辛伐他汀对2型糖尿病合并肾病葡萄糖代谢的影响

【目的】探讨辛伐他汀治疗对2型糖尿病（T2DM）合并肾病患者的糖代谢影响。【方法】选取本医院60名T2DM合并肾病患者进行辛伐他汀治疗3个月。比较治疗前后空腹血糖（FBG）、C肽、糖化血红蛋白（HbA1c），C反应蛋白（CRP）、空腹胰岛素（FINs）水平、胰岛素敏感指数（ISI）、胰岛素／葡萄糖比率（IGR）、HOMA—IR、脂联素（ANP）以及游离脂肪酸水平等变化，以评价辛伐他汀对T2DM病合并肾病患者的治疗效果。【结果】在辛伐他汀治疗3个月后的葡萄糖耐量试验（0GTT）中，各时点血糖水平较治疗前均显著下降（P〈0．05），而胰岛素与C肽在0min和30rain时较治疗前显著下降（P〈0．05）。在辛伐他汀治疗后，对比治疗前，FBG、HbA1c、CRP、血糖曲线下面积（AUC）、胰岛素AUC、FINS、ISI、游离脂肪酸（FFA）以及HO-MA—IR均显著下降（P〈0．05），尿白蛋白排泄率（UAER）也明显下降（P〈0．01），但是C肽AUC（P〈0．05）以及APN（P〈0．01）均显著上升，而IGR及校正胰岛素反应（CIR）无显著变化（P〉0．05）。【结论】辛伐他汀治疗可以显著降低血糖，提高患者对胰岛素的敏感性，改善胰岛素抵抗，从而改善T2DM合并肾病患者的糖代谢。

Effect of Simvastatin on Glucose Metabolism in Type 2 Diabetic Patients with Nephrosis

[Objective]To explore the effect of simvastatin on glucose metabolism in type 2 diabetic pa- tients with nephrosis. [Methods]Totally 60 type 2 diabetic patients with nephrosis in our hospital were treated with simvastatin for 3 months. Before and after treatment, fasting blood glucose（FBG）, C-peptide, glycosy- lated hemoglobin （ HbAlc）, fasting insulin （FINS）, insulin sensitive index （ ISI）, insulin-to-glucose ratio （IGR）, homeostasis model assessment-insulin resistance（ HOMA-1R）, adiponectin（APN） and free fatty acid （FFA） were detected and compared. The efficacy of simvastatin for the treatment of type 2 diabetic patients with nephrosis was evaluated. [Results]In OGTT test at 3 months after simvastatin treatment, blood glucose at each time point significantly decreased in comparison with before treatment（ P 〈0.05）, while insulin and C- peptide at 0min and 30min significantly decreased in comparison with before treatment（ P 〈0.05）. Compared with before treatment, FBG, HbAlc, CRP, the AUC of FBG and insulin, FINS, ISI, FFA and HOMA-IR significantly decreased after simvastatin treatment（ P 〈0.05）, and UAER also decreased（ P 〈0.01）. How- ever, the AUC of C-peptide（ P 〈0.05） and APN（ P 〈0.01） notably increased, while no significant change of IGR and CIR was observed（ P〉0.05）. [Conclusion]Simvastatin treatment can significantly lower blood glu- cose, increase insulin sensitivity of patients, modify insulin resistance and finally improve glucose metabolism of type 2 diabetic patients with nephrosis.