国际病理科学与临床杂志 2010, 30(1) 8- DOI:   10.3969/j.issn.16732588.2010.  ISSN: 1673-2588 CN: 43-1458/R
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阿托伐他汀
肥胖
高脂血症
血管内皮功能
炎症因子
本文作者相关文章
PubMed
不同剂量阿托伐他汀和停服后对肥胖高胆固醇血症患者 血管内皮功能和炎症因子的影响
马琦琳， 张赛丹， 黄澄， 蒋元军， 孙明， 杨天山仑
中南大学湘雅医院心内科， 长沙 410008
摘要： 目的：研究在肥胖高胆固醇血症患者中应用不同剂量阿托伐他汀及停服后对血管内皮功能和炎症因子的影响，探讨其可能的机制。方法：观察入选的55名肥胖高胆固醇血症患者和58名健康者肱动脉内皮依赖性舒张功能,并检测血清中NO，可溶性E选择素（SE）及高敏C反应蛋白（hsCRP）含量的变化。将55名肥胖高胆固醇血症患者随机双盲分成两组：A组27例，在常规饮食控制基础上予阿托伐他汀10 mg/d；B组28例，在常规饮食控制基础上予阿托伐他汀20 mg/d。8周1疗程，观察两组治疗前、治疗后及停药1周后上述指标及血脂的变化。结果：阿托伐他汀治疗8周后可明显降低肥胖高胆固醇血症患者总胆固醇（TC）、低密度脂蛋白胆固醇（LDLC）、SE和hsCRP水平（均P<0.01），明显提高NO水平（P<0.01），改善肱动脉内皮依赖性舒张功能（P<0.05或P<0.01）；其中B组较A组上述改变更显著（P<0.05）。停药1周后两组TC和LDLC水平均较治疗8周时明显升高(P<0.05)，但仍低于治疗前水平(P<0.05或P<0.01)；两组NO和肱动脉内皮依赖性舒张功能均明显下降，恢复至治疗前水平(P>0.05)，两组SE和hsCRP均明显升高，也恢复至治疗前水平(P>0.05)。结论：对肥胖高胆固醇血症患者应用阿托伐他汀20 mg/d较10 mg/d更能有效控制血脂水平，改善内皮功能和抑制炎症反应。而突然终止阿托伐他汀治疗可在1周内完全逆转该药对血管内皮功能的改善作用和炎症反应的抑制作用，停药对血管内皮功能和炎症因子的影响是非胆固醇依赖性作用。
关键词： 阿托伐他汀   肥胖   高脂血症   血管内皮功能   炎症因子  
Effect of different doses of atorvastatin and withdrawal of atorvastatin on vascular endothelial function and inflammation factors in the patients with hypercholesterolemia and obesity
MA Qilin, ZHANG Saidan, HUANG Cheng, JIANG Yuanjun, SUN Ming, YANG Tianlun
Department of Cardiology, Xiangya Hospital, Central South University, Changsha 41008, China
Abstract: Objective To determine the effect of different doses of atorvastatin and withdrawal of atorvastatin on vascular endothelial function and inflammation factors in the patients with hypercholesterolemia and obesity and to explore the possible mechanism. MethodsFiftyfive patients with hypercholesterolemia and obesity and 58 healthy controls were recruited to observe brachial artery endothelialdependent vasodilation, serum concentration of NO, soluble Eselectin (SE), and high sensitive Creactive protein(hsCRP). The 55 patients were randomly, doubleblindly divided into 2 groups：Group A (n=27), received atorvastatin 10 mg per day, and Group B (n=28), received atorvatatin 10 mg per day for 8 weeks at the base of diet control. Endothelial dependent flowmediated vasodilation (FMD), NO, SE, hsCRP，and blood lipid were evaluated before the treatment, after 8 weeks of atorvastatin treatment, and 1 week of therapy termination.ResultsAtorvastatin treatment for 8 weeks reduced total cholesterol (TC), low density lipoprotein cholesterol (LDLC), SE, and hsCRP, and improved NO and FMD obviously in patients (P<0.01). Comparing with the Group A, the abovementioned changes in the Group B were more profound. Withdrawal of atorvastatin for a week, TC and LDLC levels were significantly increased compared with those after 8 weeks treatment (P<0.05), but still lower than those before treatment (P<0.05 or P<0.01) in the two groups. The levels of NO and FMD decreased whereas the SE and hsCRP levels were elevated than those after 8 weeks treatment (P<0.01), and there was no obvious changes compared with those before the treatment (P>0.05). ConclusionAtorvastatin 20 mg per day reduces TC, LDLC, protects endothelial function, and inhibits inflammation to a greater extent than 10 mg per day. Sudden withdrawal of atorvastatin therapy, the beneficial effects on endothelial function and inflammation inhibition were attenuated. Effects of therapy termination on vascular endothelial function and inflammation factors are independent of cheolesterol adjustment.
Keywords: atorvastatin;obesity;hypercholesterolemia;vascular endothelial function;inflammation factor  
收稿日期 2009-10-20 修回日期 2009-12-30 网络版发布日期  
DOI: 10.3969/j.issn.16732588.2010.
基金项目:

通讯作者: 马琦琳
作者简介:
作者Email: mqilin2004@yahoo.com.cn
参考文献：
［1］卫生部心血管病防治研究中心. 2005年中国心血管病报告［M］. 北京: 中国大百科全书出版社, 2006: 14. The National Centre for Cardiovascular Disease Control & Research. Chinese Cardiovascular Disease Report 2005［M］.Beijing: Encyclopedia of China Publishing House, 2006: 14. ［2］李向平，李江，赵水平,等.血管内皮依赖性舒张功能的无创性检测［J］. 湖南医科大学学报, 1997，22（5）：387389. LI Xiangping, LI Jiang, ZHAO Shuiping, et al. A noninvasive method for detecting endothelium dependent dilation ［J］.Bulletin of Huan Medical University, 1997，22（5）:387389. ［3］Klein S, Allison DB, Heymsfield SB, et al. Waist circumference and cardiometabolic risk: a consensus statement from shaping America’s Health［J］. Am J Clin Nutr, 2007, 85(5): 11971202. ［4］Eckel RH, York DA, Rossner S, et al. Prevention conference Ⅶ: Obesity, a worldwide epidemic related to heart disease and stroke: executive summary［J］. Circulation, 2004, 110(7): 29682975. ［5］Meisinger C, Doring A, Thorand B, et al. Body fat distribution and risk of type 2 diabetes in the general population: are there differences between men and women? The MONICA/KORA Augsburg cohort study ［J］. Am J Clin Nutr, 2006, 84(3): 483489. ［6］刘静, 赵冬, 吴兆苏,等. 低密度脂蛋白胆固醇与心血管病发病关系的前瞻性研究［J］. 中华心血管病杂志, 2001, 29(9): 561565. LIU Jing, ZHAO Dong, WU Zhaosu, et al. Association of low density lipoprotein cholesterol with cardiovascular disease in a prospective study ［J］. Chinese Journal of Cardiology, 2001, 29(9): 561565. ［7］李莹, 陈志红, 周北凡,等. 血脂和脂蛋白水平对我国中年人群缺血性心血管病事件的预测作用［J］. 中华心血管病杂志, 2004, 32(7): 643647. LI Ying, CHEN Zhihong, ZHOU Beifan, et al. The predictive effects of lipids and lipoproteins on the incidence of ischemic cardiovascular disease in middle aged Chinese population ［J］. Chinese Journal of Cardiology, 2004, 32(7): 643647. ［8］Ito MK, Talbert RL, Tsimikas S. Statinassociated pleiotropy: possible neneficial effects beyond cholesterol reduction ［J］. Pharmacotherapy, 2006, 26(7Pt2): 85s97s. ［9］Patti G, Nusca A, Chello M, et al. Usefulness of statin pretreatment to prevent contrastinduced nephropathy and to improve longterm outcome in patients undergoing percutaneous coronany intervention ［J］. Am J Cardiol, 2008, 101(3): 279285. ［10］Ichiki T, Takeda K, Tokunou T, et al. Downregulation of angiotensin Ⅱ type 1 receptor by hydrophobic 3hydroxy3methylglutaryl coenzyme A reductase inhibitors in vascular smooth muscle cells ［J］. Arterioscler Thromb Vasc Biol, 2001, 21(12): 18961901. ［11］Chello M, Goffredo C, Patti G, et al. Effects of atorvastatin on arterial endothelial function in coronary bypass surgery ［J］. Eur J Cardiothorac Surg, 2005, 28(6): 805810. ［12］Mason JC, Ahmed Z, Mankoff R, et al. Statininduced expression of decayaccelerating factor protects vascular endothelial against complementmediated injury ［J］. Circ Res, 2002, 91(8): 696703. ［13］夏尊恩，李艳，汪明,等. 阿托伐他汀经ERK信号转导通路抑制CD40L诱导的内皮细胞E选择素的表达［J］. 中华医学杂志，2008, 12(48): 34323435. XIA Zunen, LI Yan, WANG Ming, et al. Inhibitor of CD40L induced Eselectin expression in endothelial cells through extracellular signalregulated kinase signaling pathway ［J］. National Medical Journal of China, 2008, 12(48): 34323435. ［14］Bonnet J, Mcpherson R, Tedgni A, et al. Comparative effects of 10mg versus 80mg atorvastatin on highsensitivity Creactive protein in patients with stable coronary artery disease: results of the CAP (Comparative Atorvastatin Pleiotropic effects) study ［J］. Clin Ther, 2008, 30(12): 22982313.
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