after treatment,and it′s more significant after 12 weeks,but there was no significant difference between statin group and combined treatment group （P 〉0.05）.After 12-week treatment,standard-reaching rates of LDL-C,TG,HDL-C,all standard-reaching of above three indexes and non HDL-C （70%,68%,80%,58% and 70%）in combined treatment group were significantly higher than those of statin group （50%,46%,48%,10% and 48%）respectively,P 〈0.05 or 〈0.01. No severe adverse reactions were observed in two groups during treatment. Conclusion：Atorvastatin combined